$3 Million Settlement for Patient’s Brain Bleed Mistaken for Migraine in Medical Malpractice Case
TOP FIVE MEDICAL MALPRACTICE SETTLEMENT IN MASSACHUSETTS IN 2011*
In the early morning hours of May 28, 2005, a 29 year-old woman presented to a community hospital emergency department by ambulance with a headache, vomiting and diminished consciousness. The ambulance personnel inaccurately reported to two emergency department nurses that the plaintiff had a history of migraines. Thereafter, the nurses and the emergency department physician did not obtain important information regarding the plaintiff’s headache – when the headache began, how it began, how intense it was, how it compared to other headaches the plaintiff might have experienced. All of that information is important in making a diagnosis, and ruling out a head bleed. The two nurses conceded that each had an independent duty to obtain the historical information, but argued that our client asked them to leave her alone – that she just wanted to speak with the doctor. They pointed to entries in the record that supported their argument. The physician too claimed that our client deliberately would not speak to him, concluding that she just wanted to go home and sleep off her migraine headache.
The ED physician had no basis to rule out a head bleed, and therefore could not have properly diagnosed migraine. Organic disease must be ruled out to form a migraine diagnosis. The physician claimed that he based his migraine diagnosis on a normal neurological examination, vomiting and the reported history of migraines. The client, however, presented with diminished consciousness, making her neurological examination abnormal; vomiting is consistent with a head bleed; and any history of migraines is irrelevant without confirmation that there was no change in the headache pattern. According to the American College of Emergency Physician’s policy then in effect, ED physician as a rule must order a CT scan for a headache patient who presents with altered mental status, and must consider a CT scan for a headache patient who presents with recurrent vomiting or a change in headache pattern. CT scanning is highly reliable for detecting subarachnoid hemorrhage.
After the ED physician sent our client home without a CT scan, she fell into a coma and was found unresponsive several hours later and rushed to Massachusetts General Hospital, where she was diagnosed with a subarachnoid hemorrhage. The neurosurgical team at MGH observed and stabilized the plaintiff, but at 7 p.m. that evening, she suffered a major re-bleed that worsened her clinical condition and increased the risk of vasospasm and stroke after surgery. The following day, the MGH team surgically clipped the aneurysm. After surgery, the client suffered several strokes that led to a catastrophic brain injury, affecting almost all of her higher functioning. While she can walk and speak, she is dependent on others to live.
The defendants’ experts, including a leading neurointensivist from MGH, were designated to testify that had the plaintiff been transferred to a tertiary hospital for neurosurgery services in the most expeditious manner possible, she still would have suffered the neurological injury that she experiences today. They claimed that immediate neurosurgery is not advocated on a patient who has only recently experienced an intracerebral hemorrhage due to the swelling that would still be present in the patient’s brain, and that our client likely would had surgery when she had it even if she had been transported to a Boston hospital earlier. They claimed further that once her hemorrhage began, she became at significant risk for vasospasm and stroke, and that the strokes she suffered after surgery were primarily due to the amount of hemorrhage from the her initial bleed. Statistical data supported defendants’ claims in that substantially more than fifty percent of subarachnoid hemorrhage patients die or suffer catastrophic injury.
Our expert was prepared to testify that had our client been transferred to Boston with an accurate diagnosis directly from the community hospital, then her medical team likely would have stabilized her condition and operated on her that day, before the major re-bleed, because there would have been no medical benefit to delay. Alternatively, had she deteriorated in the hospital as she did at home, the medical team would have observed the deterioration and would have performed emergent surgical clipping. In either event – whether she stabilized or deteriorated – our client likely would have had surgery that day, avoiding the re-bleed, and she likely would have had a good medical outcome. We pointed to authoritative studies setting forth the factors used to predict outcome after surgery on patients with ruptured aneurysms, including a leading study by MGH, and the plaintiff argued that given her young age and clinical condition upon presentation to the community hospital, she had a statistically high likelihood of a good outcome.
We settled our client’s claims and the loss of consortium claims of her family for $3 million. In connection with the settlement, trusts were created to provide a sustainable solution for the client’s long-term care and supervision, and to responsibly provide for the needs of her minor children. Among other things, the client’s trust hired a catastrophic care case manager to identify and arrange for suitable neurobehavioral treatment to improve plaintiff’s functioning as much as possible.
*As reported by Massachusetts Lawyer’s Weekly