Malpractice? Would you sue?
 

My wife and I are both self employed. Being self employed means buying your insurance on the open market. This is expensive, so much so that my wife dropped her coverage about 2 years ago.
Last Tuesday she began to have abdominal pain. She went to ER. The nurse practitioner that saw her in the ER was convinced that it was appendicitis. Blood work was ordered, urinalysis and a CT scan. I work in medical imaging so this is all very familiar to me.
Blood work was completely normal, as was the urinalysis, abdominal pain did not match classic appendicitis indication. No nausea or vomiting, diarhea or fever. This was not a classic appendicitis case. The nurse practitioner (NP) wanted to do a CT however I felt that an ultrasound would be appropriate and more cost effective.
The NP was adamant about using the CT as the only diagnostic tool and when we asked what would happen if we refused the CT he said that we could sign the AMA papers and could go home a die. Not much of a choice, so feeling bullied we agreed to do the CT.
The CT report noted that the appenix was normal in appearance with only a small amount of fluid surrounding. It could be early appendicitis or maybe not.
With this information in hand the NP decided that surgery was the next step, we (wife and I) did not get to see the report or CT images and soon had papers thrust into our hands in order to give consent for an emergency appendectomy.
We had not consulted the surgeon prior to signing consent. We asked to speak to the surgeon prior to signing. He arrived and seemed disinterested. My wife asked about the CT findings, the surgeon left the room to view the CT.
When the surgeon returned he was a bit more interested. He did an abdominal exam, asked her history and after a few minutes stated that he would not be doing the appendectomy and felt that the pain was being caused by a grapefruit sized ovarian cyst.
This grapefruit sized cyst was completely missed and not mentioned by the radiologist on the CT report. My wife was about 10 minutes away from an unneeded appendectomy that ultimately would not have solved her problem.
We were sent home with pain meds and told to see a gyno. We have since been to the gyno and it was determined that surgery to remove the cyst is needed.
To summerize,
The NP misdiagnosed and the radiologist mis-interpreted. Surgery was not performed but expensive tests that were not asked for and ultimately not need were performed.
What is fair? Ask for the non needed exams to be forgiven?
Entire bill be forgiven?
Sue for damges?

If you made it this far thru this long post, thanks for hanging in there.

Well I would be happy the process eventually worked its way out and they ultimately located the cyst from the CT scan. Would they have seen it during an ultrasound?

Best of luck for the cyst removal.

Edit: Was the cyst visible on the CT or only noticed via abdominal exam? Would the OB/GYN have ordered a CT any way due to the cyst or used an ultrasound to get the information they needed? That would kind of determine whether or not the CT was overkill. I don't see any grounds to sue though, for what?

What exactly were the "non-needed exams" here? Your wife had a CT, it showed no indication of appendicitis, the surgeon agreed and diagnosed a cyst.

Why would they forgive the bill? Your wife had the test. The NP apparently believed the CT was necessary. You had a choice to get the CT or not. No-one should be surprised that the NP didn't defer to you (the patient's husband) in determining what tests are to be done.

What damages do you have? The cyst was diagnosed, there was no unnecessary surgery, I can't see damages here at all, sorry. I'm not a practising lawyer in your jurisdiction but talk to one, I'd be surprised if anyone thought there was anything actionable here... unless you provide a $15K retainer up front, then they might think of something you could sue for ;)

Feel free to enlighten if I'm missing something. I don't mean to dump on your situation. I know how difficult things are when your spouse is sick, believe me I know. But the "I'll sue" mentality also drives me up the wall. My wife works in a law office with a lawyer who specializes in medical malpractice and she has seen a lot of this stuff. But unless your wife had died or been permanently disabled because of a medical mistake it is generally not worthwhile to sue. The damages are just not there.

I hope your wife makes a speedy recovery from surgery!

regards

d.

Ultrasound is the preferred method of imaging ovarian cysts, and was what I suggested as opposed to the CT. We are glad to have figured out the problem.
Legal action is somewhat distasteful to me, human mistakes are made, however some of the mistakes made in my wife's case are procedural. If the hospital is not punished for its lack of oversight then they have no incentive to change.
Forgive the entire bill, forgive the uneccessary testing, sue for damages. WWCND, wwchucknorrisdo?

