Case Report: Failure to obtain timely surgical consultation, evaluation and treatment of abdominal aortic aneurysm
(Excerpts taken with permission from Minnesota Trial Lawyer Association’s (MTLA) “Minnesota Case Reports”)
On August 12, 2000, B.F. age 69, came to the emergency department of hospital with complaints of shortness of breath and a “weird feeling” across her chest and into her arms. It was concluded that B.F. probably had a mild chronic obstructive pulmonary disease (emphysema) exacerbation. She was to use her inhaler more often and come back for re-evaluation if her symptoms worsened.
The next evening, August 13, 2000, B.F. returned to hospital complaining of chest heaviness and being out of breath at rest. An EKG, lab work, and a chest x-ray were performed but none were diagnostic of her problem. Dr. J.B. admitted her to the hospital shortly before midnight. Dr. B. spoke to Defendant Dr. H. regarding evaluating B.F. in the morning.
On August 14, 2000, Dr. H. saw B.F. in the hospital. His examination results as reflected in his notes revealed “an obvious palpable pulsatile mass on the left abdomen, appears to be about 6-7 cm in size. She does have femoral pulses. There is a bruit heard over this mass.” Dr. H.’s impression of the abdominal mass was “probable aortic aneurysm.” (An aortic aneurysm involves the aorta, one of the large arteries that carries blood from the heart to the rest of the body. The aorta bulges at the site of the aneurysm like a weak spot on a worn tire.)
Dr. H.’s plan included having an ultrasound performed to evaluate the mass in her abdomen, and having B.F. see him back in the clinic. On the morning of August 14, 2000, Dr. H. wrote orders which included, “Abdomen US [ultrasound] today if possible”, and “may go home after US or if unable to do today, discharge today.”
The ultrasound was completed at about 11:38 a.m. on August 14, 2000. The interpreting radiologist did not dictate his report until the next day. B.F. was discharged to home at noon. Her discharge instruction sheet reflects an appointment for follow-up with Dr. H. set for August 23, 2000. The dictated ultrasound report details a 6.9 cm saccular aneurysm and thrombus (blood clot) present within it.
On August 19, 2000, B.F. presented to hospital again, this time with burning left flank pain. She was evaluated by Dr. D.B. who noted Dr. H.’s diagnosis of abdominal aortic aneurysm five days earlier. Dr. B. palpated B.F.’s abdominal mass and estimated the aneurysm to be 7 - 8 cm in size. Dr. B. arranged for emergency transport to another hospital in Grand Forks for B.F. to undergo a CT scan with contrast for evaluation of the aneurysm.
B.F. was seen by Dr. D. on arrival in Grand Forks. She was minimally responsive and had low blood pressure and mottled skin from the umbilicus down. Her abdomen was distended and tense. Dr. D.’s assessment was ruptured abdominal aortic aneurysm. Dr. D. took B.F. directly to the operating room for emergency repair. The blood loss in her abdomen was massive. Despite Dr. D. being able to repair the aorta, B.F. remained in critical condition at the conclusion of the surgery. She was brought to intensive care where she soon succumbed to complications of the rupture and resulting bleeding. On August 19, 2000, B.F. was pronounced dead at 10:41 p.m.
The jury found that the plaintiff proved at trial that defendants failed to obtain timely surgical consultation, evaluation, and treatment of B.F.’s abdominal aortic aneurysm and failed to disclose to and discuss with B.F. the risk of rupture of her abdominal aortic aneurysm, the virtual certainty of death should the aneurysm rupture, and the necessity for urgent surgical treatment. As the result of defendants’ negligence and their deviation from accepted standards of medical practice, B.F.’s abdominal aortic aneurysm ruptured and she died.
Plaintiff did not bring a claim for wage loss or medical expenses. B.F. was survived by five adult children.
Settlement:
| $256,166 reduced by 20% contributory negligence to $204,933 |
Case Name:
| G.F., as trustee for the next-of-kin of B.F., deceased, vs. R.H.H., M.D |
Date:
| August, 2004 |
Attorney:
| Wendy J. Zeller
|