Washington DC Metro Medical Malpractice Lawyer Blog

Plaintiffs' experts testified that the healthcare providers failed to document the occurrence of inadvertent spinal anesthesia, a failure that was a substantial factor in the healthcare team's lack of response to decedent's postpartum signs of infection. If a patient has had a "wet tap" or intrathecal catheter, the patient can be watched for complications that may occur with that condition. Inadvertent spinal anesthesia must be noted in the L&D chart and the patient carefully followed to determine "what impact this event may have on the course of the labor and the patient's postpartum period." In particular, for any patient with inadvertent entry into the intrathecal space and persistence of fever greater than 100.4 F, the standard of care required ongoing medical and nursing evaluation to rule out CNS infection.

The failure to assess the new mother's condition over the next eight hours (when the patient and family were pleading for someone to check on their loved one) directly resulted in the failure to recognize the existence of postpartum febrile morbidity and treat her empirically for postpartum infection. Any standard antibiotic regimen for postpartum infection, if timely administered, would have halted the progression of the Strep salivarius infection which eventually resulted in her death. Responsibility for the lack of such an evaluation, and thus for this woman's death, rests upon the physicians for their failure to record the occurrence of inadvertent high spinal anesthesia, with its attendant risks of central nervous system infection.

Plaintiffs' nursing expert testified that the nursing standard of care required that her temperature be monitored closely following the initial recording of elevated temperatures. The standard of nursing care also required that the attending physician be notified with the expectation that empiric antibiotics would be started. The patient's fever persisted, as confirmed by the record and multiple family members, but the progression of her temperatures was not adequately followed by the hospital nursing staff. Persistence of febrile morbidity in a postpartum patient must be documented and communicated to attending physicians, and if no action is taken, must be communicated up the nursing chain of command.

Nursing negligence in the immediate postpartum period is evident in the failure of the nurses to communicate orally regarding the patient's postpartum condition with the attending physicians or the postpartum unit. Likewise, the initial FCCU nurse, failed to apprise the patient's other healthcare providers regarding her postpartum fevers and headache. The nurse's administration of Motrin, coupled with lack of nursing follow-up and lack of communication with the physicians, obscured the patient's condition and contributed to the failure to diagnose and treat this patient in a timely manner.

These initial nursing failures were compounded by the continuing failure to evaluate the patient and summon needed assistance. Despite the persistence of fever following the administration of Motrin at 8:00 p.m., no physician was summoned for many hours. This continuing negligence was highlighted by the late and inadequate report provided by the nurse leaving for the night to the incoming nurse. At that time the departing nurse only communicated that this patient had a history of migraines and emotional anxiety. This history, coupled with the failure to disclose persistent fever and the administration of Motrin, served to obscure the significance of her continuing symptoms and was a substantial factor in the overall failure to recognize and treat the CNS infection.

Lastly, the failure to implement the house doctor's verbal order for ampicillin was a clear departure from applicable nursing standards. This nurse admitted that this medication was ordered but not given. Had an antibiotic such as ampicillin been administered within a few hours of the patient's initial complaints of a pounding headache, it is likely that the progression of her Streptococcus salivarius infection would have been reversed. This pathogen is extremely susceptible to a wide spectrum of antibiotic medications, including ampicillin.

In the context of inadvertent spinal anesthesia, with a large epidural needle entering the intrathecal space containing CSF, the persistence of fever and headache is particularly ominous and mandates a diagnostic evaluation. The duty to undertake such an evaluation, leading to the administration of antibiotic medication, rested upon the shoulders of this woman's team of physicians, and each member of that team contributed to the ultimate failure to provide timely and effective medical treatment. The patient should have been seen by a physician many hours earlier.

All experts agreed that this woman died as a result of a bacterial infection. The disputed issues among the experts were whether the fatal infection was iatrogenic or community-acquired, and whether antibiotic treatment in accordance with the standard of care for treatment of bacterial meningitis or meningoencephalitis would have been effective.

