2.5million malpractice award story

[Warderino92]

I read the story linked below and was curious as to your guys take on it. Is the patient partially responsible since she didn't proceed to her appointment in the morning following her trip to the ED? Is a 2.5 million award justifiable?

http://www.thestate.com/news/nation-world/national/article82950257.html#fmp

---

Members don't see this ad.

 

[throwaway948738]

You forgot to mention that the negligent doctor Brandie Niedens is from a Caribbean Medical School.

Is this what you wanted to start???

Mission accomplished.

 

[The Kraken]

Case tl;dr - Advanced maternal age, near end of pregnancy, factor 5 Lieden and protein S deficiency aka hypercoaguable state. On "blood thinners" goes to ED with abdominal pain. Gallstones and an abdominal hematoma the size of a fist.

Discharged with pain meds. Dr knows hypercoaguable state treated with "blood thinner."

Hematoma grows to "volleyball" size within X day(s), complications arise, lose 50% blood volume and baby dies. Mom is probably lucky to be alive to be honest.

I mean the doctor f*cked up regardless of schooling location, it's malpractice and the award amount is probably justified.

 

[WilliamofOckham]

You forgot to mention that the negligent doctor Brandie Niedens is from a Caribbean Medical School.

Is this what you wanted to start???

Mission accomplished.

Someone sure is defensive today...

 

[slim4thewin]

Honestly, although the ER physician was told by the on-call OB-GYN it would be OK to discharge the patient, the ED physician still has the final say so the onus falls on him/her to make the decision in the best interest of the patient. Having worked in the ER for 3 years now, I can cay without a doubt that none of the doctors I have worked with here would EVER discharge a patient that late in her pregnancy with TWO separate clotting disorders and especially with the hematoma finding. There are just too many things that could go wrong in that situation. Now, maybe if there was no hematoma and everything else was normal, that would be a different story. But in this case, the 2.5 million certainly seems justified

 

[Crayola227]

I agree it was malpractice but I have a low opinion of the mom at this point

I'm reading between lines and coming to conclusions I probably have not right to, BUT

maybe if she had made it to her ob appt, or gone back to the ED, the baby would still be alive
doesn't excuse the doctor but leaves a bad taste in my mouth she pulled a no show and didn't call

 

[deleted480308]

I agree it was malpractice but I have a low opinion of the mom at this point

I'm reading between lines and coming to conclusions I probably have not right to, BUT

maybe if she had made it to her ob appt, or gone back to the ED, the baby would still be alive
doesn't excuse the doctor but leaves a bad taste in my mouth she pulled a no show and didn't call

The ER doc was told by the ob specializing in high risk pregnancy she would be seen in 4hrs after discharge. The standard of care for the hematoma was to wait for a period of time and recheck the size....which the attending ob could hve done just fine.

This is a mess but the only thing that makes it the "doctor's fault" is the fact that people love to blame doctors. This is on the patient who was given reasonable instructions and didn't follow through.

 

[Crayola227]

The ER doc was told by the ob specializing in high risk pregnancy she would be seen in 4hrs after discharge. The standard of care for the hematoma was to wait for a period of time and recheck the size....which the attending ob could hve done just fine.

This is a mess but the only thing that makes it the "doctor's fault" is the fact that people love to blame doctors. This is on the patient who was given reasonable instructions and didn't follow through.

good point

we are held to a standard of saving people from themselves
and we have to outfox them in our management to predict and circumvent their own stupidity
"so and so CHF'er won't show up for an outpt ECHO on Monday, and they will go home and eat Cheetos. Therefore, we must keep them for the weekend and do it inpt."

lots of times admit/dc decisions are just because we can't rely on the patient to have any follow through

to be fair, given the clinical picture, you could argue medically this patient was safer in the hospital those 4 hours than they would have been at home, if you were going to be doing more frequent vital checks or if you had continuous BP monitoring. There was no telling what that hematoma was gonna do before 4 hours was up. You have no idea how long it was there, and doesn't matter. Whatever might have gone wrong is different than anything that might go wrong *now that you know.*

however, would she have had a better outcome if she had been in the hospital from the very day the hematoma was noted to the day it blew? hard to say. As a med student on ob/gyn, I can say people can die from acute blood loss just as fast in and out of the hospital.

but a baby died so there you go
#WhySpecialtiesWithNoBabiesRock

 

[Psai]

Oh god, a 38 years old with factor 5 leiden and protein s deficiency?

