u/efunkEM

Case here: https://expertwitness.substack.com/p/thrombotic-thrombocytopenic-purpura

tl;dr

Lady with lupus comes in with shortness of breath and weird neuro complaints.

ED doc orders CT head, CXR, EKG that were reportedly unremarkable.

Road test done, patient briefly desats to 80s but is discharged anyway.

Bounces back, labs show severe anemia and thrombocytopenia.

She’s admitted to ICU but codes and dies.

Lawsuit goes to bench trial, judge awards $3.3 million.

IMO not getting labs in a lupus patient who is short of breath and has neuro complaints is below the standard of care. This is a rare case I think I side with the plaintiff. But I’m curious what you guys think?

Case here: https://expertwitness.substack.com/p/contrast-induced-nephropathy-vs-hemolytic

A woman with multiple days of diarrhea was seen at several telemedicine visits and an ED visit.

She was started on multiple different antibiotics.

She was eventually seen by GI and scheduled for a colonoscopy.

She developed severely worsening abdominal pain and bloody diarrhea so she went to the ED.

Her mother-in-law (a neurologist) asked the hospital docs to look out for her.

The ED doc went to the waiting room to say hi to her and put some orders in. He didn’t write a note or examine her, just a social visit and get orders rolling.

It was delta wave of COVID so it take 8+ hours for her to get roomed. It was a different ER doctor who actually saw her when roomed. The CT abd pelvis w contrast that had been ordered 8+ hours ago, was finally done. Lab had lost the first round of labs so they weren’t back.

After she got the contrast, the labs came back showing severe AKI.

She was admitted. The nephrologist thought she just had a bad AKI for a few days, requiring dialysis.

Eventually they realized she had HUS.

She was dialyzed a few times as an outpatient as well, until her kidneys recovered.

The patient sued the ER doctors, claiming it was the contrast that caused her kidney injury.

They ended up settling.

This is probably one of the worst expert opinions I’ve ever read. They claimed that the ER doctor was not just negligent, that it was GROSS negligence.

Absolutely wild to me that this lady gets HUS and then tries to pin the temporary and now resolved kidney damage on the ER doctors who were trying to help expedite her care during the worst days of the pandemic, while she was trapped in the waiting room.

Case here: https://expertwitness.substack.com/p/missed-posterior-circulation-stroke

tl;dr
38-year old man presents with weeks of headache, shortness of breath, dizziness, diaphoresis, wife says bulging eyes, etc…

Just got back from Russia where he had dental work done.

CT head wo was negative, EKG/labs unremarkable, got headache cocktail, felt better, discharged.

A few hours later wife finds him unresponsive, looks like seizure, frothing at mouth.

EMS arrives, gives him, takes him to the ED.

Workup shows left vert dissection with distal basilar clot.

Pt survives, not locked in but with significant disability.

They sue both ER doctors, their employer, the hospital, the radiology group (but no individual radiologists).

End up settling about 7 years later with the first ED doctor and the ED group.

Case went to the state Supreme Court bc the EM doctors were independent contractors (not hospital employees), so the hospital argued they had no liability. This was true for decades, but the Supreme Court decided it no longer applies.

Really tough diagnosis here with lots of distracting factors. Doc allegedly did a fairly complete neuro exam that was normal, but plaintiff expert says no way could it have been normal.

My biggest learning pearl was seeing another case of basilar artery occlusion presenting as “seizure”. Also saw that with a prior locked in syndrome case.