DELAYED DIAGNOSIS OF MENINGEAL INFECTION, RESULTING IN DEATH
SPECIALTY: Physician Assistant and Emergency Medicine
ALLEGATION: The patient initially presented to the Emergency Department on February 1, 2009, complaining of sinus pain, an abscessed tooth, swelling in the right side of her forehead, and headache. The patient was evaluated by a physician assistant (PA), who conducted a physical exam and reviewed a sinus CT report from January 2009 revealing extensive sinus disease. A new head CT without contrast was ordered and was negative for bony erosion into the cranium, but did show extensive parasinus disease with some edema of the scalp on the right side. The PA diagnosed the patient with extensive sinusitis, and prescribed oral clindamycin and hydrocodone and referred the patient to an otolaryngology (ENT) provider with instructions to call the following day to schedule an appointment. The PA was also aware of the patient’s plans to have an infected tooth extracted in the following days.
The patient was seen the following day by an ENT provider. An endoscopic nasal exam was conducted and a culture was obtained. The patient was diagnosed with chronic maxillary sinusitis, bony erosion around tooth no. 2 into the maxillary sinus, acute ethmoidal sinusitis, and acute frontal sinusitis. In addition to the oral clindamycin, the patient was also prescribed a prednisone taper to help with inflammation.
On February 3, 2009, the patient had the infected tooth extracted. Later that evening, just before midnight, the patient returned to the Emergency Department and was seen by the emergency physician for complaints of worsening pain. A physical exam confirmed the patient did not have a stiff neck, forehead swelling, scalp swelling, or confusion. There was no indication of a cerebral abscess and no acute intracranial findings. The neurological exam was negative and was without focal deficits in any form. The patient reported 10/10 pain, which was attributed to the recent dental extraction, biopsy, and the fact that the patient had missed doses of the pain medication and antibiotics. The ED physician administered 900 mg of intravenous clindamycin, Dilaudid, Reglan, two liters of saline, and Tylenol, and monitored the patient’s condition, which continued to improve. The patient was discharged with careful instructions to return to the Emergency Department the following day if symptoms did not continue to improve or if any new symptoms presented.
The following evening, the patient was noted by family to be speaking gibberish and acting oddly, and ultimately collapsed. An ambulance was called, and the patient was taken to the hospital. Upon arrival, the patient was obtunded and non-responsive. An MRI/MRA showed a diffuse cerebritis with significant brain swelling, a right-to-left midline shift, and very little cerebral flow. The patient continued to deteriorate and passed away. The cause of death was brain herniation resulting from cerebral meningitis. A small amount of erosion was found in the back wall of the patient’s frontal sinus bone and in the dura, which communicated with the right cranium and caused the corresponding subdural empyema.
PLAINTIFF ATTORNEY: Mary Schultz
PLAINTIFF EXPERTS: Richard Beck, MD, Otolaryngology, Richard Sokolov, MD, Infectious Diseases, James Winters, MD, Emergency Medicine, Elliot Felman, MD, Family Practice
DEFENSE ATTORNEYS: Bruce Megard and Eric Byrd, Bennett, Bigelow & Leedom
DEFENSE EXPERTS: Frank Riedo, MD, Infectious Diseases, Gregory Moran, MD, Emergency Medicine, Jeffrey Larson, MD, Neurosurgery
RESULT: Defense Verdict, Spokane County
IMPROPER PRESCRIPTION OF OXYCODONE RESULTING IN DEATH
SPECIALTY: Family Practice
ALLEGATION: Beginning in 2007, the patient had been seen for various medical issues, including back and leg pain for which pain medication was prescribed. In July 2011 it was found that the patient had violated the pain contract based on a urine toxicology report that showed positive for THC. The prescription for narcotics was discontinued. The patient returned in October 2012 with continued pain complaints and was refused narcotic pain medication.
The patient returned to the clinic in 2015 and received prescriptions for various medications, including valium and narcotic pain medication. On June 12, 2015, the patient was prescribed 90 oxycodone pills for pain. On June 15, 2015, the patient’s wife called the clinic and stated that only seven of the 90 pills remained, and that the patient was slumped over and could barely walk. She was instructed to take the patient to the Emergency Department, but apparently did not do so. The patient was found dead at 4 a.m. on June 16, 2015.
PLAINTIFF ATTORNEY: Robert Lloyd and Tim Greene with the Law Office of Greene & Lloyd
PLAINTIFF EXPERTS: Thomas Clark, MD, Pathology (Tacoma, WA), Michael Schiesser, MD, Internal Medicine/Addiction (Fall City, WA), Howard Miller, MD, Family Medicine (Renton, WA), Tracy Skaer, PharmD, Pharmacy (Spokane, WA)
DEFENSE ATTORNEYS: Michele Atkins and Chad Beck with FAVROS (Seattle, WA)
DEFENSE EXPERTS: Brigit Grimlund, MD, Family Medicine (Seattle, WA), Bill McCarberg, MD, Family Medicine/Addiction (San Diego, CA), Larry Lewman, MD, Pathology (Clackamas, OR)
RESULT: Defense Verdict, King County
IMPROPERLY PERFORMED HIP SURGERY IN LEG-LENGTH DISCREPANCY
SPECIALTY: Orthopedic Surgery
ALLEGATION: The patient had a long history of medical treatments, including back surgeries performed in 2005, 2006, and 2007, and a knee surgery performed in 2008. The patient developed hip pain in 2012 and was diagnosed with avascular necrosis of the right femoral head.
The patient was first evaluated by the orthopedic surgeon in May 2012 for hip pain, as well as for groin pain and complaints of sciatica in the right leg. A right intraarticular hip injection took the edge off the pain, but the pain continued to worsen. On June 26, 2012, the orthopedic surgeon performed a total right-hip arthroplasty after performing the usual pre-surgery templating. The goal with surgery was to prioritize stability over leg length. Two weeks post-op, the patient was found to have the left leg 1 cm longer than the right. Thereafter the patient continued to complain of low-back, groin, and right-buttock pain. Hip motion was good and did not cause discomfort.
On December 12, 2012, the patient underwent a fourth back surgery by another provider as a result of stenosis and radicular pain. In March 2013 the patient again began complaining of right-hip pain that went down her thigh. In January 2014 the patient sought care from another orthopedic surgeon for back pain and attributed it to a leg-length discrepancy caused by her hip surgery.
In 2017, in spite of several additional providers recommending against additional hip and spine surgery, the patient underwent another spine procedure in December.
Defense experts testified that the patient’s post-op groin pain and other complaints were the result of chronic degenerative disc disease at L4–5 and not related to the hip surgery.
PLAINTIFF ATTORNEY: William J. Macke (Portland, OR)
PLAINTIFF EXPERT: James Ryan, MD, Orthopedic Surgery (Albany, OR)
DEFENSE ATTORNEYS: Karen O’Kasey and Colleen Scott, Hart Wagner (Portland, OR)
DEFENSE EXPERTS: Joel Hoekema, MD, Orthopedic Surgery (Bellingham, WA), Timothy Keenen, MD, Orthopedic Surgery (Tualatin, OR), Paul Duwelius, MD, Orthopedic Surgery (Portland, OR)
RESULT: Defense Verdict, Clark County