“She was negligent,” said Henry, the other juror. “She should have admitted her (Hughes) for monitoring for that hematoma.”

Thank god we have jurors with medical degrees adjudicating on medical malpractice cases

 

[petrosgp]

This is why Jury trials might as well be called witch hunts. The ED doctor was told by someone far more qualified on pregnancy than her that the patient could go home, and knew that she would be checked up by a doctor in a few hours anyway. The fact that she didn't follow up with her scheduled visit to the OB/GYN is purely on her. We can't be expected to protect people from their own stupidity, that only absolves them of all responsibility and makes them even more careless about their own health.

 

[deleted245139]

Yeah, I agree with the above - there is little onus on the patient to follow through. It runs so deeply counted to the push to maximize healthcare dollar spending. Do less, obs more, limit admissions, BUT- own the patients follow up, lack of personal responsibility, etc.

Years ago Annals of Em Med published an article about small PTX treated with pigtails being stable for discharge with close follow up.... Nope. Not a chance. From where I stand, I may never see them again, have no idea what their true ability to follow up is. Even IF I speak with their primary, they may skip the apt for being 'tired'. Scary game.

Completely agree that this lady shouldn't have gone home- that said, this lack of any push to,hold a patient accountable for their healthcare outcomes is infuriating when we are all pushed to "make team healthcare decisions" and "involve the patient". Apparently, we are only educated doctors when something horrible happens... Prior to that, the patient knows better than I do.

Dr google for all.

 

[Brahnold Bloodaxe]

This is why Jury trials might as well be called witch hunts. The ED doctor was told by someone far more qualified on pregnancy than her that the patient could go home, and knew that she would be checked up by a doctor in a few hours anyway. The fact that she didn't follow up with her scheduled visit to the OB/GYN is purely on her. We can't be expected to protect people from their own stupidity, that only absolves them of all responsibility and makes them even more careless about their own health.

And of course, if this EM doc went ahead and admitted the patient and nothing happened aside from making hospital CEOs bonus larger, the doc would be admonished for being a greedy physician purposely extorting the system for her own profit despite not earning a penny from the admit! lol

 

[Mad Jack]

Headline should read, "Woman Ignores Medical Advice and Kills Baby, Replaced with Pile of Physician's Money." Can't even imagine being the doctor in this case, I'd be furious beyond belief. The public has no business determining medical malpractice cases, it's sickening.

 

[scootad.]

Maybe I'm missing something, but why wasn't the OB on-call named in the lawsuit? Why bother requesting any consults if they share zero liability?

 

[The Kraken]

This is why Jury trials might as well be called witch hunts. The ED doctor was told by someone far more qualified on pregnancy than her that the patient could go home, and knew that she would be checked up by a doctor in a few hours anyway. The fact that she didn't follow up with her scheduled visit to the OB/GYN is purely on her. We can't be expected to protect people from their own stupidity, that only absolves them of all responsibility and makes them even more careless about their own health.

Counter points for discussion:
1) Mom leaves ED probably 3am or later, going to be pretty hard for her to get to a 9am appointment especially if she takes whatever pain meds.

2) They never said the aPTT/PT/bleeding time/anti-Xa but if she's on enoxaparin prophylaxis and the news article says "if the doctor checked...her blood....wasn't clotting" I'm guessing her aPTT/PT/anti-Xa was pretty high.

Aren't you, as the attending EM physician, taking an Ob/gyn's advice with a GIANT rock of salt? A 4+ inch new hematoma on enoxaparin and a high aPTT/PT/anti-Xa and 36-8 weeks pregnant? Just let her stay in the hospital until 9 am for practicality. I've seen worse reasons for admits.