The medical record in this case demonstrates her increasing physical pain and mental anguish, with notations of headache, chills, fever, agitation, eye pressure, neck pain, thrashing around in bed, feeling suffocated, and suffering the onset of severe seizures. As a new mother responsible for her infant son, the decedent was particularly vulnerable to the emotional and psychological effects of such injuries. Her husband testified that his wife repeated in anguished tones, "This is not normal," and "I don't want to die." There can be no more frightening situation for a young mother, with a mounting fear of her own death so soon after giving birth.

Please read Part I - When Things Go Wrong After Giving Birth, Make Your Voice Heard

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

These days doctors and hospitals are busier than ever. Reimbursements for medical services are being cut every year, and to make up for lost income many providers are simply seeing more patients. The unfortunate result is overbooked schedules, long waiting times, and often a reduced quality of care. Therefore, it is vitally important for a patient to be an advocate when obtaining medical treatment. Here are some suggestions to help you get the best medical care for yourself or your loved ones:

• Bring a list of questions to the doctor's office. When seeing a doctor, patients often feel rushed (doctors usually are), and may be nervous, forgetting to ask questions they had in mind earlier. You should think beforehand about questions you want to ask, and write them down to bring to the appointment.
• Trust your intuition. You know your body better than anyone. If you feel something is amiss and the doctor is "brushing you off," don't be afraid to raise your concern a second or third time, or to obtain an opinion from another doctor. You might need to pursue an answer on your own.
• Bring a friend or loved one to your appointment. Most appointments go fast and are over quickly, and it is easy to forget what the doctor said. A second set of ears in the room will help you retain what you were told.
• If it is not possible for someone to accompany you, bring an electronic recording device. Just be sure to ask the doctor first if you may record the appointment. Many cell phones now have recording features. An alternative is to bring pen and paper and take notes.
• Schedule yourself for either the first or last appointment of the day. If you are the first appointment of the day, the doctor will not yet be behind schedule, so your visit should feel less rushed. If you are the last appointment of the day, you may have to wait for a doctor who is late, but if you have much to discuss and want time to express all your concerns, this is the best time to do it.

In today's overburdened healthcare system, mistakes and oversights are bound to happen. Unfortunately, it may no longer be prudent to simply trust the doctor and accept his word. If you believe something is wrong and has been inadequately addressed, be persistent and follow-up as much as you feel necessary -- chances are the doctor will take your concerns seriously. Above all, it is up to you to make sure you get the right medical care to maintain your health.

Stein, Mitchell, and Muse, LLP has successfully handled cases of negligent medical treatment for more than 40 years. If you have questions about a possible claim, we invite you to contact our office for a free consultation.

Brain tumors, or intracranial neoplasms, can be a particularly devastating form of cancer. While these tumors are not always malignant or fatal, a patient's prognosis depends heavily on their size, location, and early detection. But such detection is unfortunately difficult, as changes are masked by the skull and pain is usually absent due to the lack of sensory nerves within the brain. Symptoms are often delayed until the late stages of disease, when increased intracranial pressure can begin to damage the brain's structure. Even this is dependent upon the particular form of the tumor, and prompt imaging should be obtained to recognize the potential harm wrought by brain tumors.

A malignant brain tumor can be primary, originating in the brain, but the vast majority are secondary tumors resulting from late-stage, metastasized cancer in another organ which has spread to the brain through the lymphatic system and bloodstream. Benign brain tumors are still serious and can be life-threatening. Because the brain is enclosed within the skull, the growth of even a small tumor can cause severe and permanent damage through increased pressure exerted on the brain.

Certain brain cancers like Medulloblastoma and Oligodendroglioma have good median survival rates, while Glioblastoma multiforme, the most common form of brain malignancy, is also the deadliest. Treatment options are dependent on the form and severity of the brain cancer, but typically include the use of surgical excision, radiation, and chemotherapy.

It is important for both doctors and patients to be aware of brain tumor symptoms that are often overlooked or mistaken for another condition. These include headaches or migraines without prior history, especially in patients 50 or older, or in children under 6. Additionally, neck stiffness, increased intracranial pressure, behavioral or consciousness changes, neurological dysfunction, and vomiting not caused by other illness or headache can be indicative of a brain tumor. If these symptoms are present, and other conditions are ruled out, doctors should immediately perform an MRI or other high-resolution imaging procedure to ensure that a tumor is not the cause.

