MedMal Insider

Incidental Lung Nodule Overlooked, No Follow-up, Fatal Cancer Advances

December 30, 2023 17:00 - 12 minutes - 23.6 MB

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.

Overdose or Poor Documentation?

October 17, 2023 17:00 - 9 minutes - 18.1 MB

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.

Response to Charges of Discrimination can Help or Hurt a Hospital, Any Employer

July 12, 2023 17:00 - 13 minutes - 25.1 MB

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.

Slow to Diagnose Endocarditis After Repeat Visits

April 04, 2023 17:00 - 11 minutes - 20.3 MB

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.

Signs of Bias in Rejected Request for Accommodation

December 12, 2022 10:00 - 11 minutes - 21.1 MB

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.

Health Payment Reform Act: Rules to Protect Providers

September 27, 2022 09:00 - 7 minutes - 6.95 MB

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.

Cardiac Event Mismanaged in ED

April 13, 2022 09:00 - 11 minutes - 21.4 MB

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

Woman’s Stroke Progressed in ED without Intervention

November 16, 2021 10:00 - 9 minutes - 17 MB

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.

Surgery Change Needed Better Consent

August 06, 2021 09:00 - 10 minutes - 19.8 MB

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.

Lack of Preparation, Safety Culture, Contributed to Loss of Baby

June 02, 2021 09:00 - 9 minutes - 17.5 MB

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.

Unclear Discharge Instructions, Patient Loses Foot

February 28, 2021 10:00 - 10 minutes - 19 MB

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.

Woman Dies from Post-op Stroke When Anticoagulant Not Restarted

December 17, 2020 10:00 - 10 minutes - 18.9 MB

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.

Young Patient, Flawed Test, Fatal Delay in Colon CA Diagnosis

October 08, 2020 09:00 - 7 minutes - 14.5 MB

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.

“What Else Might This Be?” Might Have Saved PE Patient

July 20, 2020 09:00 - 14 minutes - 25.9 MB

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.

A Forgotten Stent and Unclear Responsibility for Follow Up

April 02, 2020 09:00 - 9 minutes - 17 MB

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.

Nothing is “Routine” for an Anxious Patient or Family

February 27, 2020 10:00 - 8 minutes - 15.6 MB

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?

Status Change Missed, Consultation Flawed, and the Patient Loses Baby

December 23, 2019 10:00 - 11 minutes - 20.4 MB

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.

Radiology Didn't Know Risk Status Before Patient Fall, Head Injury

May 21, 2019 19:04 - 19.8 MB

Radiology Fall Risk

Radiology Didn’t Know Risk Status Before Patient Fall, Head Injury

May 16, 2019 09:00 - 10 minutes - 19.8 MB

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.

Fatal Misplaced Tube Casts Light on Supervision, Competence Assessment

April 08, 2019 09:00 - 9 minutes - 13.2 MB

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.

ICU Feeding Tubes

April 05, 2019 19:04 - 13.2 MB

ICU Feeding Tubes

Doctors Lose Their Own Malpractice Case

August 14, 2018 09:00 - 5 minutes - 5.24 MB

The defendant’s role in a successful defense against a claim of malpractice is critical, but it isn’t easy. Clinician have to be able to follow advice from lawyers, cope with their own emotions, which often include anger or fear, and project competence and likability to potential jurors. These things—none of which are taught in medical school—can be a challenge to a medical professional. Sometimes malpractice cases have to be settled because the defendant clinician cannot adapt to the legal s...

Part I: Harvard Joins IHI to Cut Referral Mistakes

April 16, 2018 09:00 - 13 minutes - 12 MB

In any complex medical system, malpractice cases can arise from failures in the referral process. Typically these are situations in ambulatory care where the doctor recommends that a patient see a specialist, but it either doesn't happen or nobody acts on the result. A new tool from The Institute for Healthcare Improvement and CRICO helps guide doctors and practices to prevent these referral errors and the harm from resulting diagnostic failures.

