Date of Death: January 28, 2004
Injuries: Diverticulitis; untreated bowel perforation and abscess resulting in sepsis and death.
Medical Expenses: Medical expenses for Mr. Doe were $227,877.
Settlement: $1,075,000 (Total)
$475,000 from settlement with defendant Skilled Nursing Facility
$600,000 from settlement with defendants Medical Clinic, Dr. X, and Dr. Y.
The entire net settlement proceeds went to the surviving wife because they had no children together.
Report Submitted By: Ron Perey
Facts:
This case involved the death of plaintiff John Doe, at the age of 60, on January 28, 2004, after his diverticulitis (inflammation and infection of out-pouchings in the colon (diverticula)) and bowel perforation and abscess went under-treated while at the defendant Doe Skilled Nursing Facility, while he was under the care of defendants Dr. X and Dr. Y in the course of their employment with defendant Medical Clinic. John Doe was recovering from an unrelated below-knee amputation at the defendant Skilled Nursing Facility. On January 5, 2004, Mr. Doe was transferred from the hospital to the Skilled Nursing Facility. His physicians and the defendant nursing staff were aware of his history of diverticulitis. It was fully anticipated by Mr. Doe, his wife and his surgeon that he would return to his employment as an accountant and his normal life shortly after completion of physical rehabilitation and prosthetic training.
On Monday, January 5, 2004, when Mr. Doe transferred to the Skilled Nursing Facility, he was not experiencing abdominal pain. However, pain began in the evening on Tuesday, January 6, 2004 and was reported to Dr. X on Wednesday, January 7, 2004, as left-sided abdominal pain, consistent with his other flares of diverticulitis. He was afebrile, but also had nausea and constipation. Dr. X concurred with Mr. Doe's self-diagnosis of diverticulitis and initiated oral antibiotic treatment with Gatifloxicin (Tequin) and Flagyl. She thought she ordered a complete blood count (though she had not). No radiographic studies were undertaken to evaluate whether Mr. Doe had simple diverticulitis or a more complicated situation with abscess or perforation. That evening Mr. Doe began vomiting. The defendant Skilled Nursing Facility or Medical Clinic did not have a policy or procedure for treating or assessing diverticulitis.
Mr. Doe's abdominal pain continued over the next several days. The progress notes suggested that the abdominal pain improved, though his wife, who was with him every day and most nights, was certain that it did not improve and the staff seemed to confuse his abdominal pain with his stump pain. Mr. Doe was receiving substantial amounts of narcotic pain medication and other analgesics during this time. No changes were made to limit his diet or “rest his bowel” and he continued on a full texture low salt diet. He also was given laxatives and Metamucil, which were contraindicated. His nutritional intake during this time was poor with only 50% of most meals consumed and many meals with less than 25% intake.
On Saturday, January 10, 2004, Mr. Doe became more confused and disoriented. He still did not have a fever, but had low blood pressures and poor urine output. He continued to have pain, as well as nausea and vomiting. No physician examined him on January 10th or Sunday, January 11, 2004, despite nursing notes indicating that the charge nurse was contacting the physician. Skilled Nursing Facility did not have a policy or procedure requiring a physician to come in to the facility to assess a patient before making a diagnosis and issuing an order. The defendant doctors did not work weekends or take call from 5:00 p.m. on Friday to 8:00 a.m. on Monday.
On Monday, January 12, 2004, Mr. Doe’s wife was so concerned about her husband’s abdominal pain and the lack of concern by the nursing staff that she went to the office of his primary care physician in the morning to plead for his intervention after waiting for 4 hours, she saw the primary care physician who then paged defendant Dr. Y who happened to be present at the Skilled Nursing Facility, and he did go see Mr. Doe. Dr. Y's progress note documented Mr. Doe’s complaint of “continued left lower quadrant persistent pain for 5 days.” Mr. Doe had no fever, but a blood pressure of 80/53 at about noon (very low), pulse of 70, respirations 20 with oxygen saturation 93%. He was started on IV fluids for hydration and his blood pressure medications were held. Dr. Y agreed with the diagnosis of “persisting diverticulitis” despite oral antibiotic treatment, but took no steps to rule-out complications such as abscess formation or perforation. Though Dr. Y mentioned a CT scan to the family, one was not performed. No CT or any other radiographic evaluation was done to determine whether Mr. Doe's persistent pain and worsening condition despite oral antibiotics was due to the fact he had a diverticular abscess or perforation.