We have handled cases of undiagnosed brain tumors. If you or a loved one has been misdiagnosed and suffered injuries as a result of suspected malpractice, please contact any of our qualified medical negligence attorneys at Stein, Mitchell, and Muse, LLP.
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See part one
See part two

If you are around the age of 50 or have a family history of colon cancer, chances are that your physician will instruct you to schedule a colonoscopy. Many of us have heard others talk about the dreaded "prep" they must endure the night before the procedure. True, it's not a particularly pleasant experience, but it is a very important diagnostic tool for catching colon cancer in its initial stage, thus saving your life. This type of cancer is slow-growing, which is why the colonoscopy is repeated every five years. However, there are instances where the physician will instruct the patient to return more frequently. It is important to be mindful of when you are due for your next colonoscopy,

On the day of the procedure, after emptying your colon the night before (usually by drinking a special solution ordered by your physician), you will be lightly sedated. During this 20-30 minute procedure, the physician inserts a flexible thin tube (with a light and tiny camera) and examines the entire colon, as well as the lower part of the small intestine. The doctor will be looking for polyps (a mass or growth of tissue), as well as an explanation for any complaints of bloody stools, rectal bleeding, and chronic diarrhea, among other concerns or complaints. If polyps are present, they are removed since some eventually develop into cancer.

One tragic colon cancer case can be found on our website under "Settlement in Colonoscopy Cancer Case," where we alleged that the physician's negligence included, among other things, that the colonoscopy was performed in 10 minutes, a time which we contended was far too fast to properly visualize the colon.

See part one

Stein, Mitchell & Muse LLP has medical malpractice lawyers who have worked on galactosemia related cases in the Washington DC area. Galactosemia is an inherited disorder in which the body is unable to metabolize galactose, a type of sugar found in milk. People with galactosemia must avoid all forms of milk, human or animal, including products containing dry milk, and other foods with galactose for life. Infants can be fed with soy formula, meat-based formula, Nutramigen, or any other lactose-free formula. If fed milk, an infant with galactosemia will have substances made from galactose build up in their system. These toxic substances will damage the brain, liver, kidneys, and eyes, causing cataracts, cirrhosis of the liver, mental retardation, delayed speech development, tremors and uncontrollable motor functions, and many other serious injuries. This condition is not the same as being lactose intolerant; galactosemia is far more serious. Lactose intolerance will likely result in abdominal pain, whereas galactosemia can cause serious irreversible effects or even death.

Inborn errors of metabolism, also known as inherited metabolic disease and congenital metabolic disease, are defects of genes. Newborns must be tested without delay; otherwise, harmful, irreversible effects can occur within the newborn's first few days of life. Screening now tests for over one hundred disorders, including galactosemia. If there is a family history of galactosemia, the fetus should be tested in utero. Prenatal diagnosis is possible by directly measuring the enzyme galactose-1-phosphate uridyl transferase. Infants with galactosemia can develop signs and symptoms in the first few days of life if they are given formula or breast milk that contains lactose. These signs and symptoms include but are not limited to convulsions, irritability, lethargy, poor feeding, poor weight gain, jaundice, vomiting, amino acids in the urine and blood plasma, enlarged liver, fluid in the abdomen, or low blood sugar. When the health care provider fails to test (or a misdiagnosis occurs), toxic substances will begin accumulating in the infant's body putting the newborn's health at risk.

If you or a loved one suffered medical negligence or malpractice related to galactosemia or other diagnostic testing that your newborn should have received but did not receive, our experienced team can help. Contact our office today for a free consultation.

We hope you enjoyed this series by Laurie A. Amell, a nurse and an attorney who practices law in the Washington D.C., Virginia, and Maryland. Ms. Amell is a partner at Stein, Mitchell & Muse LLP, a Washington D.C. law firm conveniently located in D.C. across the street from the Mayflower Hotel at the Farragut North Metro station.

See part one, two, three and four. See the related birth injury series.