There's probably a reason this one wasn't settled and it's because the law firm knew they were going to win. This is a lot less about whose fault of EM doc or Ob and that a lady almost died and her baby did because of serious **** ups.

Edit: guess you monitor anti-10a for enoxaparin

 

[Brahnold Bloodaxe]

Counter points for discussion:
1) Mom leaves ED probably 3am or later, going to be pretty hard for her to get to a 9am appointment especially if she takes whatever pain meds.

2) They never said the aPTT/PT/bleeding time/anti-Xa but if she's on enoxaparin prophylaxis and the news article says "if the doctor checked...her blood....wasn't clotting" I'm guessing her aPTT/PT/anti-Xa was pretty high.

Aren't you, as the attending EM physician, taking an Ob/gyn's advice with a GIANT rock of salt? A 4+ inch new hematoma on enoxaparin and a high aPTT/PT/anti-Xa and 36-8 weeks pregnant? Just let her stay in the hospital until 9 am for practicality. I've seen worse reasons for admits.

There's probably a reason this one wasn't settled and it's because the law firm knew they were going to win. This is a lot less about whose fault of EM doc or Ob and that a lady almost died and her baby did because of serious **** ups.

Edit: guess you monitor anti-10a for enoxaparin

Practicality and malpractice are two very different things. Every single episode of medical care in the history of the world could have been handled at least somewhat "better" but that is not grounds for a lawsuit. The question is not whether the doc could have done better but whether what she did was unreasonable and negligent.

 

[Zebra Hunter]

Counter points for discussion:
1) Mom leaves ED probably 3am or later, going to be pretty hard for her to get to a 9am appointment especially if she takes whatever pain meds.

2) They never said the aPTT/PT/bleeding time/anti-Xa but if she's on enoxaparin prophylaxis and the news article says "if the doctor checked...her blood....wasn't clotting" I'm guessing her aPTT/PT/anti-Xa was pretty high.

Aren't you, as the attending EM physician, taking an Ob/gyn's advice with a GIANT rock of salt? A 4+ inch new hematoma on enoxaparin and a high aPTT/PT/anti-Xa and 36-8 weeks pregnant? Just let her stay in the hospital until 9 am for practicality. I've seen worse reasons for admits.

There's probably a reason this one wasn't settled and it's because the law firm knew they were going to win. This is a lot less about whose fault of EM doc or Ob and that a lady almost died and her baby did because of serious **** ups.

Edit: guess you monitor anti-10a for enoxaparin

What serious **** up? The mothers? No matter how hard we try, we can't force a consultant to admit a patient. That case would have been a difficult sell for admission for most OBs unless you try to sell it as abdominal trauma in late pregnancy. I don't see much fault in what the ER doctor did, there is no "standard of care" to have repeat imaging of an abdominal hematoma, and this doctor's lawyers must have absolutely sucked if they could not explain that...or the jury were idiots. Hell, the ER doctor went out of their way to ensure a follow up within 4 hours of discharge. It was all just a freak accident and I don't think anyone should be blamed for it.




Also...

“But even doctors make mistakes,” said lawyer Kathy Hagen, who represented Hughes with colleague Russell Dameron of the firm Watson & Dameron. “When they make a mistake, there has to be justice.”

**** this logic.

 

[NaOH]

Those children's names are atrocious.


Sent from my iPhone using SDN mobile

 

[Crayola227]

Those children's names are atrocious.


Sent from my iPhone using SDN mobile

lol, you noticed that, too?

38 years old on the 4th kid no man in the picture, wait there's more but I don't have the heart to say it
maybe someone else can chime in on the elephant

 

[ProfMD]

Maybe I'm missing something, but why wasn't the OB on-call named in the lawsuit? Why bother requesting any consults if they share zero liability?

This is why one should not request "curbside consults." They set up both the consulter and consultant to liability. Also, in my opinion, they potentially lead to worse patient care. We have disallowed curbside consults at my place for these reasons.

I am surprised no one has commented on the baby in the freezer thing - creeps me out. Also, it seems like jurors contacting the plaintiff after the trial for coffee dates removes any semblance of impartiality on the part of the jury.

