MedMal Insider

A 30-year-old woman experiencing her first pregnancy, presented to the Labor and Delivery unit. She was given the wrong drug and required an emergent C-section. The "five rights" of medication administration focuses on individual factors and not necessarily on system flaws. Many organizations are also promoting just culture, which encourages reporting near-misses and patient safety events, and focuses on psychological safety and promoting a non-punitive reporting culture.

A patient was imaged for abdominal pain, but the radiologist saw and reported an incidental finding of a nodule on the lower lung that was not pursued or revealed to the patient for 2 years. The cancer had metastasized, and the patient died from lung cancer 18 months later.

The patient’s family alleged that improper management of the patient under anesthesia resulted in cardiorespiratory arrest, permanent brain damage, and a persistent vegetative state. While the cause of the patient’s cardiac arrest is uncertain, the CRNA failed to note which medications and doses were administered during the procedure, and the case was settled for more than $1 million.

When hospitals and medical practices face charges of discrimination from employees, the consequences can include litigation, large payments, morale problems, and less quality care for the patients they serve. How an employer responds can make all the difference in outcomes. Based on closed claims in the Harvard medical system, two cases illustrate that point. We interview Megan Kures, of Hamel, Marcin, Dunn, Reardon and Shea, who offers some principles to follow.

One thing that seemed to be missing in this particular evaluation was a formal differential diagnosis that may have been present in the physician’s brain, but wasn’t documented, and there’s no evidence that it was really thought about.

Boston Attorney Megan Kures explains how a hospital should respond to a request for accommodation. Tip: it shouldn’t be a knee-jerk no, and be sure to involve HR from the start.

After a state medical error disclosure and apology law went into effect in November 2012, health providers in Massachusetts have protections and rules to follow.

An otherwise healthy 50-year-old woman presented to the Emergency Department with atypical chest pain. Discharge and death the next morning followed.

The patient needed to be evaluated by a stroke team and a neurologist promptly to decide whether any treatment was indicated or possible. Triage should be the same whether the ER was empty or overcapacity.

The goal was to treat uncontrolled pain from tumors but the patient was left with unexpected hearing loss. The patient sued when she claimed the surgeon changed the side of the operation without consulting her. For ideas that might help prevent these negative outcomes, we talk with Douglas Smink, MD, MPH, an associate medical director for CRICO and the Chief of Surgery at Brigham and Women's Faulkner Hospital.

This OB patient’s risk factors were not adequately considered, and the team’s failure to follow protocols and secure back-up contributed to a lawsuit and a settlement of over $1 million.

In a lawsuit naming the Emergency Medicine physician and a nurse, the patient alleged that a dressing was applied too tightly, compromising the circulation and resulting in a gangrenous foot, requiring amputation. Despite an eventual defense verdict, some lessons show how to prevent this bad clinical result and a five-year legal ordeal.

Restarting heparin was not in the post-op instructions. In a lawsuit naming four physicians, the patient's estate alleged negligent failure to restart anticoagulation, resulting in a stroke and ultimately, her death. The case was settled for more than a million.

Despite multiple visits to her PCP with similar complaints over years, this young patient did not get a timely diagnosis of colon cancer and died. Dr. Carla Ford looks at the testing, communication among providers, and some diagnostic insights for the next patient.

A fatal PE misdiagnosis may have gone wrong from the very beginning. With analysis based on closed claims in the Harvard medical system, urgent care specialist Jonathan Einbinder explores ways an ordinary case with a tragic outcome might be prevented in the future.

The patient sued his oncologist and the hospital, claiming they mismanaged his post-op recovery when a stent was left behind for a year, leading to complications that required additional surgery.

In this case, a pediatric practice struggled to satisfy the family of a boy after two years of appropriate primary care. What did they learn about communicating with patients and their families over routine medical matters?

In this case, communication between the primary provider and a phone consultant needed more clarity. And changes in the patient's status needed a stronger response, if a tragic outcome had any chance of being averted.

In this closed Harvard malpractice case, a patient fell during a radiology study because her risk status wasn't communicated from the unit effectively. It was not a typical fall—on the way to the bathroom alone. Hospitalist Adam Schaffer, MD, MPH, analyzes what went wrong and suggests some effective practices to prevent severe injury in places you don't expect, with eyes on the patient.

In this case, a 75-year-old female was admitted to the ICU with respiratory failure. A misplaced feeding tube led to her death. ICU intensivist Dr. Laura Myers discusses lessons from this case about supervision and assessing a provider's competence with a new procedure.