The medical malpractice attorneys at Stein, Mitchell & Muse LLP have experience working with complicated pregnancy related cases in the DC, Maryland and Virginia area. Pregnancy-induced hypertension (PIH), also called gestational hypertension, preeclampsia, toxemia, or toxemia of pregnancy, is one of the complications of pregnancy that can occur. PIH is when an expectant mother experiences swelling from fluid retention, and high blood pressure (i.e., 160/100), as well as having protein present in the urine.

While some swelling is normal during pregnancy, it may be a sign of PIH if you experience some swelling that does not resolve or that is accompanied by rapid or sudden weight gain, high blood pressure, or protein in the urine. Other symptoms of PIH include dizziness, abdominal pain, severe headaches, changes in reflexes, visual disturbances, decreased or bloody urination, or excessive vomiting and nausea.

Mild PIH can be treated at home with a quiet, restful environment with limited activity or bed rest. It is important that you follow the diet and fluid intake guidelines from your health care provider and maintain your scheduled appointments. Your perception of fetal movement every three hours is also important. Any changes need to be reported to your health care provider immediately.

If your PIH worsens, hospital admission will be necessary so you can be closely monitored. High blood pressure is treated with medication, and magnesium is given through an IV to prevent seizures. PIH is serious as it can prevent the placenta from receiving enough blood, which can cause low birth weight in your baby. Although rare, other complications are also possible, including placental abruption, maternal seizures, temporary kidney failure, liver problems, or blood clotting problems. Severe cases may require early delivery. Blood pressure usually returns to normal after delivery. Sometimes, however, it may remain high, requiring medication. As preeclampsia can be confused with other diseases, physicians should consider PIH in pregnant women beyond 20 weeks gestation with these symptoms.

We have had successful cases involving PIH claims. Please schedule a consultation with our law firm if you believe that you or your child were injured because of improper treatment of PIH.

See part one, two and three. See the related birth injury series.

While often thought of as commonplace and fundamental, pregnancy is an amazingly complex process which unfortunately can be plagued with a variety of complications. One fairly common condition is called placenta praevia, in which the placenta, the organ that nourishes the developing fetus, grows in the lowest part of the womb covering the cervix.

There are different degrees of placenta praevia including low lying (the placenta does not infringe on the cervical os), marginal (when the placenta grows against but does not actually cover the opening of the cervix), partial and complete (placenta covers the top of the cervix). Risk factors include having an abnormal uterus, having multiples like twins or triplets, and having many previous pregnancies or scarring of the uterine wall from c-sections, surgery, or abortion.

The concern with this condition is that it can in some cases cause sudden and severe bleeding, putting both mother and baby in danger. The primary symptom of placenta praevia is spontaneous and painless vaginal bleeding (bright red) around the late second or early third trimester. However, it is usually confirmed through ultrasounds, before any bleeding occurs. Doctors typically will order pelvic rest and reduced activity to try to prevent bleeding. Additionally, most women with placenta praevia will require cesarean section delivery, which can be performed on an emergency basis if there is heavy life-threatening bleeding, to prevent death to themselves or their baby. Because of this, placenta praevia greatly increases the risk of having a preterm delivery.

When pregnancy problems occur it is important to receive prompt and proper medical treatment. If you or a loved one are a victim of malpractice involving placenta praevia, schedule a free consultation today. We have experience successfully handling medical malpractice cases involving this and other pregnancy complications. We are conveniently located in DC on the Red Line at Farragut North.

See part one and two. See the related birth injury series.

Part 4

As we have seen, many conditions can result from malpractice during gestation or birth, but injuries can also be inflicted by delivery itself. Our team at Stein, Mitchell, and Muse have managed several cases involving brachial palsy. This injury occurs when there is excessive stretching to the arm or shoulder, usually caused by shoulder dystocia, breech births, or if an infant's arms are pulled during delivery. This results in bruising of brachial plexus, a collection of nerves located in the shoulder that innervate the entire arm.

Symptoms appear immediately following birth or develop soon after and may include absence of the Moro reflex, reduced grip strength, or lack of movement in the infant's affected arm. There are several forms of brachial palsy, which are based on the severity and location of symptoms. If only the upper portion of the arm is affected, it is often simply a brachial plexus injury, while the presence of symptoms in the hand only is indicative of Klumpke paralysis. If both the upper and lower arm are affected then it is likely a form called Erb's paralysis.

