Top 5 Expert Witness Cases
The Expert Witness Newsletter has now been running for 3 months with 16 total cases published. Thank you for subscribing and for spreading the word to physician colleagues.
This week we will recap the best cases and highlight major learning points.
Reviewing expert witness opinions is an excellent way to drive home lessons about risk management and ways to improve the care we provide to patients.
Specialties: EM, Neurology, Medical Critical Care
Synopsis: Seen in ED with back pain, neurology consulted and recommended lumbar MRI without any significant findings. Admitted to medicine, patient found to be paraplegic the following day.
Learning points: Spinal cord lesions in the thoracic spine can cause low back pain and leg weakness. They are easily missed when only a lumbar MRI is ordered.
2) Case #3: Missed Lesion on PET Scan [Subscriber Content]
Specialties: Diagnostic Radiology / Nuclear Medicine
Synopsis: Patient with breast cancer undergoes PET scan, no lesions identified. 10 months later a follow-up scan shows a T3 vertebral body lesion.
Learning points: The radiologist went back and amended his report from 10 months earlier. It is a bad idea to go back and amend charts once a mistake is discovered, as the physician is essentially admitting the mistake and makes it very hard to defend their earlier actions.
3) Case #12: Stroke During Aneurysm Repair [Subscriber Content]
Specialty: Interventional Neurology
Synopsis: A 56-year-old man presents to the ED with severe headache. A CT angiogram shows a 7x4mm aneurysm on his anterior communicating artery. The next day an interventional neurologist was attempting to coil the aneurysm when he lost control of the coil. It migrated downstream, causing a large stroke and permanent disability.
Learning points: Unexpected bad outcomes are the substrate for all medical malpractice cases. Patients who are severely disabled usually end up with higher settlements than situations when the patient dies. After an initial offer of $5,000,000, the two sides negotiated a confidential settlement.
4) Case #9: Undetected Preeclampsia Leads to Fetal Loss
Specialty: OBGYN
Synopsis: A woman was pregnant for the 5th time, and developed headache, abdominal pain, and general malaise. She reported elevated blood pressures at home, but in the doctor’s office they were within the normal range. She was later seen with severe abdominal pain, found to be very hypertensive, developed a liver hematoma and lost the baby.
Learning points: The patient called the OB multiple times reporting her BP, and the call logs were used by the plaintiff to depict the physician as uncaring and inattentive. Documenting review of phone calls to the office can counter this unfair narrative.
5) Case #14: Cardiac Arrest After Cardiology Appointments [Subscriber Content]
Specialty: IM/Cardiology/Interventional Cardiology
Synopsis: A 69-year-old man had cardiology appointments over many years for atrial fibrillation and aortic stenosis. At his final visit he had shortness of breath, orthopnea, and leg swelling. His pulse ox was 91% on room air. A cardiac catheterization was scheduled for 2 weeks ahead, but the patient had a cardiac arrest and died the next day.
Learning Points: The cardiologist did not document a cardiac or pulmonary physical exam at the final visit. When these basic steps get missed, it hands the case to the plaintiff on a silver platter.
Reviewing these cases is valuable for 2 reasons:
1) Learn from the mistakes of others. This newsletter is essentially an online M&M conference. Reviewing cases from other specialties is critical to building a strong foundational understanding of the way the medicolegal system works.
2) Build understanding of the expert witness industry. The current pandemic has made many physicians realize their clinical income is not guaranteed. Building alternative sources of income is wise, and providing ethical review of cases can be very lucrative.
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