 

[Brahnold Bloodaxe]

Also, it seems like jurors contacting the plaintiff after the trial for coffee dates removes any semblance of impartiality on the part of the jury.

When you read what some of those jurors said it seems pretty clear the verdict was driven primarily by feeeelingz rather than logic.

Two jurors were so moved by the trial and Hughes’ story that they recently contacted her through Facebook, inviting Hughes to share hugs and dinner at a Mexican restaurant in Liberty.

“You know,” said juror Shannon Henry, 45, “through the whole trial, I never made eye contact with her. Until the very end, I didn’t cry. I was doing everything I was supposed to — very impartial. But it was so emotional when I left, I wanted to hug her.

“… Everyone I talk to, that can sit down and hear the whole thing, says, ‘Oh, that poor woman.’ They cry. They have so much compassion for what she went through.”

I want to make a larger point about society and the composition of juries and other important institutions but it's liable to get me banned so I'll desist

 

[badasshairday]

All I can say is that medicine sucks. Still paying for this mistake for a decision I made a decade ago.

 

[Mad Jack]

lol, you noticed that, too?

38 years old on the 4th kid no man in the picture, wait there's more but I don't have the heart to say it
maybe someone else can chime in on the elephant

Four kids. Working minimum wage jobs. Zero fathers in the picture. Giving them names that give them a collective credit score of -284 collectively before they've even gotten started at the whole life thing. Not following up with her doctor's appointment when she knew her baby could be at risk. This all adds up to an extensive history of bad decision making, and yet- the doctor is clearly 100% liable.

I bet that $2.5 million doesn't last her a year.

 

[Psai]

Four kids. Working minimum wage jobs. Zero fathers in the picture. Giving them names that give them a collective credit score of -284 collectively before they've even gotten started at the whole life thing. Not following up with her doctor's appointment when she knew her baby could be at risk. This all adds up to an extensive history of bad decision making, and yet- the doctor is clearly 100% liable.

I bet that $2.5 million doesn't last her a year.

That award doesn't go into her pocket. They still have to appeal and whatnot which I'm sure will many more months, if not years. The award will probably be reduced after which the lawyer will take a significant portion for fees.

 

[Mad Jack]

That award doesn't go into her pocket. They still have to appeal and whatnot which I'm sure will many more months, if not years. The award will probably be reduced after which the lawyer will take a significant portion for fees.

Lawyers usually take 40% of big cases. Taxes will take 40% of what's left. That'll leave her with $900,000, likely another four years from now, which she'll probably blow in nine months.

 

[Crayola227]

to be fair, a lot of EDs have strict policies on keeping you until your pain meds wear off to a certain point, and I can see *why* she missed her 9 am appt and isn't a bad patient merely for that, but where is the phone call between then and Tuesday, the next day?

"Hmm, I was so worried for my life/limb/fetus I went to the emergency room, and apparently this was important enough for me to be seen 4 hours later in my busy ob-gyn's office at 9 am sharp, opening time. Oh ****! look, it's 3 pm I slept in!" You would think there would at least be a phone call to say, "hey preggo lady here just out of the ED and was supposed to come in. Just thought I'd check in case THAT MATTERED." But no, pain pills were given so problem solved *slurs words and passes out*

 

[TooMuchResearch]

Maybe I'm missing something, but why wasn't the OB on-call named in the lawsuit? Why bother requesting any consults if they share zero liability?

The consultant never saw the patient.
We don't know what the consultant put in their phone consult. Consultants are tricky. Sometimes they say x over the phone and document y. If the consult note isn't written before the patient leaves my department (or the consultant provided recommendations over the phone on a recorded line), the consult maybe didn't happen the way I think it happened.
We don't know if the phone consult was documented by OB.
It's easier to sue the person who got paid.

OB was probably initially named then dropped once more information was available.

 

[scootad.]

^^ you raise some excellent points. I'm amazed that now in the year 2016, in light of our countries' love and obsession with lawsuits, hospitals/ED departments still allow "informal" consults over the phone without seeing patients in person.