Most mild cases of brachial palsy require only range of motion exercises and gentle massage as treatment, and will heal spontaneously within weeks. Unfortunately, those that do not resolve by the time the child is 3-6 months old may involve permanent nerve damage and have a very poor outlook for recovery. Surgery can be performed to attempt to repair nerves or transfer tendons, but its success is typically limited.

Modern obstetrical care has reduced the likelihood of brachial palsy by providing options to avoid difficult deliveries to begin with. Sadly, in spite of these improvements, children continue to suffer this avoidable birth injury when doctors ignore risk factors like abnormally large infants, breech positioning, or a mother's narrow pelvis and do not opt for cesarean section delivery.

See part one here.
See part two here.
See part three here.

Life can turn in an instant. For some, as we have discussed in our recent blogs, this upheaval happens in the form of a birth injury. There are other instances, though, where these conditions are overcome and patients are able to lead relatively normal, productive lives. It is all the more grievous when later in life, a medical practitioner's negligence becomes the stumbling block for these individuals.

One such case we handled involved a boy with spina bifida and hydrocephalus. These conditions are usually caused by defects during intrauterine development. Spina bifida involves a condition when the spine does not fully close around the spinal cord, resulting in the formation of a myelomeningocele or sac containing the protruding spinal cord and overlying membrane. Ninety percent of patients with myelomeningocele also develop hydrocephalus, or "water on the brain." Hydrocephalus occurs when excessive cerebrospinal fluid (CSF) builds up in the ventricles, or cavities, of the brain. If untreated, this causes intracranial pressure to increase, potentially enlarging the skull and causing brain damage, mental disability, or death.

The boy had successful surgery as an infant to repair his spine and place a shunt that would control the pressure in the ventricles of his brain by removing excess CSF. Despite having executive dysfunction, ADHD, and several other medical conditions associated with his hydrocephalus, he either functioned or showed promise of functioning at normal levels in all areas. He was mainstreamed in school, managed to cope with his difficulties, and was expected to graduate with his peers.

At the age of 16, he began to experience periodic severe headaches. After examination, it was found that his shunt, though still functioning, needed revision. Surgery was initially successful, but indications of infection prompted removal of the entire shunt system, requiring placement of a new one at a later date. His surgeon suggested that he could perform an additional and unnecessary procedure, making a 4-5mm hole in the third ventricle for CSF to drain. He did not inform the boy or his parents of all the possible risks, nor did he mention simpler alternatives that were available. During surgery, this doctor also felt he could see well enough to carry out the delicate operation without the assistance of a visualization device. During surgery it became apparent that the attempted repair was a complete failure, and had caused the boy to suffer serious brain injury.

Our law firm's investigation showed that the surgery had been executed in a negligent manner, cutting too deep and in the wrong location, severing the connections between various parts of the brain. Whereas the boy had successfully overcome congenital hydrocephalus and was college-bound, he is no longer fully independent and depends on assistance from others to perform many vital functions. We filed suit on his behalf promptly and recruited top national experts in neurosurgery and neuroradiology to support the case. Fortunately, we were able to achieve a very substantial settlement for this young man and his family, providing help that they desperately need to deal with the problems caused by an unnecessary and cavalier surgical misadventure.

Hospitals have responsibilities towards their patients for their administrative, nursing, and medical staff. A hospital does not provide mere room and board; it carries overwhelming medical and nursing obligations for a steady influx of patients, whether in the emergency room, the operating room, diagnostic facilities, physiotherapy and occupational therapy, or any other hospital-based service. In this blog we will go through several of these duties in detail, looking at the circumstances that determine when a hospital is liable to its patients, as well as the kind of lawsuits that can address hospital failures to deliver medical and related services that meet the applicable standards of care.

