Medmal/colostomy/diverticulitis/er Care

[Sumner]

I think you might have answered my medmal question earlier this week, but the link for a follow-up question expired so here is the latest question, enlightened by a review of emergency room medical records.  My 43 year old friend went to the emergency room with severe abdominal pain.  The doctors did blood and urine tests to rule out appendicitis and kidney stones and the cat scan showed that my friend had a perforated colon and "free fluid and free air" in her abdomen, from diverticulitis. The docs put her on an antibiotic(iv) plus vicodin, then sent her home at 3 am with prescriptions for more antibiotic(ciproflaxin), flagyl and vicodin, which are all commonly used to treat diverticulitis. The docs also told her to return if she had a fever of 100.5 or blood in her stool which would signal a perforated colon(even though the CT scan already said she had a perforated colon).  So 14 hours later, at 5 pm, her fever hit 100.5 and her pain was still severe(it never was less than severe, even when she left the ER at 3 am earlier that day). Upon arrival at the ER this second time, she was scheduled for a colostomy and exploratory surgery to clean out her insides of the pus and feces that came from the perforated colon.  She was told post-op that she could have died.  Her incision was 7".  My question is whether there is a med mal case here because the docs did not admit her(rather than send her home for the symptoms to worsen) the first time she went to the ER when the CT scan showed she had a perforated colon?  

(She had insurance coverage and it looks like the antibiotic and flagyl and vicodin course of treatment were within the standard of care, so the question is what is the legal consequence for the docs' sending my friend home rather than keeping her in the hospital?)

Thanks!!

ANSWER: Was this the patient who got the perforation from a colonoscopy? If so, I guess my answer to that was adequate for your purposes.  I think you know the answer already to the current question about sending her home with a confirmed perforation.  God forbid she would have suffered major life changing complications or worse as a result of the known perforation after being sent home from the ER, it would be a hell of a med mal case.  High likelihood that sending her home was malpractice but the issue is damages. Unless she suffered those severe complications because she wasn't treated properly at the first hospital visit, and she is now basically in the same condition as if they did do the surgery at the first visit, then the malpractice did not result in major damages to her, therefore no case. Hope that makes sense to you. This is no way excuses the less than optimal care that she initially received.

---------- FOLLOW-UP ----------

Thanks.  No, this is not the patient who got the perforation from a colonoscopy. In response to your response, she did suffer worse complications from being sent home.  Had she been admitted when the docs at the ER found the tiny perforation in the CT scan the first night, she likely would have had a surgery to clean the colon and a resection(cut the infected part out and reattach it, without a colostomy). Because she was sent home and told to return once she had a fever and/or blood in her stool, the perforation was far worse and she had to have a colostomy(and 7" incision to do exploratory surgery to clean out her abdomen) and she could easily have died.  So should we take this to an attorney? Thanks!!

[katehudson92]

There is nothing to lose by consulting with a local medical malpractice attorney but here is the problem: Such a case would cost the lawyer many thousands of dollars out of his pocket. He would have to hire an expert in ER standard of care issues and a gastroenterologist as an expert on the affects of not doing the surgery at the first opportunity.  I presume the colostomy is temporary and don't you think it possible that it would have been necessary even if the surgery was done sooner? How do you know the incision would have been any smaller? I don't think you do. These are assumptions on your part. In any event, unless is it fairly open and shut that the patient now has a lifetime of bowel disability that she would not have had but for the delays at the ER, the case will not command the hundreds of thousands of $$ that are needed to interest the attorney in taking on the case. This is cruel I know. Acts of medical malpractice get swept under the rug by the hundreds every day because of how difficult and expensive it is to sue successfully. In this case, it is guaranteed that the hospital would deny liability and with high powered lawyers paid by their insurance, would fight the case all the way. So, the case is not open and shut and the damages resulting from the alleged malpractice are difficult to assess. Much as I would like to have an open and shut case against a hospital, I wouldn't touch this one. Sorry, that is my opinion but no harm in seeking others.