Mary – An Abdominal Surgery Settlement
The following case shows the importance of giving every client a fair shake and how not every case has to result in a million dollar settlement to achieve vindication. When Mary came to us for advice about getting sued for causing a serious motor vehicle accident on I-95, neither she nor we were thinking about medical malpractice. But Mary’s story was compelling, as she nearly died after being discharged from the hospital on the day of the accident.
Mary is from Columbia and speaks mostly Spanish. When she arrived at the ER, however, she recalled having to speak mostly English. Mary knew that she had broken her leg and that seemed to be what everyone was most concerned about. But according to Mary it was her stomach that was hurting her the most. Mary explained to us that despite her complaints all of her stomach tests came back negative and she was sent home the same day with her leg in a cast and with instructions to follow up with an orthopedic surgeon seven days later.
Not long after her discharge, Mary recalled feeling sicker. With no medical insurance and no doctor of her own, she felt she had no choice but to wait for her scheduled follow-up appointment for her leg. She later explained to us that she trusted the doctors in the emergency room and believed them when they told her nothing was wrong. She told us that she was embarrassed to complain too much in front of her husband.
By the time Mary arrived at the hospital a week later, she was nearly comatose. She was given fluid resuscitation and immediately taken to the operating room where she was cut from her breastbone down to her belly button to allow the surgeons the ability to fix the hole in her intestine and wash out the infection. Thankfully for Mary, she survived the difficult operation and went on to recover reasonably well having only minor residual GI issues to deal with on an occasional basis.
After speaking with Mary we were initially skeptical about taking the plunge into her case. We felt bad for her but we knew that pain is one of the most common symptoms encountered in emergency rooms across the country and if the hospital conducted the appropriate tests and sent Mary home, how could we say it was their fault? But people like Mary don’t get many opportunities to have their voices heard. So we gave her the benefit of the doubt and began an investigation.
In our review of the medical records we noticed a hand-written nursing assessment buried deep in the chart documenting that Mary had a pattern of bruising across her stomach from where the diagonal strap of the seat belt contacted her body known as a positive seat belt sign. We also noticed documentation establishing that she had vomited “bloody emesis” on several occasions which is a mixture of stomach contents mixed with blood. The last important thing we noticed was the timing of Mary’s abdominal CT scan which was done within an hour of her arrival. According to the radiologist who interpreted that scan, there was evidence of fluid but no sign of intestinal or internal organ injury.
When we took our findings to the experts for review, we established that Mary did not meet the criteria for discharge and that emergency room doctors failed to follow through on appropriate principles of differential diagnosis. The positive seatbelt sign alone dramatically increased Mary’s likelihood of having sustained an injury to her intestine. But according to the experts we spoke to, it was the symptoms of extreme pain and bloody vomiting coupled with the fluid seen on the CT scan that should have raised the bigger red flag. According to the radiologist we spoke to, gastrointestinal injuries such as Mary’s do not always show up right away and have a much better chance of being caught if the scans are conducted over a period of time.
As with many medical malpractice cases, the pre-suit process is only the first step and attention has to be given to all the other issues that will come up along the way including causation. In Mary’s case, causation was tricky because according to the colorectal surgeon we spoke to, Mary was going to need to have surgery at some point to treat the injury she suffered in the accident. That meant we could not blame the ER doctors for the surgery itself, only for the added difficulties associated with the surgery and the effect on Mary’s recovery based on the deterioration in her condition.
During negotiations, we took into account causation and rather than arguing long-term consequences we highlighted the nightmarish experience Mary went through from the time she was sent home to the time of her re-admission. Based on that, we felt the mid six-figure dollar settlement we achieved for Mary was representative of the unnecessary harm she endured during that period of time.