A case of medical negligence

Summary

Failure of many physicians to identify fatal drug reaction costs man his life

Often, medical malpractice cases are not the fault of just one practitioner. In many cases, there are several people who share responsibility for the medical negligence. This month's case looks at one of those situations. This case involved a whole system failure, involving numerous physicians and a hospital.

The patient, Mr. B, was a 52-year old husband and father of five. He worked as a computer programmer and was relatively healthy, seeing his primary care physician about once a year for check-ups, to monitor his hypertension, and for minor complaints. Mr. B most recently saw his PCP, Dr. F, 45, for a urinary tract infection and the physician prescribed Septra (trimethoprim and sulfamethoxazole). But a week later, Mr. B developed chills, fever and vomiting. He called Dr. F, who told him that it was likely a viral infection and he should feel better in a few days. The doctor told him to remain on the Septra.

But five days later, Mr. B had not improved. In fact, he was significantly worse. He had now developed a rash covering his body and a sore throat so severe that he could not speak. Unsure what to do, his wife took him to the emergency department of the local hospital. However, with five young children at home and no child care, she could only stay with her husband a short while and had to return home.

In the emergency department, staff noted that the patient's rash extended from his trunk up the back and to his neck and arms. Mr. B was unable to speak or provide information to the hospital's doctors, so hospital staff called his primary care physician, Dr. F.  Dr. F told the hospital staff that the patient had recently had a urinary tract infection, but did not inform the hospital's doctors that Mr. B was on Septra.

Mr. B was admitted to the hospital with a diagnosis of drug reaction, although at this point the hospital did not know what he was having a reaction to. Once admitted, he was seen by the hospital's infectious disease consultant, but the consultant did not take a history, as was required for a drug reaction. Mr. B still could not communicate, but neither the infectious disease consultant, the hospital physicians, nor Dr. F asked Mr. B's wife to retrieve his medicine bottles from home.

Shortly after being admitted to the hospital, Mr. B's condition worsened. His skin began to fall off. Hospital policy required that patients with skin reactions be seen by a dermatologist, however it was the weekend and no dermatologist was on call at the hospital. No outside dermatologist was brought in to see the patient. Another physician in the hospital diagnosed Mr. B as having Toxic Epidermal Necrolysis (TEN) syndrome and Stevens-Johnson syndrome (SJS).

Per the standards and procedures of the hospital, patients with TEN or SJS must immediately be transferred to the burn unit and be treated as a burn victim due to skin loss. However, this did not happen. By now, Mr. B's wife had enlisted childcare help and had other family members at the hospital trying to advocate for Mr. B. Despite the family's push to have Mr. B admitted to the burn unit, it took five days after he was diagnosed for this to happen.

Medical staff in the burn unit immediately identified Septra as the cause of the drug reaction and confirmed the diagnosis of Toxic Epidermal Necrolysis syndrome, but by then it was too late to stop the drug reaction. Mr. B died a week later despite efforts to save him. He left a widow and five elementary- and middle school-aged children.

When Mr. B's wife got over the shock of losing her husband, anger set in. She consulted with a plaintiff's attorney and explained the whole situation.

After having the medical records looked at by an expert, the attorney agreed to take the case, and he filed a suit against Dr. F, the infectious disease consultant, the hospital's physicians and the hospital itself.

As one would imagine, preparation for such a trial took a long time and was extremely complex. Each defendant had his or her own attorney, and each attorney wanted to do their own discovery, subpoena documents, and gather evidence. Experts were hired by all sides. Settlement negotiations took place, but were not successful.

Finally, the trial began. After two long weeks of trial, and faced with the prospect of at least another week, the defendants settled with the plaintiff for a sum of $6 million.

Legal Background

To begin preparing for a trial, both sides engage in a process known as “discovery.” Discovery is the formal process of exchanging information between the parties about the witnesses and information they plan to present at trial. The purpose of discovery is to allow the parties to learn what evidence may be presented at a trial, and to avoid last minute surprise evidence or witnesses when there would be no time for the other party to obtain contradictory evidence.

Discovery may include subpoenaing documents, requesting physical exams, and depositions. Depositions are oral statements, given out of court but under oath, by a person who is involved in the case. Depositions enable a party to get a preview of what a witness will say at trial (and it gives that party a chance to impeach a witness's credibility if he or she says something different at trial than they said during the deposition).

Discovery gives attorneys a chance to evaluate the case before the actual trial starts, and is a useful tool for deciding whether to settle. Sometimes, as in this case, a settlement cannot be negotiated prior to trial and it takes witnessing the jury's reaction to the testimony (or in this case, pictures of Mr. B's condition prior to his death) to convince the parties that a settlement is a better option.

Protecting Yourself

This sad case was an example of a systems failure on multiple levels. Dr. F did not recognize Mr. B's initial symptoms after taking Septra as a drug reaction and so didn't take the patient off the drug. Then Dr. F inexplicably failed to notify the hospital that the patient was on Septra. The infectious disease consultant at the hospital did not take a complete drug history, as was required. Neither that physician nor any of the other doctors asked Mr. B's wife to bring in any prescription bottles.

Mr. B was not immediately seen by a dermatologist at the hospital, as he should have been. And once diagnosed with TEN and SJS, he was not immediately transferred to the burn unit as required by the standard of care for his conditions. The hospital neglected to follow its own policies.

There were numerous times along this tragic path when disaster might have been averted, but instead one failure followed another. Always take a detailed medication history, and particularly when it appears that someone is suffering a reaction. If the patient is unable to communicate, ask family to retrieve the patient's medicine bottles. The more information you possess, the better chance a patient will have. 

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