Could not have said it better myself. I'm neither a medical professional or a lawyer but I have a basic understanding of damages. And luckily, you don't have any. :cool:

What are your damages? I would say you don't have any. The only attorney you could get to take that case will be a very shady operator.

I would write a letter to the hospital regarding the callus treatment by the NP in the ER, unprofessional and not acceptable anywhere I have ever been on staff. Perhaps ask for a portion of the bill to be forgiven, no way do they agree to forgive it all, no justification for that. If the NP had said okay and done what you suggested and then there was a problem, that absolutely would be malpractice and actionable.

Ovarian cyst may rupture on its own. My wife has issues with that. I would encourage you to be extremely circumspect about surgery for an ovarian cyst.

1) Don't bother suing.

2) Don't let yourself be bullied into making decisions about a medical diagnosis. Go somewhere else for another opinion.

3) Don't ever let a NP tell you what surgery is needed. See a doctor, preferably a specialist.

Just my 2 cents.

I would be happy about the surgeon knowing what he did. Since your wife does not have any insurance, I would negotiate the costs and be done with it.

You might very well start negotiating the cyst surgery in advance.

Reading crap like this depresses me...

1. Are you a doctor? Unless you are, your suggestion of -what- tests and procedures you -feel- they should use is out of line, IMO.

2. The hospital DID have oversight - the DOCTOR who properly diagnosed your wife's problem and didn't remove her appendix.


I think since you're paying without insurance you should try to negotiate the bill if you like, but they didn't do anything wrong.

No harm done, actually the real problem was found. Write a letter.

Yep. Write a letter thanking the surgeon for his diagnostic skills.

An acute abdomen is a proper indication for surgical exploration. Even if they had performed a laparoscopy expecting appendicitis and found an ovarian cyst, there is no malpractice.

But go ahead and sue. They are rich and they have insurance. Get a piece.

I understand why you are unhappy, but I don't see how they owe you anything.

File a complaint with the hospital to voice your displeasure. You don't want to be the source of yet another frivolous lawsuit because you're "unhappy" even though you've suffered no damages.

Here is where the mistakes were made. IMHO

The initial diagnosis of appendicitis was incorrect. The only symptoms that my wife exhibited matching appendicitis was non specific abdominal pain. It was peri-umbilical and when a proper abdominal exam was given the mass was palpable on the left side.
The NP was dead set on getting that appendix out despite many signs pointing to a different diagnosis.
The only time an MD saw her was when the surgeon appeared at our insistence.
The CT scan findings were incorrect. How can you miss an 8cm mass?



Was harm caused to my wife? Monetarily, yes. Physically, yes. A CT radiation exposure is similar to smoking about 200 cigarettes in harm to the body. The total number of cancers reported, about 2% can be traced to medical imaging radiation exposure.

Is this grounds for a lawsuit, probably not but I am waiting on the hospitals next move. I have the good fortune of having some connections within the hospital. I have spoked to the risk mgmt officer, the ER head and will soom meet with the patient liason administrator.

At first blush the "all's well that ends well" line of thinking seems correct. I do feel that a number of procedural errors were made.

Obama Care!

This. Had they removed your wife's appendix in error then you would have damages.

I understand that this is out of pocket, so it hurts much much more. But this is our sue happy society at it's worst. Typically hospitals will work with cash customers, I would explain your displeasure at your treatment and ask to negotiate a cash payment.

BTW, in a sad bit of irony, the insane cost of malpractice insurance due to frivolous lawsuits is a big part of the high medical costs that you will now have to pay............

I was about ten minutes away from being T-boned at an intersection! Who should I sue?

The irony would be that they reluctantly performed an ultrasound, missed something big, your wife was truly mis-diagnosed, and had life-threatening consequences.... or, heaven forbid, lost her life.

Then you'd have sued for sure.

Thus, hospitals err on the side of over-testing....

....and still get sued for over-testing

SMH

I thought you *DID* get t-boned? Who did you sue!?

My wife got T-boned, she is fine, car is totaled, nobody got sued. All's well that ends well!

My T-bone reference was in response to Bivenator re "nothing happened, but could have".

(Should have used green font in my first post.)