Jury awards family $20 million after NP misses diagnosis

[Urzuz]

Twin Cities jury awards $20M in malpractice case for woman who died after giving birth

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[bashwell]

Eid "chose not to diagnose Ms. Bermingham with sepsis" and determined that the new mother had a urinary tract infection, the suit read, although lab tests found no bacteria in Nicole Bermingham's urine, according to the suit.

UTI vs sepsis! Fairly big difference.

 

[chocomorsel]

I wonder what lab results she ordered that she then ignored or didn't pick up on.

And did she really "choose" to not diagnose her properly or did she just not "know"? I wonder how long she's been a nurse practitioner or nurse? A fever of a 102? That would be a bad ass UTI.

Well, nurses want to play doctor? Let them pay the consequences.

 

[Pharmado]

It is unfortunate that this woman died. I can't say what led the jury to find in the families favor, but awarding 20 million for anything in crazy. No one can bring this woman back. This NP was likely over worked with narcotic seekers, parents whose children have a runny nose and uninsured pts looking for refills and missed the diagnosis. Giving this family 20 million dollars just means that healthcare in Minnesota just got 20 million dollars more expensive. People are sympathetic and want to reward this family for their suffering, without considering where all this money has to come from. This type of thing is the reason that healthcare is so expensive in the US, and the reason that doctors are forced to perform so many unnecessary tests.

 

[Psai]

Even the experts don't know how to really define sepsis or how to treat it so I'm not sure why we have juries making these determinations

 

[chocomorsel]

Because the average reading level of the American Juror or the average person in General is what? 7th Grade?
As in, most people are not that intelligent. And they are led by prosecutors like sheeple.

 

[Man o War]

I'll never forget the family trip to urgent care where the NP misdiagnosed swimmers ear and treated for a Middle ear infection systemically. After an excruciating 36 hours with no improvement, a physician had another look and couldn't believe the mistake. Cleared right up with some drops.
So, nothing surprises me anymore with midlevels.

 

[DrOwnage]

Honestly can't blame the family, I think that a medicine intern would have saved this woman's life. Degrees matter. Schooling matters. Although I agree the settlement is a little large, this is a tragedy. Hard to lose a life so close to gaining one.

 

[nimbus]

Honestly can't blame the family, I think that a medicine intern would have saved this woman's life. Degrees matter. Schooling matters. Although I agree the settlement is a little large, this is a tragedy. Hard to lose a life so close to gaining one.

I wouldn't make too much of her training and educational background. Similar events have happened with board certified EM doctors and sepsis is a hot topic in EM.

http://www.emdocs.net/early-sepsis-why-do-we-miss-it-and-how-do-we-improve/

 

[anbuitachi]

I wouldn't make too much of her training and educational background. Similar events have happened with board certified EM doctors and sepsis is a hot topic in EM.

http://www.emdocs.net/early-sepsis-why-do-we-miss-it-and-how-do-we-improve/

I wouldn't say this patient has early sepsis. It isn't very early. And if I read correctly, part of the nurses defense was blaming the doctors

 

[Planktonmd]

I did not know that sepsis is now diagnosed based on lab results! I obviously was misinformed and always thought that sepsis was a clinical diagnosis.
I wish that jury would publish their guidelines so we can all learn how to properly diagnose sepsis.

 

[pgg]

$20M is pretty ridiculous and jury awards based on "feelings" are a major problem. That the miscarriage of justice harmed some NP this time instead of a doctor isn't real uplifting to me.

The only gratifying aspect of this case is that this independent NP failed to throw the doctors under the bus. But I'm still having a little trouble mustering my normal levels of schadenfreude at nursely comeuppance.

 

[leaverus]

$20M is pretty ridiculous and jury awards based on "feelings" are a major problem. That the miscarriage of justice harmed some NP this time instead of a doctor isn't real uplifting to me.

The only gratifying aspect of this case is that this independent NP failed to throw the doctors under the bus. But I'm still having a little trouble mustering my normal levels of schadenfreude at nursely comeuppance.

agree. theres no victory for anyone here.

 

[twoliter]

I think the lack of information is making us all jump to conclusions, which I'm trying not to do. If you think $20 million is too much for a malpractice verdict, fine. I won't argue with that. But those just assuming a jury diagnosed sepsis or that the sepsis (missed) diagnosis was based on lab results alone have as much (little) information as I do from that article. The article did say she had fever of nearly 102 F, nausea, and pelvic pain. Now what if the unmentioned information contained: leukocytosis with WBC of 20k, tachycardia, hypotension, mental status changes, peritoneal signs (which may or may not have been assessed), and testimony from physicians that they feel the obvious signs of sepsis were overlooked? Obviously, most of us wouldn't agree with sending the patient out on some PO antibiotics, right? We can't assume the patient had all those signs/symptoms, but we can't assume she didn't have any or all of them either.

 

[Orin]

Hmm, the 69 year old NP missed the diagnosis of sepsis on a 30 year old orthopedic PA who was four days post-partum. There's a lot of weirdness and sadness here.

