It is common knowledge that most lawsuits never make it to trial. Many are dismissed and some go before a judge or jury, but the majority of cases end up settling. They can settle at different times in the process. Sometimes cases are settled early on, but some cases are literally settled on the courtroom steps prior to the start of trial. Sometimes cases are settled during or even after trial (but before the jury’s verdict).

There are many reasons why parties to a lawsuit decide to settle. For some, it is to avoid the mental and emotional stress and financial burden of a trial. Others are pressured to by their malpractice insurance provider. Sometimes the decision takes place in the midst of trial if things don’t seem to be going well. This month we look at a case where several health care practitioners were sued, and all decided to settle the case except for one physician. What did he ultimately decide to do, and why?

The patient, Mrs M, was a 26-year old married mother of 2 young daughters. She had a history of methicillin-resistant Staphylococcus aureus (MRSA) infections, which exhibited as boils and carbuncles. She presented to the emergency department of her local hospital on Friday morning, complaining of unbearable back pain and fever. She related that she had developed a lesion in the middle of her back, and as it was healing, her pain and fever began.

She was admitted to the hospital by Dr I, an internist. He ordered blood and urine tests. The blood test revealed an elevated white blood cell count, indicating infection. The urinalysis was clear, with no indication of bacteria. Nevertheless, Dr I decided to ask for a urology consult.

The urologist, Dr U, saw the patient Friday afternoon. Despite no sign of bacteria in the urinalysis, Dr U made a diagnosis of kidney infection. Dr U was concerned about the patient history of MRSA, however, and so he asked for an infectious disease consultation.

The request to Dr D, the infectious disease specialist, was made at 3:45 pm on Friday. The physician did not respond. Three more times over the weekend, hospital nurses called Dr D asking her to consult on the case. Although Dr D was in the hospital over the weekend to see other patients, she did not see Mrs M.

The internist and the urologist were aware that the infectious disease consult was prudent, and that it did not happen on Friday, Saturday or Sunday, yet they made no attempts to transfer the patient elsewhere, or to find another specialist.

Mrs M had presented at the hospital on Friday morning in great pain and with a fever, and this continued through the weekend. Then things began to get worse. On Sunday, Mrs M’s nurses noticed weakness in her lower extremities, and an inability to empty her bladder. This was reported to Dr U, who performed an informal neurological examination, but noted no weakness at that time, and did not request a neurology consult. By Sunday evening, Mrs M could no longer walk, and had lost feeling in her legs. Dr I was notified at home and said that he would get a neurology consult in the morning.

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In the morning, the infectious disease specialist finally showed up and quickly diagnosed Mrs M with an epidural abscess from a MRSA lesion on her back and ordered an MRI and decompression.

Despite treatment, Mrs M was left permanently paralyzed from the waist down with permanent loss of bladder and bowel control. Mrs M and her husband were devastated by her diagnosis. They sought counsel from a plaintiff’s attorney and filed a medical malpractice lawsuit against the internist, the urologist, the infectious disease specialist, and the hospital. The lawsuit alleged delayed diagnosis and improper treatment of the epidural abscess resulting in paralysis.