Case #1022: Appendicitis
On November 10, the Plaintiffs’ Decedent was a 34 year-old male with no previous medical conditions and/or complaints, was presented to the Defendant Hospital emergency room for emergency care and treatment. At that time, the Plaintiffs’ Decedent presented with a history of eight hours of nausea and vomiting with severe abdominal pain on a scale of 9 out of 10. The pain was located around the umbilicus. The Plaintiffs’ Decedent described his pain as stabbing in nature and was so severe that the Plaintiff’s Decedent was noted to have positive guarding.
Upon physical examination, the Decedent’s bowel sounds were hypoactive, and he was extremely tender to palpation. Flat and upright x-rays revealed the presence of a 3.7 x 2.7-centimeter calcification in the right lower quadrant. Evaluation by ultrasound ruled out gall bladder disease and, as a result, CAT scans were recommended. The Defendant emergency room physician requested a consultation with the Defendant surgeon.
It is alleged that these Defendants were negligent in their ongoing failure to diagnose the presence of a simple appendicitis. It is alleged that with the Decedent’s presenting signs and symptoms, these Defendants were obligated to affirmatively rule out the presence of appendicitis through the use of a CAT scan and/or other diagnostic modalities — none of which were ever performed. The Plaintiffs’ Decedent presented with a surgical abdomen which these Defendants negligently failed to diagnose. Had these Defendants acted in conformity with the standards of care and completed a CAT scan or other diagnostic modalities necessary, a diagnosis of appendicitis would have been made, and this 34-year-old young man would have undergone a successful appendectomy. He would have subsequently returned home, to his family and employment, to resume all of his normal activities with absolutely no deficits.
However, as a direct and proximate result of the ongoing negligence of these Defendants, the tests and studies were not performed and a totally erroneous diagnosis of gastroenteritis was made. Incredibly, the Plaintiffs’ Decedent was discharged from the Defendant Hospital with that diagnosis and with no required surgical intervention.
The following day, November 11, the Plaintiffs’ Decedent was taken by ambulance to another Defendant Hospital emergency room. There, he was seen and admitted.
It is asserted that the care rendered to the Plaintiffs’ Decedent at this Hospital was nothing short of appalling. It is asserted that when the Plaintiffs’ Decedent arrived, he was complaining of intolerable abdominal pain, had been unable to eat, and was posturing in pain. His abdomen was tender with decreased bowel sounds, and he required Morphine, (a Class-A narcotic) for the pain from which he continued to suffer.
Amazingly, these Defendants ordered a CAT scan which was never completed. It is asserted that a CAT scan (which was required to be performed at the previous Hospital but was not) was likewise required to be performed at this Hospital. Therefore, these Defendants never made the diagnosis of appendicitis.
Additionally, it is alleged that there was a minimum of 2,000 cc’s of green fluid removed from the Plaintiffs’ Decedent by nasogastric tube at approximately the time he was transferred from the emergency room to the Defendant Hospital’s surgical floor. The Decedent’s abdomen was distended with increased pain on palpation. By this time, the Decedent’s white blood cell count was 8,000 with the first bands being recorded at 24%. Additionally, it is alleged that during the course of the day, the Decedent’s white blood count had moved from 8,000 to 1,900 and back to 3,600. It is asserted that this is clear and compelling evidence that the Decedent was developing an extremely serious process known as “cold sepsis.” It is asserted that this process demands surgical exploration on an emergency basis. However, it is asserted that the Defendant surgeon continued his negligence by failing to made the diagnosis, by failing to recognize the surgical abdomen, by failing to perform a CAT scan, and by failing to immediately intervene with abdominal surgery.
During the course of the night, the Decedent’s laboratory values continued to demonstrate an ongoing surgical abdomen which was simply being ignored. For example, his temperature at midnight was 100%, but had plunged to 96% by 4:00 p.m. — also indicative of cold sepsis. In fact, the Decedent was complaining of severe abdominal pain even in the face of previously administered Morphine and subsequently administered Demerol (also a Class-A narcotic). By the time these Defendants even ordered regular x-rays, the Plaintiffs’ Decedent was unable to stand. By 3:45 p.m., a swan ganz catheter had been inserted and a nasogastric tube was draining “coffee ground material.” At 5:00 p.m., the abdomen was again noted to be taught and distended with no detectable bowel sounds — yet there was no surgical intervention due to ongoing negligence.
Subsequently, the Plaintiffs’ Decedent was moved to the post-anesthesia care unit. However, he was not seen by an anesthesiologist until 6:00 p.m. At that time, the anesthesiologist noted that the Decedent continued with pain and was having difficulty in breathing. It is asserted that the anesthesiologist understood that the Plaintiffs’ Decedent was in extremis – beyond a critical life threatening condition. Shortly thereafter, a blood pressure was not obtainable, the patient was began to lose consciousness, and ultimately went into full cardiac arrest at approximately 6:15 p.m. Notwithstanding resuscitative efforts, the Plaintiffs’ Decedent died and was ultimately pronounced dead at 6:45 p.m.
It is asserted that the Plaintiffs’ Decedent suffered with nothing other than an appendicitis which was ignored by these Defendants’ for such a significant period of time that it proved fatal. All that was required in the care and treatment of the Plaintiffs’ Decedent was a CAT scan and/or any other appropriate tests to determine the fact that he was indeed suffering with a classic appendicitis which was grossly misdiagnosed. It is further asserted that had an exploratory laparotomy or surgical intervention been provided for the appendicitis, the Plaintiffs’ Decedent would have made an uneventful recovery.