First, let us consider a fairly typical scenario. Mr. and Mrs. Fox have been married for 42 years, have 3 children and 7 grandchildren. Today, they are very nervous as Mrs. Fox needs to undergo a hysterectomy for uncontrollable vaginal blood loss, years after her menopause. They have been assured the surgery is simple. Mrs. Fox trusts her gynecologist, and has checked herself into the hospital after his assurance of her safety. However, she still worries about the anesthesiology, and wonders whether she will she wake up after the procedure. She also worries about the food, since she has such a sensitive stomach, and about whether she might contract an infection while staying in the hospital. She is also anxious about whether the staff at the hospital will give her the medications she feels she must have.

Indeed, these concerns address some of the many functions and duties of a hospital. The staff must ensure that the doctors you don't select, like the anesthesiologist, are selected carefully and are qualified to work in a hospital. The hosital must have a quality assurance team to make sure that only competent MDs staff the hospital. Mistakes from improperly trained practitioners can kill a patient. The hospital also has the responsibility of making sure the operating rooms are clean and free of virulent bacteria, in addition to supervising healthcare providers' hygienic behavior and conduct. The administrative employees, as well as the RNs who give the patients their medications, are to observe the behavior of patients and visitors. The hospital has an administrative staff that facilitates meetings between MDs, RNs and social services to improve the flow of information and consistency of care. The hospital also has to establish and maintain diagnostic labs to make sure that laboratory work is done in a competent and timely fashion.

What will happen to Mrs. Fox in her surgery? What can go wrong? And how does the hospital's responsibility mesh with MD responsibility? More on that to come!

In treating and preventing serious disorders in infants, often time is of the essence. This was true for a case we successfully concluded in which the decision to delay taking action caused serious harm to a child. The 22-year-old first time expectant mother was healthy before pregnancy and received prenatal care. She went into labor at 36 weeks of gestation (4 weeks early), and presented to her local hospital at around 9:30 am. She was fitted with a fetal monitor, which initially showed the child's vitals to be normal and stable. An hour-and-a-half later, the monitor began to display persistent late decelerations, loss of beat-to-beat variability, and a hyperstimulated contraction pattern, which were ominous in terms of fetal well-being and reserve.

A certified nurse midwife was informed of the situation. She ordered oxygen, increased intravenous fluids, and placement in a slight Trendelenburg position (feet elevated higher than the head), and then said she would return to check on the patient. When she was soon called back by another nurse, she did not respond.

An obstetrician was notified; both he and the midwife monitored the patient over the next two hours, placing a fetal scalp monitor and intrauterine pressure catheter, and periodically checking the tracings of the fetal heart strip. He decided to take over care from the midwife at around 1:40 pm, as the patient reported painful contractions. He informed her that along with continued negative indications from the fetal monitor tracings, it might require her to undergo a primary cesarean section.

Given the persistent signs of fetal distress for over an hour, an emergency cesarean section delivery should have been performed no later than 12:30 pm. However, the obstetrician caused further delay when he then erroneously determined that the new fetal heart tracings revealed no abnormalities and left the hospital to return to his office. This was extremely negligent, yet neither the nurse nor midwife utilized the chain of command in light the doctor's inaction. In fact, they failed even to contact him or another qualified physician until 3:00 pm. It took another twenty minutes for the obstetrician to arrive back at the hospital, and cesarean delivery was not performed until 3:45 pm.

The nearly five hours of fetal distress allowed before action was taken resulted in the child being born limp, suffering from acute perinatal asphyxia with no heart rate or spontaneous respiration. He was immediately placed in the neonatal intensive care unit. At the time of his discharge, his diagnoses included birth asphyxia, acidosis, possible sepsis, prematurity, and hypoglycemia. He was later confirmed to also have HIE or hypoxic/ ischemic encephalopathy and cerebral palsy, as well as serious organic brain damage. He suffers resultant developmental delays, impairment of cognitive functioning, severe expressive dysphasia, emotional deficits, and behavioral abnormalities including self-injurious behaviors.

Our team of lawyers was able to prove that the defendant's deviations from applicable standards of care resulted in a negligent delay in performing a cesarean section delivery and caused the minor plaintiff's numerous birth injuries, all of which would have been avoided with a timely delivery. The jury awarded several million dollars for the child, as well as money for the mother in the conservative venue of Fredericksburg. The defense filed a lengthy post-trial motion; however, the Virginia Supreme Court rejected the appeal.