Poor Communication of Doctor's Orders Leads to Preventable Death

January 03, 2018 09:15 - 9.18 MB

Failure to supervise and confirm orders led to a preventable death and a search for system-level changes to how NPOs are communicated.

Poor Communication of Doctor’s Orders Leads to Preventable Death

December 22, 2017 10:00 - 10 minutes - 9.18 MB

When a speech and swallowing evaluation showed the patient to be at risk for aspiration, the resident documented a plan that the patient be given nothing by mouth. But the NPO order was not entered into the system, a technician attempted to feed him, and he aspirated. This was not communicated to the attending. After transfer to the ICU, he succumbed to additional morbidities, including aspiration pneumonia.

ED Stuck on Wrong Diagnosis, Blamed the Patient?

November 21, 2017 15:15 - 8.98 MB

When a patient returns over and over again with the same symptom complex, the providers really need to start to think, "am I missing something?"

ED, Stuck on Wrong Diagnosis, Blamed the Patient

November 20, 2017 10:00 - 9 minutes - 8.98 MB

A 26-year-old male presented to the emergency department with burning chest pain. After two more visits within four days for the same complaint, he died at home from acute coronary thrombosis. Did the clinicians' frustration with the course of his condition lead them to blame the patient rather than reconsider their diagnosis?

NP Misses Fatal Illness on Phone with Patient's Dad

September 12, 2017 15:15 - 10.3 MB

Fixated on flu symptoms, the nurse missed available information that indicated the patient should have been brought to urgent care to prevent an unnecessary tragedy.

NP Misses Fatal Illness on Phone with Patient’s Dad

September 11, 2017 09:00 - 11 minutes - 10.3 MB

A father called his son's pediatrician's office on a winter week-end night and told the nurse practitioner that his nine-year-old had not felt well for three days. The nurse fixated on flu symptoms and told the father to push ginger ale. When the father checked on the boy 12 hours after the call, he had died from diabetic ketoacidosis and his diabetes mellitus was undiagnosed until autopsy.

For This Patient, Opioids for Pain Resulted in Suicide, Court Settlement

August 01, 2017 09:00 - 12 minutes - 11.6 MB

The patient had a history of suicidality when her psychiatrist referred her to a sleep specialist. Three weeks after the second doctor increased her oxycodone dose to treat restless leg syndrome, the patient used the drug to kill herself.

Culture Helped, Hurt in this Dosage Error

February 28, 2017 10:00 - 7 minutes - 6.73 MB

In this case, an 8-year-old girl experienced a tenfold dosing error of clotting factor, requiring admission and observation due to increased risk of stroke. It could be said that the culture at this hospital both contributed to the error, and contributed to a good response by staff.

No Review of Test Result, and Girl Suffers Wrong Dx for Years

December 23, 2016 10:00 - 8 minutes - 8.12 MB

An 8-year old girl was treated over three years for a condition she never had. Multiple providers missed a test result that showed she had celiac disease, so it went untreated and she suffered. The resulting lawsuit resulted in a settlement against two of her doctors. This case study not only reviews the facts, but it also features suggestions from an expert reviewer on how to prevent similar mistakes managing test results.

Missing an MI When Symptoms Didn't Match Diagnosis

September 01, 2016 09:00 - 7 minutes - 6.41 MB

A presumptive diagnosis during an office visit kept the doctor from broadening the differential to include a much more serious condition. Commentator Carla Ford, MD says, “These are the kinds of situations that our primary care providers and urgent care providers are faced with all the time.”

Distraction, Poor Planning for OB Patient

August 04, 2016 15:29 - 54.1 MB

Fetal bradycardia forced an emergency C-section, but the family claimed the care team should have been more prepared.

Was This Primary Care Provider Too Rushed?

May 17, 2016 15:29 - 7.36 MB

Providers find extra challenges diagnosing stroke in the primary care office.