 

[cbrons]

Honestly, although the ER physician was told by the on-call OB-GYN it would be OK to discharge the patient, the ED physician still has the final say so the onus falls on him/her to make the decision in the best interest of the patient. Having worked in the ER for 3 years now, I can cay without a doubt that none of the doctors I have worked with here would EVER discharge a patient that late in her pregnancy with TWO separate clotting disorders and especially with the hematoma finding. There are just too many things that could go wrong in that situation. Now, maybe if there was no hematoma and everything else was normal, that would be a different story. But in this case, the 2.5 million certainly seems justified

And you are qualified to make that determination based on what credentials?

 

[cbrons]

^^ you raise some excellent points. I'm amazed that now in the year 2016, in light of our countries' love and obsession with lawsuits, hospitals/ED departments still allow "informal" consults over the phone without seeing patients in person.

GL trying to get the only gastro in the entire county to come see a fat pig who drank, smoked, and ate his way into pancreatitis at 3a.m.. Hospitals are in bad need of (certain) physicians in many areas, and demanding they see every single one of these trainwrecks at any hour of the day is simply not going to happen.

 

[cbrons]

Four kids. Working minimum wage jobs. Zero fathers in the picture. Giving them names that give them a collective credit score of -284 collectively before they've even gotten started at the whole life thing. Not following up with her doctor's appointment when she knew her baby could be at risk. This all adds up to an extensive history of bad decision making, and yet- the doctor is clearly 100% liable.

I bet that $2.5 million doesn't last her a year.

What can you do when you live in a upside down topsy turvey idiotic country that lets 12 braindead, toothless *****s monday-morning quarterback a physician in an ER catering to the lowest common denominator of society

 

[Crayola227]

GL trying to get the only gastro in the entire county to come see a fat pig who drank, smoked, and ate his way into pancreatitis at 3a.m.. Hospitals are in bad need of (certain) physicians in many areas, and demanding they see every single one of these trainwrecks at any hour of the day is simply not going to happen.

What can you do when you live in a upside down topsy turvey idiotic country that lets 12 braindead, toothless *****s monday-morning quarterback a physician in an ER catering to the lowest common denominator of society

 

[Etorphine]

I've said it before, and I'll say it again. Med students would be wise to consider low liability specialties..

 

[Crayola227]

I've said it before, and I'll say it again. Med students would be wise to consider low liability specialties..

LOL the only thing I really remember my med school saying was the equivalent of "hey check out this study almost everyone in all specialties got a med mal problem at some point in their career don't sweat it too much"

there was more to say on med mal in general, but when it came to your point, the only thing confirmed for me was that ob/gyn and EM are high liability

there was something too about paths & rads not being as liability free as people like to imagine

that's all I got

please, do tell

 

[TBV]

By awarding her the money, the jury has clearly shown that the patient had no responsibility to go to her appointment. And if the patient is deemed incapable of being able to do something as basic as taking care of herself and her baby by showing up for an appointment, then clearly the state has a duty to protect her. I look forward to hearing which group home she will be placed in, with the award money being used to pay for her around the clock supervision and care.

Wouldn't make much difference where the money came from, sounds like the state has been supporting her ass for a few decades as it is.

 

[NontradCA]

I, like everyone else in the threat have no right to say whether this is justified or not. But, my opinion is 2.5 mill awarded isn't much for your loved one. Just reading the OP, it seems the patient died after not making their 9am outpt appointment after leaving the ED? Lol, if they're gonna die because of a missed follow up appt 6 hrs later, they should just be admitted. I'm not sure how you can say that's on the PT.

 

[Zebra Hunter]

I, like everyone else in the threat have no right to say whether this is justified or not. But, my opinion is 2.5 mill awarded isn't much for your loved one. Just reading the OP, it seems the patient died after not making their 9am outpt appointment after leaving the ED? Lol, if they're gonna die because of a missed follow up appt 6 hrs later, they should just be admitted. I'm not sure how you can say that's on the PT.

