Alleged Delay in Diagnosis and Treatment of Appendicitis in 11 Year Old Girl
After jury selection, WRSH Partner Jason Rubin reached a $1 million settlement in a medical malpractice case arising out of an alleged delay in the diagnosis and treatment of appendicitis in an 11 year old girl.
Plaintiff presented to the emergency room of defendant hospital with a three day history of abdominal pain, vomiting and diarrhea. She was evaluated by a pediatrician who noted, among other things, that she had diffuse tenderness throughout the abdomen. The pediatrician made a preliminary diagnosis of gastroenteritis. Several hours later, plaintiff vomited bile, which raised the concern for a possible small bowel obstruction. An abdominal x-ray was ordered, which showed a dilated small bowel. A nasogastric tube was inserted and a pediatric surgery consult was requested.
Plaintiff was evaluated by the pediatric surgeon, who noted that plaintiff's pain had migrated from the epigastric area to her suprapubic area. He also noted diffuse tenderness throughout the abdomen. The surgeon made a differential diagnosis of appendicitis or severe gastroenteritis and recommended a CT scan to further elucidate the diagnosis. However, shortly thereafter, the CT scan was cancelled because the results of a stool study indicated that plaintiff had rotavirus--- an intestinal virus that can cause gastroenteritis.
The next morning, plaintiff's nasogastric tube was removed because of improvement in her clinical condition. But later that evening, she again vomited bile and her abdomen became distended. The pediatric surgeon was contacted, who recommended a CT with oral and IV contrast. However, when plaintiff attempted to drink the contrast, she couldn't tolerate it. The CT scan was again cancelled and a decision was made to transfer plaintiff to a hospital in Manhattan. There was a significant delay in effectuating the transfer and the pediatric surgeon was again contacted. He recommended that a CT scan with contrast be performed while plaintiff was awaiting transfer. However, this CT scan was never performed.
Plaintiff was ultimately transferred to the hospital in Manhattan the next morning. A CT scan was ordered at approximately 11 AM but wasn't performed until approximately 8:30 PM. The CT study was initially interpreted by a radiology resident at approximately 10 PM. The resident reported the findings to be consistent with an inflammatory bowel process. The next day, the CT study was reviewed by a radiology attending, who made an interpretation of acute appendicitis. Plaintiff then underwent a laparoscopic appendectomy, which revealed a ruptured appendix, peritonitis, abscess and small bowel obstruction. Plaintiff remained feverish post-operatively and another CT scan was performed one week later, which revealed pelvic abscesses and a fecalith, Plaintiff thereafter underwent an exploratory laparotomy to drain the abscesses and to retrieve the fecalith. Postoperatively, the laparotomy incision became infected and she developed a subcutaneous abscess, requiring plaintiff to undergo a painful bedside drainage procedure. Plaintiff was hospitalized for a total of 45 days. She has made a seemingly full recovery but has a scar on her abdomen at the site of the wound infection.
We claimed on behalf of plaintiff that there was a delay in performing a CT scan, which resulted in a delay in the diagnosis and treatment of appendicitis. Although the appendix had likely ruptured prior to plaintiff's presentation to the hospital, we contended the delay in performing surgery and administering antibiotics was a substantial factor leading to her need for a second, open surgery, development of a wound infection and prolonged hospitalization.