Through the evening of January 12, 2004 and into January 13, 2004, Mr. Doe’s abdominal pain worsened. Calls were made to his primary care physician, who ordered administration of morphine sulfate IV, which Mr. Doe received three times with minimal relief of the pain. Morphine is contraindicated with diverticulitis because it is known to increase the intraluminal pressures of the bowel and may cause a perforation. No physician examined Mr. Doe and no further nursing interventions were undertaken until the morning of January 13, 2004, when he was finally sent by a telephone order from Dr. Y via ambulance to hospital ER around 8:45 a.m., to be evaluated for a “possible acute abdomen and for surgical consultation,” because he was in extreme abdominal pain and breathing shallowly. In the ER, he was found to have an acute abdomen (a rigid abdomen requiring surgical intervention) and after x-rays confirmed pneumoperitoneum (air in the abdominal cavity due to perforation of the intestine). He was taken to emergency abdominal surgery where multiple perforations of his colon were identified, including perforation of a diverticular abscess. His abdomen was full of stool and a large portion of his colon was removed, with a colostomy placed. He experienced systemic sepsis.
Unfortunately, Mr. Doe was never able to recover from his peritonitis and sepsis. He had multi-organ system failure and could not be removed from the ventilator. His condition worsened and he died 15 days later on January 28, 2004 after enduring indescribable pain and suffering. Mr. Doe's wife was at his bedside day and night. Her last memories of her husband are of him in his hospital bed at Providence Everett Medical Center, suffering for the last two weeks of his life on the ventilator with multiple tubes and lines. He could make eye contact with her, but nothing else. Mr. Doe was a strong Norwegian, but ultimately, all of his body systems failed and he died after 16 days of immeasurable suffering.
If the doctor had performed a CT scan, the abscess and perforation would have been detected and he would have had surgery and most probably survived.
County: King County Washington, Cause No. [Confidential]
Trial Judge: Judge Greg Canova
Plaintiffs: Estate of John Doe, Jane Doe (Spouse).
Defendants: Undisclosed Skilled Nursing Facility, Doe Medical Clinic, Dr. X, and Dr. Y
Trial date: January 30, 2006
Date of Settlement: Settlement with Doe Skilled Nursing Facility: August 23, 2005
Settlement with Undisclosed Medical Clinic, Dr. X, and Dr. Y: October 24, 2005 - $1,075,000
Plaintiffs’ Attorneys: Ron Perey, Thomas V. Harris and Doug Weinmaster
Perey~Harris, Seattle, Washington
Defendants’ Attorneys: Confidential.
Plaintiffs’ Experts: W. Scott Helton, M.D., Chicago, IL, (General Surgeon); Mark A.
Molos, M.D., Shawnee, KS (Internist/Gasteroenterologist);
Deborah Robin, M.D., Nashville, TN (Internist/Geriatrician);
Hugh Clark, M.D., Seattle, WA (Internist/Geriatrician);
Kenneth Sand, M.D.,Weston, MA (Internist/Infectious Disease);
Gary Stimac, M.D., Bellevue, WA (Radiologist);
Gregory Moneta, M.D., Portland, OR (Vascular Surgeon);
Lowell Bassett, Ph.D, Seattle, WA (Economist).
Defendants’ Experts: Michael A. Kovar, M.D., Seattle, WA (Family Practice) for Defendant Medical Clinic, Dr. X and Dr. Y; Michael Kimmey, M.D., Seattle, WA (Gastroenterologist); Daniel Pepper, M.D., Seattle, WA (Vascular Surgeon); P. Scott Pollack, M.D., Seattle, WA (Internist); Jerrold R. Turner, M.D., Ph.D, Chicago, IL (Pathologist); William Partin, CPA, Seattle, WA (Economist).
Mediators: Scott Holte, (mediation with Skilled Nursing Facility, 8/23/05)
Gary Bloom, (mediation with Medical Clinic, Dr. X and Dr. Y, 10/24/05).
Date of Death: January 28, 2004
Admitted Liability: No. Liability contested.
Summary Judgment: None.
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