1. The patient did not die, the pt's unborn child did
2. The pt missed their appointment only 4 hrs after discharge because she was tired, she did not become significantly sick until the following day

 

[NontradCA]

1. The patient did not die, the pt's unborn child did
2. The pt missed their appointment only 4 hrs after discharge because she was tired, she did not become significantly sick until the following day

So the baby doesn't count as a patient? And just from knowing the pathophys of blood loss it wouldn't seem the mother started exsaguinating abruptly, which is supported by presence of hematoma at presentation.

 

[Zebra Hunter]

So the baby doesn't count as a patient?

No, the baby does not count as a patient during the initial ER visit.

 

[NontradCA]

No, the baby does not count as a patient during the initial ER visit.

What's your reasoning for this?

 

[Zebra Hunter]

What's your reasoning for this?

I'm not going to go down this ridiculous tangent with you.

 

[NontradCA]

I'm not going to go down this ridiculous tangent with you.

You're the one who brought this up, and it makes no sense. Run along now little troll.

 

[shoal]

You're the one who brought this up, and it makes no sense. Run along now little troll.

you have a lot to learn paddawon. this is clear in legalize and current practice patterns. the fetus did not check in... the mother did. hematomas and bleeding is very unpredictable. that couldve stsrted bleeding the following day. as an ER doc ive spent my time making an appointment for you. i think its important. you dont go... ohhh thats my fault... right. next time ill make sure i drive you and sleep at your house. or my admission rate just doubled.

Sent from my VS986 using Tapatalk

 

[NontradCA]

you have a lot to learn paddawon. this is clear in legalize and current practice patterns. the fetus did not check in... the mother did. hematomas and bleeding is very unpredictable. that couldve stsrted bleeding the following day. as an ER doc ive spent my time making an appointment for you. i think its important. you dont go... ohhh thats my fault... right. next time ill make sure i drive you and sleep at your house. or my admission rate just doubled.

Sent from my VS986 using Tapatalk

So then why do we have the lawsuit if the fetus died? Is it because the mother almost died?

 

[shoal]

So then why do we have the lawsuit if the fetus died? Is it because the mother almost died?

its because its the american civil legal system with a jury of lay folks and lots of emotion. read the article.... the jury wanted to go get coffee with the plantiff afterwards... come on.

Sent from my VS986 using Tapatalk

 

[NontradCA]

its because its the american civil legal system with a jury of lay folks and lots of emotion. read the article.... the jury wanted to go get coffee with the plantiff afterwards... come on.

Sent from my VS986 using Tapatalk

Ok that makes sense. So why wasn't this woman on warfarin instead of heparin if the fetus is not being treated as well?

 

[HelpPleaseMD]

Ok that makes sense. So why wasn't this woman on warfarin instead of heparin if the fetus is not being treated as well?

wtf.. location: trump tower makes sense

 

[NontradCA]

wtf.. location: trump tower makes sense

I find this quite ironic.

 

[Wordead]

I, like everyone else in the threat have no right to say whether this is justified or not. But, my opinion is 2.5 mill awarded isn't much for your loved one. Just reading the OP, it seems the patient died after not making their 9am outpt appointment after leaving the ED? Lol, if they're gonna die because of a missed follow up appt 6 hrs later, they should just be admitted. I'm not sure how you can say that's on the PT.

What service do you want the ED to admit to? OB already said to discharge.

 

[FIREitUP]

Case tl;dr - Advanced maternal age, near end of pregnancy, factor 5 Lieden and protein S deficiency aka hypercoaguable state. On "blood thinners" goes to ED with abdominal pain. Gallstones and an abdominal hematoma the size of a fist.

Discharged with pain meds. Dr knows hypercoaguable state treated with "blood thinner."

Hematoma grows to "volleyball" size within X day(s), complications arise, lose 50% blood volume and baby dies. Mom is probably lucky to be alive to be honest.

I mean the doctor f*cked up regardless of schooling location, it's malpractice and the award amount is probably justified.

You forgot the part where they gave the mom an appointment the next day and she missed it: "But because she was exhausted and had just left the hospital, she missed the appointment, a point the defense would raise in court."