The practice of medicine has always been a fast-paced and complex environment; with modern life growing ever busier, the risks from mistakes in the doctor's office grow as well. The best precaution against becoming a victim of malpractice is being an active participant in your healthcare. Being your own advocate by staying informed, speaking up, and getting second opinions can prevent minor errors from growing into life-threatening issues. This is especially important when planning and undergoing surgery.

Recently, we represented the husband of a 66-year-old woman who died after suffering preventable complications from elective foot surgery intended to treat the pain of Charcot Collapse. There were several breaches of the standard of care by the surgeon who operated on her, as well as the doctors and staff who were involved in her subsequent emergency care.

Many common elective surgeries performed today do have non-surgical alternatives. These options should be discussed and evaluated by your doctor to determine which will provide the greatest benefit with the least risk. If surgery is decided upon, it is usually required that you be cleared through a preoperative exam to ensure that you are healthy enough for surgery. At the very least, your surgeon should be familiar with your medical history.

In this case, the woman's doctor recommended elective surgery over a non-invasive shoe-orthotic combination. He did not take into account her preexisting conditions, including age-related softening of the bones known as osteopenia, which put her at a much higher risk of developing osteomyelitis (bone infection) and made her a poor candidate for the surgery he suggested. He then failed to have her sent for medical clearance, which given her poor general health, she would not have received. Her infection risk was further exacerbated by her history of hypertension, high cholesterol, obesity, pre-diabetes and metabolic syndrome. Combined with her medical history, this should have caused her to be followed carefully and at the slightest sign of infection be cultured and treated with antibiotics with the assistance of an infectious disease consult. Instead, when she returned for her postoperative appointment complaining of wound pain and oozing, her doctor dismissed it. He provided no instructions on signs of infection to look for, and told her to return in nine weeks, both of which provided false reassurance which would further contribute to the delay of her treatment.

The bacteria seeded around the metallic devices in her foot causing a wound infection and osteomyelitis. Allowed to intensify without the administration of antibiotics, her condition deteriorated. Her husband, fearing for her safety, returned her to the medical center where she suffered still more negligence. Despite obvious indications that she needed urgent attention, she had to wait 16 hours for a bed to become available before she was given any antibiotics. During this time, the amount of bacteria attacking her was allowed to double five times, spreading to all of her body's systems at an alarming rate. The result was sepsis, or blood poisoning, which quickly led to multiple organ failure. Over three weeks of intense conscious pain and suffering followed, as she relied on a ventilator, feeding tube, dialysis, and other live-preserving instruments. We were successfully able to achieve a seven figure settlement for her family in a fairly short amount of time.

Recently, we handled a medical malpractice case in Maryland involving a baby with a preventable brain injury leading to cerebral palsy.

There are many causes of brain injuries in children. Some are preventable; some are not. A condition known as Kernicterus is a preventable form of severe brain injury in children.

It is advisable to assess all brain injuries in children in order to determine whether these injuries are genetic, or whether they are related to preventable or nonpreventable causes.

Parents of a baby of 8 months came to our law firm to ask us to review the records of their daughter who had cerebral palsy on the basis of early jaundice after delivery. They were able to tell us that their daughter was yellow after birth and that when she was admitted to the hospital in their hometown the little girl needed a replacement transfusion of her blood. The records indicated that the baby was discharged on day 4 of life after a normal vaginal delivery. She was yellow at the time and her bilirubin levels were somewhat high. On her first wellness visit to the pediatrician she was yellow and lethargic, and she was not sucking her mother's breast effectively to obtain nourishment. The couple was told to come back one week later and to continue and feed the baby the best they could. Four days later the mother noticed her daughter to be listless, sleeping constantly, and not crying at all. The mother decided to take the baby to the emergency room of the local community hospital. On arrival in the ER the baby's blood was found to contain high levels of bilirubin and an MRI of the skull and brain detected that the child's bilirubin had attached itself to certain areas in her brain known as cerebral nuclei. These areas are known as "kerns" in German, which combined with "icterus" (meaning yellow) explains the origin of the name "Kernicterus."
Kernicterus is a serious and potentially devastating neurological illness in children.

