Expert Witness Case #4
This case concerns a 40-year-old woman, referred to as Ms. S. She was an active professional, who sought cosmetic surgery on her face. Dr. S performed the surgery without complications and she was released. About 7 days later, she developed sudden onset of severe facial and neck swelling and presented to an ED, where she was seen by Dr. O and Dr. G.
This occurred in a free-standing ED, and therefore transfer was required to another facility. Due to the rapidly advancing swelling of the airway, they elected to intubate her prior to transport. The intubation was very challenging, and required multiple attempts. Eventually one of the paramedics from the EMS crew was able to intubate her.
While she was being moved from the ED bed to the EMS stretcher, the ET tube became dislodged. She developed hypoxia, became ashen, and went into cardiac arrest. Resuscitation was unsuccessful.
The family filed a lawsuit against the ED physicians. Dr. O was trained in Emergency Medicine. Dr. G is a Family Medicine physician working in the ED. The plaintiff’s attorney must file an expert witness opinion written by a doctor with similar training as the defendant. Therefore, a physician dual certified in EM and FM was hired to write the following opinion.
The defense attorney called the pathologist who did the autopsy as an expert witness. The summary of her opinion is shown here:
This opinion illustrates the legal defense. They feel that the patient died when the hematoma compressed neurovascular structures, not because of the failed attempts at intubation.
An EM expert was also hired:
The lawsuit ended in a settlement days before going to trial. The settlement is confidential.
MedMalReviewer Opinion:
1) The patient’s death occurred in 2012. The lawsuit was filed in 2014 and the settlement occurred in December 2020. This lengthy timeline is fairly common for malpractice cases, and is often surprising to clinicians who are facing their first lawsuit.
2) A challenging airway in a situation with no backup is every EM physician’s worst nightmare. This case also raises the issue of the safety of free-standing EDs, and physicians who are not EM trained working in EDs.
Specialty: Radiology
Synopsis: 49-year-old woman with breast cancer undergoes PET scan. Nearly a year later, the radiologist goes back and amends his report.
Featured: Plaintiff’s 7-figure settlement offer.
Specialty: Cardiology
Synopsis: 68-year-old man undergoes stress test that reveals new ischemia. No follow-up occurs and the patient dies a week later on the golf course.
Featured: The actual stress test report.
'DOPE'. How damning can this be coming from an expert witness?