Troubled Brew: Multiple Providers, Disjointed Care, Lost Kidney Function

February 02, 2016 10:00 - 9 minutes - 8.42 MB

In this case, we see issues that can arise in care that takes place across multiple institutions and providers, especially when the patient is self-referring. This patient was left with seriously-impaired kidney function, and he alleged a delay in diagnosis. Joining us is Dr. Carla Ford, who reviews medical malpractice claims for CRICO.

Spine Surgery: Someone Should Have Said 'Time Out'

September 04, 2015 16:51 - 9.04 MB

Case Study: Response to spine surgery complication injured the patient and relationships.

Spine Surgery: Someone Should Have Said ‘Time Out’

September 02, 2015 09:00 - 9 minutes - 9.04 MB

This review of a closed malpractice claim shows the risks when communication before, during, and after a surgical complication goes awry.

Diagnostic Dropped Ball: Nobody Followed Up on Lung Nodule

May 07, 2015 09:00 - 8 minutes - 12.1 MB

After a referral visit to a pulmonologist to follow up on a worrisome CT, none of the three parties—the PCP, the patient, and the pulmonologist—ever addressed the issue of the lung nodule again. The patient saw her primary care doctor several times for check-ups and minor issues over the next several years. The patient never returned to see the pulmonologist, and was not explicitly told by either doctor that she might have cancer. Four years after her visit with the pulmonologist, the patien...

Unfair But So What? Trial for MD After Patient Skips Screening

March 03, 2015 10:00 - 8 minutes - 8.03 MB

During an initial physical for a new 38-year-old female patient, the PCP noted a normal breast exam, and recommendations for a screening mammogram and colonoscopy due to family history of colon cancer. A mammogram was never done, although the patient returned to this physician practice a dozen times over the next several years for episodic care. Then she presented with a a self-identified lump, followed by a cancer diagnosis. Dr. Carla Ford discusses the patient safety and risk management im...

Asplenic Patient Disabled after Providers Overlooked Infection Risk

March 25, 2014 09:02 - 6 minutes - 5.77 MB

Despite multiple visits to her PCP, a 30-year-old woman without a spleen was never given prophylactic antibiotics or told the risks of a high fever. A mishandled telephone triage delayed her trip to the ER, and the resulting pneumococcal sepsis led to permanent disabilities and a $1 million-plus settlement.

Missed Steps Delay Breast Diagnosis

October 31, 2013 09:00 - 10 minutes - 9.26 MB

Even though the patient identified a lump on her breast, it took more than a year to diagnose cancer. Family history-taking and proper imaging were lacking. CRICO interviews one of the authors of a Harvard breast care management algorithm, Michelle Specht, MD, to consider how following such a guideline could have helped the gynecologist and radiologist—and ultimately the patient.

A Missed MI Diagnosis and Death After Office Visit

July 25, 2013 09:00 - 9 minutes - 8.32 MB

As in many missed MI cases, the primary care physician did not order an EKG. Thomas Sequist, MD, of Atrius Health, describes where some of these cases typically go wrong, and how using a Framingham Risk Score can help with the evaluation process in the office practice.

Misread of Data Slowed Response, Hurt Patient

April 17, 2013 09:00 - 8 minutes - 7.65 MB

Fetal heart rate tracings indicated earlier intervention after prolonged induction of labor. The obstetrician and nurse midwife were faulted for not working more closely together.

Misread of Data Slowed Response, Hurts Patient

April 16, 2013 20:15 - 8.36 MB

A young woman presented to Labor and Delivery at 39.6 weeks with ruptured membranes and irregular contractions; a vaginal delivery was complicated by shoulder dystocia after prolonged induction of labor, resulting in a baby with low Apgars, respiratory distress, neonatal seizures, and permanent cognitive and developmental deficits. A lack of close collaboration between the nurse midwife and the covering obstetrician was blamed for a slow response to worrisome fetal heart rate tracings.

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