Our review of the records documented that the child had high levels of bilirubin and should have been treated rather than discharged from the hospital after birth. Early treatment is simple and highly effective: the baby is placed under a lamp emitting ultra-violet light which breaks down bilirubin very effectively. Even at the first wellness evaluation the baby's condition could still have been treated effectively with blood transfusions and ultraviolet light. Our medical experts told us that the delay in diagnosis and treatment was negligent and amounted to a serious failure of the healthcare providers to follow the standards of care for monitoring young babies with early jaundice. Following a year of litigation we were able to obtain a significant settlement to fund the child's lifelong needs including medical, rehabilitation and remediation services.

Gerard Mitchell
Dr. Michael Cohen

Many civilians in the Washington DC area receive their medical care at military hospitals. This is one of the benefits of being in a military family. However, some military hospitals are understaffed or staffed with doctors in training who only see a patient once or twice before the patient gets passed off to a different doctor. Continuity of care is lost. Communication breaks downs.

This can be a recipe for medical errors and medical negligence. As stated by a federal judge, when he entered judgment in favor of the patient in a military medical malpractice case:

It is fairly easy to observe how [the malpractice] could have happened, given the large number of caregivers and the multiple patient records. The left hand did not know what the right hand was doing - observations by one caregiver were not communicated to, or were not considered by, others. Information provided by the patient was not acted upon in a timely manner, and questions that should have been asked were not. One cannot imagine a better example to cite in support of the need for centralized electronic record-keeping. For this patient, such reforms will be too late, and the consequences for her are devastating.

It is important to keep in mind that, if you or a loved one has suffered preventable injuries from military medical care, it may be very important to act quickly. There are time limits for making a claim and filing lawsuits against the government. Those time limits are part of a series of laws known as the Federal Tort Act, which allow civilians to bring claims against the federal government if the negligence of a government employee - including a military doctor or health care providers - causes harm.

The injured person cannot, however, wait too long to bring that claim. The Federal Tort Claims Act requires the injured person or their representative to file a claim with the responsible government agency or military branch within two years of the injury or the claim may be barred. That claim is filed by submitting a "Form 95" to the proper authority. Once that Form 95 is submitted, the government agency or military branch evaluates the claim. Most claims are rejected or the amount offered is insufficient. The claimant then has six months after rejection to file a lawsuit in federal court. If the claimant does not file within six months of the rejection or inadequate offer, the claim may be barred.

Stein, Mitchell & Muse recently brought to successful conclusion a complicated medical negligence case involving a 61-year-old man who underwent routine knee surgery and died at the hospital two months later from a persistent post-operative infection. We represented the deceased's wife and children in claims under Maryland's Wrongful Death Act (Md. Code Ann. Cts. and Jud. Proc. §3-904), alleging that the orthopedic surgeon failed to:

● disclose the heightened risk of infection when performing knee surgery shortly after the patient had blood clots in his lungs;
● examine the patient after he made repeated phone calls from home to report symptoms of wound infection;
● monitor the infection after the patient was re-hospitalized but failed to improve;
● recognize the signs of infection tracking up the thigh and into the abdomen;
● detect and treat internal bleeding caused by advanced infection before multiple organ failure led to death.

The deceased's family members sought damages for his medical bills, funeral expenses, lost future earnings, lost household services, and conscious pain and suffering, as well as for their own profound grief resulting from his unexpected death. The case was settled for a confidential amount on the second day of a two-week jury trial.

Wrongful death cases like this present complex issues on all fronts. Beyond establishing that the patient died as a result of the surgeon's negligence while several other physicians were involved in his treatment, a successful outcome requires navigating the various rules on what damages can be claimed and proven by surviving family members. For example, in this Maryland case involving adult children not residing with their father, only the deceased's widow (who was also the personal representative of his estate) could recover economic damages for his lost financial support and the value of his household services. The family's noneconomic damages - i.e., their past and future grief, often the most personal element of loss - were capped by statute (Md. Code Ann. Cts. and Jud. Proc. §3-2A-09), and the jury would not be told about that limit. If this had been a District of Columbia case, no compensation for the survivors' grief would have been available because DC's Wrongful Death Act does not recognize that element of damages.