Malpractice a Medico-Legal Story

By Nelson Ancalmo

A case of Medical Malpractice goes to trial with unexpected consequences.

• Language: English
• Publisher: Nelson Ancalmo
• Release date: May 29, 2010
• ISBN: 9781452352633

Nelson Ancalmo

Nelson Ancalmo M.D. was born in San Salvador, El Salvador, Central America. After finishing his Medical School, he traveled to the United States to complete his training in Cardio-Vascular Surgery. Presently he is retired and lives in Austin, Texas where he devotes his free time to writing, graphic design, astronomy and music. e-mail: [e-mail]

Book preview

PROLOGUE

Medicine is a unique and wonderful profession. It is an art and a science, and the correct mixture of these two elements produces an environment designed to care not only for the physical ailments that torment the patients, but also to provide support and encouragement to carry them through a devastating ordeal.

But patients are not alone. Around them is an entire social structure that includes family members, friends, coworkers and people that in one way or another have become acquainted with them. When a physician takes a patient under his or her care and concentrates only on the patient, ignoring this complex structure that gravitates around him or her, he is creating a reaction that will trigger a wave of discontent, anxiety, and even anger. This relationship, that should have been one of trust and gratitude, and even friendship, becomes one of demand, accusations, and revenge and ultimately turns into a legal action against the doctor or doctors involved. The following is a fictional story in which a physician decided to ignore one of the basic elements in a doctor-patient relationship: COMMUNICATION.

Chapter 1

THE FATEFUL DAY

5 am. Harrisburg, Arkansas. November the First.

Harrisburg is a small community located in Northeast Arkansas. With a population of about 2500 inhabitants, it is a peaceful and quiet place to live. It is located halfway between Jonesboro a major city to the North, and Wynne, a medium size town to the South.

Janet Smith woke up and began her daily routine getting ready for another day. It was Monday and the weather had cleared after a couple of showers the night before. It was rather cool and the promise of more severe weather was in the daily news forecast. Outside her bedroom window, the sun was beginning to shine, and the view of her backyard with fallen leaves on the ground and bare tree branches reminded her that winter was only a few weeks away. She knew that her son Michael was waiting for her to take care of her grandaughter. This is something she enjoyed very much and at the same time provided help for Michael’s family so that he and his wife could both go to work. For Janet, it was very important to perform this baby sitting for her son; she felt as she was giving back some of the love and care she had received through out her life.

Janet’s life had been plagued with a chronic illness called Lupus. In her case it had been severe, causing pains and skin outbreaks that in one occasion prompted a physician to compare them with leprosy. But she was a woman with a very strong Christian faith, and that faith had given her the strength to cope with the devastating effects of her disease. An aggressive treatment had brought some degree of relief. Her skin was now clear and the only thing that bothered her were those severe joint pains.

She was a small woman in her 50’s, thin and full of energy, very friendly and always willing to help and care for others. That morning as she walked into her bathroom, she felt a severe pain in her back. It confused her because at the same time, her legs became very weak and could not support her. She fell to the floor and began calling her mother, with whom she lived in the house, for help.

When her mother found her, she still was on the floor but her legs were beginning to recover their function. She immediately called Michael and minutes later dialed 911. Both Michael and the ambulance arrived almost at the same time. Michael lived in the same city not far away, but the ambulance people got lost and took some time to find the correct address.

Unfortunately, due to the rains of the night before, the driveway to Janet’s house was muddy and the ambulance got stuck. While the paramedics were taking care of Janet and placing her on a gurney, a neighbor got his four-wheel drive truck and pulled the ambulance out of the mud.

Because of previous favorable experiences of the family, they asked the ambulance service, to take Janet down south to Wynne instead of heading up north to the larger hospital in Jonesboro. The paramedics, even when they have a certain degree of medical training, were incapable of recognizing the seriousness of Janet’s illness and failed to advise the family otherwise. The 25 minutes drive was uneventful and since Janet was doing well, there was no need for a high speed, siren blaring trip.

Chapter 2

6.30am. Cross County Memorial Hospital, Wynne, Arkansas.

