Dr D was an employee of a large medical practice. She had been the primary care physician to Ms P for the past seven years, since the patient was in her mid-20’s. The physician had always been impressed with Ms P, who in addition to working as an elementary school teacher, taught exercise classes in a local gym and was a marathon runner. Ms P was fit, and mostly visited Dr D for minor complaints which were easily resolved. Four years ago, the patient came in with complaints of persistent dizziness. As part of the work-up to figure out the cause, the patient was sent for an MRI at the local hospital. The MRI revealed that Ms P had a venous varix in her brain, but this was determined not to be the cause of the dizziness symptoms, which turned out to be an inner ear issue.
As Ms P’s primary care physician, Dr D was copied on the MRI report, and that was where things went wrong. Dr D was copied on numerous diagnostic reports every week, even every day. She tried to review them all and respond when necessary, but in this case, although she looked at it in regard to the dizziness complaint, she didn’t think about the future implications of the MRI report. It was filed away, and the finding of the venous varix was not noted anywhere, nor was it conveyed to the patient, or put on Ms P’s “problem list” which was shared with other treating physicians.
A few years later, Ms P became pregnant with her first child. Dr D was delighted for the patient and her husband, and happily sent Ms P’s records and “problem list” to her obstetrician. However, the venous abnormality wasn’t mentioned, and so the obstetrician was unaware. The patient was never warned of the risk of the venous varix rupturing during vaginal labor, or that a c-section would avoid placing additional stress on the veins in her head and neck.
Ms P delivered her daughter via natural childbirth. Twelve hours after the birth, Ms P experienced a sudden, searing headache as the venous varix in her brain ruptured. She was taken to emergency surgery to remove part of her skull. After surgery, Ms P lapsed into a month-long coma. When she awoke, the patient discovered that her legs and left hand were paralyzed, her trunk muscles were impaired, and she had difficulty chewing, swallowing, and speaking. The prognosis was poor — her injuries were permanent, and she would require round the clock care for the duration of her life.
Dr D was horrified when she heard the news and wracked with guilt when she realized that by not noting the venous varix on the problem list, she had inadvertently harmed her patient. She was sadly unsurprised by the notification that she, personally, and the practice she worked for, were being sued.
Her employer’s defense attorney did not want to discuss settling the case. Her own attorney, provided by her malpractice insurance, was willing to go along with the practice’s attorney, and so the case went to trial. The two-week long trial ended with a verdict against Dr D and her employer in the amount of $32 million.
As soon as the verdict was delivered, and the jury filed out of the courtroom, the medical practice’s attorney immediately made numerous motions, including for a new trial, for an appeal, to set aside the verdict and to challenge the jury’s award.
But Dr D had had enough. She told her own attorney that she did not want to be a part of the appeals or other challenges; she just wanted to be done with the case. A private settlement was worked out between Dr D and her former patient for a sum close to the $5 million cap of her insurance. (It is not unusual in a case with more than one defendant for one of the defendants to settle, but the case will still continue against the defendant or defendants who are remaining.)
The practice, however, continued to file motions appealing the judgment. The judge denied the majority of these motions. The case, without Dr D as a party, was appealed to a higher court. On appeal, the appellate court affirmed the lower court’s judgement and the $32 million verdict.
While no one can predict the future, there are sometimes clues, and some of them can be acted on. In this case, the MRI showing of venous varix in the patient’s brain did not necessarily mean that it would rupture, but it should have been a warning.
Had the obstetrician known about the condition, she would have been warned that a scheduled c-section might be a safer option, and that the ‘pushing’ part of childbirth could be dangerous in this case. Had the patient known about the condition, she could have asked her obstetrician about how to safely deliver the baby. But since neither knew, no precautions could or would be taken.
The old adage “knowledge is power” is very appropriate here. Knowledge about the condition would have given the patient or her physicians the power to make appropriate changes. While the condition was not the cause of the dizziness for which the patient had the MRI in the first place, once Dr D had this information, she needed to do something with it. That “something” could have been to tell the patient, to note it on the problem list, or to make an entry in the patient’s records indicating this was something to keep in mind in the future. Although it wasn’t the issue at the time, it clearly was something that could be an issue in the future. Dr D failed to see the possible future ramifications of her patient’s condition, and ultimately failed her patient.