Verdicts and Settlements

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VERDICT/SETTLEMENT

Facts/Liability:

This is a medical negligence case arising from the death of a retired seventy-two year old husband, father, and grandfather, whose aorto-duodenal fistula went undiagnosed and untreated at two different hospitals until he exsanguinated on the operating room table.

Approximately seven years prior to his demise, the decedent underwent an aortobifemoral bypass procedure at a local hospital. The procedure addressed a blockage in a blood vessel in his abdomen and left him with a noticeable scar extending down the center of his abdomen. Seven years later, he was emergently transported to the same hospital due to nausea, diarrhea, and black stool. The emergency department physician wrote Afem bypass@ under surgical history and the decedent was admitted with a diagnosis of AGI bleed – lower.@ The plaintiff then came under the care of a hospitalist, who did not note the extensive scar down the center of the decedent’s abdomen and omitted the aortobifemoral bypass from the plaintiff’s surgical history list. The decedent was seen by a gastroenterologist on the day of his admission, and the gastroenterologist noted the presence of his abdominal scar but he mistakenly wrote that the decedent was status post femoral-popliteal bypass, rather than aortobifemoral bypass. A femoral-popliteal bypass addresses a blockage in the leg and would not have explained the abdominal scar. The procedure that led to the abdominal scar was important because it provided a likely explanation for the decedent’s unexplained bleeding. Because the GI doctor was unaware of the prior abdominal surgery, he instead suspected that the decedent was suffering from an upper GI ulcer and performed an esophagogastroduodenoscopy (EGD) which was unremarkable. Another EGD was performed by another gastroenterologist a short time later and again there was no evidence of active bleeding and no evidence of an ulcer. The decedent was then discharged home.

Two days after being discharged from the first hospital, the decedent vomited blood and was emergentlytransported to another hospital. He was seen in the emergency department, where the surgical history completed by a nurse again mistakenly listed femoropopliteal bypass rather than aortobifemoral bypass. The decedent was admitted with a diagnosis of a GI bleed. The attending hospitalist at the second hospital did not note the decedent’s midline abdominal scar and continued the mistake of her predecessors by listing femoropopliteal bypass among the decedent’s surgical history. Another GI specialist did the same. The decedent remained at the second hospital for the next five days, and underwent five more EGDs which failed to identify a source for his bleeding. At one point, a nurse’s note correctly identified the decedent’s prior aortic bypass but apparently no physician saw that entry or recognized its significance.

Shortly after the last EGD, the decedent was rushed to the operating room due to profound bleeding from his orogastric tube, decreased blood pressure, and increased heart rate. An exploratory laparotomy was performed by a general surgeon, who quickly recognized that the decedent’s abdominal scar did not fit with the prior doctors= notes referencing a femoropopliteal bypass. The surgeon was able to get the duodenum off the graft with difficult dissection and then had to blow up a Foley balloon in the aorta to stop the bleeding. The decedent received approximately 18 units of blood and a number of units of fresh frozen plasma; however he expired on the surgical table. The surgeon later told the family that the aorto-duodenal fistula could have been repaired had it been diagnosed before it opened up in the final event.

The estate sued the two hospitals, as well as the employers of the two ER doctors, the two hospitalists, and the three GI specialists.

Injuries:

The plaintiff alleged that the decedent experienced severe physical pain and emotional distress prior to his death and his estate incurred medical expenses, funeral expenses, and other out of pocket losses.

Specials (if any):

Medical and Funeral Expenses:                                  $          106,946.48

Verdict/Settlement:

Settled after suit but prior to trial at mediation for a confidential amount.

Plaintiff=s Experts (if any): Confidential

Defense Experts (if any): Confidential

Plaintiff=s Counsel (please include name and firm):

Jared R. Green, Esquire

Abramson, Brown & Dugan

1819 Elm Street

Manchester, NH 03104

Defense Counsel (please include name and firm): Anonymous

Insurance Carrier (if relevant): Anonymous

Date of Injury: 2009

Date of Verdict or Settlement: 2013

Mark Abramson
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