Janet arrived at the Emergency Room and was transferred to a room with her family. They sat there waiting anxiously to see the Emergency Room doctor. Dr. Johnson had arrived at the hospital 30 minutes before to begin his 12 hour shift in the Emergency Room. He went immediately into the room to see Janet shortly after her arrival. She gave him the history of her symptoms and mentioned that she has been afflicted, for the last fifteen years or so, with Lupus. Amongst her medications she also mentioned that she took steroids on a daily basis.

Lupus erythematosus is a disease of the connective tissues, i.e. the cells that hold things together in our body. Steroids are use to decrease the effect of this autoimmune disorder, but as a side effect, they also weaken the strength of the tissues.

While waiting in the Emergency Room, Janet had a bloody bowel movement. This was reported to the doctor by the nurse taking care of her. At this time her vital signs were within normal limits and her legs seemed to be back to normal.

Dr. Johnson, after his examination and with the facts he had learned, had several diagnoses in mind: 1. An abdominal aneurysm (a ballooning of the aorta); 2. A gastrointestinal bleeding. (bleeding from the stomach or colon) 3. Lupus, given by the patient’s history. He ordered a series of tests including chest X-rays of the chest, blood counts, and a CT scan of the abdomen. Because of the possible compromised renal function secondary to her lupus, he requested this study without the use of radio opaque contrast material. This would prevent further damage to her kidneys, but at the same time, it would provide less information about her abdominal aorta. Janet was doing fine except for some pain in her chest. Because of the lupus, chronic pains were a common symptom and these complaints were attributed to painful joints.

The radiology department at Cross County Memorial Hospital did not have an in house radiologist. The studies were taken by a technician and sent by Internet to a group of physicians located in Mississippi and the report would come back by phone to the attending doctor. These are verbal reports; the written ones are not available until the next day.

Dr. Johnson read the chest X-rays him and didn’t see any thing abnormal. Since he was concerned about his diagnosis, he decided that it would be better to admit Janet for observation to their Intensive Care Unit.

Chapter 3

8.00am. Emergency Room

Since Janet did not have a regular physician in Wynne, Dr. Johnson paged the physician on call for that morning. Dr. Kramer was a Family Practice doctor, born and raised in the area. He had been practicing in Wynne for more than ten years and was well regarded in the community. He was a young, well-mannered, intelligent individual with a busy office practice. Besides seeing patients in his office, he was one of the few in Wynne who had elected to deliver babies and this part of his practice was enough to keep him busy day and night. When the phone call came in, Dr. Kramer was about to begin a busy Monday morning. Patients were already lined up in his waiting room, most of them with appointments made weeks in advance. The previous night had been one typical of his profession. The young mother started feeling pains on Saturday evening and delivered a healthy looking girl late on Sunday night. He was ready for a well-deserved rest, and his mind was wandering around that soft leather recliner in his living room with a cool drink in his hand and some of his favorite Chopin music on the stereo system. Dr. Johnson’s call brought him back to reality. The doctor informed him about Janet’s clinical condition, his suspicions and the need for admission to the Intensive Care Unit for observation. At this time, the patient was stable, had no more bleeding, and the laboratory work was within normal limits. Dr. Kramer agreed to take her under his care and gave additional orders to be carried out on admission to the Intensive Care Unit. He also requested to be informed of the results of the CT scan.

The verbal report of the CT scan had not yet been received. To complicate things even more, Day Light Saving Time fell in the early hours of that Monday, so all the clocks were supposed to be moved one hour back from 2.00 am to 1.00 am in the morning. As expected, not everybody was aware of this, so the timing of orders and entries in the patient’s chart were all equivocal.

Dr Kramer remained in his office and continued to see patients. He decided he would see Janet later on. This was an unexpected thing and he needed to get his schedule back in order.

Chapter 4

9.30am. Emergency Room.

The verbal report was given initially to Dr. Johnson. He became concerned because he was told of the presence of an abdominal aortic aneurysm with a possible dissection. The radiologist in Mississippi, in his written report received on the following day, suggested an additional study, an MRA (magnetic resonance angiogram) including the chest