 

[Noyac]

The only gratifying aspect of this case is that this independent NP failed to throw the doctors under the bus. .

But they certainly tried to:
"Attorney Chris Messerly, who along with Elizabeth Fors represented the family, said the defense admitted during the trial that there was negligence in Bermingham's care in the emergency room but blamed doctors."
I believe that this is an important take away from this. Every time a midlevel is sued they pass the blame on to the docs. So why in the world do OR's continue to work with them at such staggering levels?

Also, why in the world wasn't an OB consulted at least. This pt was 4 days post delivery.

 

[Maverikk]

Fever of a 102, chills, negative UTI..I would do a little more searching, overnight obs with PO abx at the very least even if she was talky talky, normal vital signs/wbc. If it was a positive UTI, PO abx, observe until symptom improvement. And an OB should've at least seen her.
20 mil? She's 30 and healthy, may have had another 50 years and now a child to raise.

 

[NOsaintsfan]

A lot of details are missing but the article provides some info:

"The 30-year-old woman, a mother for the first time, returned to the hospital 12 hours later and died."

So she presented to the ED, was seen, discharged home and 12 hours later returned with obvious sepsis. The article claims her presenting symptoms were...

"Her symptoms included chills, nausea, a fever of nearly 102 degrees, and pain in her vagina, rectum and back."

Remember this is 4 days post partum.
In addition it states that the NP diagnosed a UTI but...

"had a urinary tract infection, the suit read, although lab tests found no bacteria in Nicole Bermingham's urine"
Could be sterile pyuria...i guess.

If the patient truly didn't "look sick" on initial presentation she must have evolved awful quickly. So much badness here. It's a tragedy. With the info the article provides it certainly makes the NP like......well maybe she should have gone to medical school.

Of course she blamed the doctors.

 

[lobelsteve]

agree. theres no victory for anyone here.

Wrong. The attorneys won.

The family did not. Trade 12million or so to be a newborn who never knew his mom, or the new dad who has lost his wife, now has baby to raise. No winner there. Onky grief, and hopefully perseverance and strong family support.

 

[deleted697127]

I did not know that sepsis is now diagnosed based on lab results! I obviously was misinformed and always thought that sepsis was a clinical diagnosis.
I wish that jury would publish their guidelines so we can all learn how to properly diagnose sepsis.

Procalcitonin is a pretty good lab test if your lab has it.

 

[PainDrain]

Fever of a 102, chills, negative UTI..I would do a little more searching, overnight obs with PO abx at the very least even if she was talky talky, normal vital signs/wbc. If it was a positive UTI, PO abx, observe until symptom improvement. And an OB should've at least seen her.
20 mil? She's 30 and healthy, may have had another 50 years and now a child to raise.

Endometritis should have been on the differential here and Post-partum group A strep infection should be high on the differential for any patient with a fever of that level, rigors, pelvic pain and an elevated WBC. It only takes a few doses of IV abx to control but without treatment it is devastating. It should enter the differential for no other reason then it's high mortality. If the NP ordered labs and didn't follow up on them then she is absolutely negligent.

 

[Planktonmd]

Procalcitonin is a pretty good lab test if your lab has it.

So, everyone who shows up in the ER with a fever should get a procalcitonin level and if positive should get admitted to the ICU and treated for sepsis?

 

[Painted]

Lactate?
New clinical criteria for septic shock: serum lactate level as new emerging vital sign

 

[Psai]

Man when will this nonsense about tissue hypoxia and lactic acidosis die? Everyone whines about learning the krebs cycle but no one seems to realize that creating lactate consumes hydrogen ions. Tissues also dont become hypoxic, nor do you get anaerobic metabolism. You actually get more aerobic metabolism.

 

[deleted171991]

$20M is pretty ridiculous and jury awards based on "feelings" are a major problem. That the miscarriage of justice harmed some NP this time instead of a doctor isn't real uplifting to me.

The only gratifying aspect of this case is that this independent NP failed to throw the doctors under the bus. But I'm still having a little trouble mustering my normal levels of schadenfreude at nursely comeuppance.

I agree. I hope the federal initiative to limit malpractice caps will pass in the Senate, too.

 

[deleted171991]

Lactate?
New clinical criteria for septic shock: serum lactate level as new emerging vital sign

No-name journal. No-name authors. Go to garbage, sight unseen.

 

[deleted697127]

So, everyone who shows up in the ER with a fever should get a procalcitonin level and if positive should get admitted to the ICU and treated for sepsis?

Definitely maybe.

Don’t miss the diagnosis of sepsis!

 

[deleted59964]

A lot of details are missing but the article provides some info:

"Her symptoms included chills, nausea, a fever of nearly 102 degrees, and pain in her vagina, rectum and back."

Remember this is 4 days post partum.

Of course she blamed the doctors.

If she got a needle in the back I'd want to know about this presentation.