Pediatric Emergency Medicine: Legal Briefs

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An Illinois man fell 10 f. from a ladder while trimming trees in his yard and landed on his right hip.1 He was taken to a local emergency department (ED), where x-rays of his hip and lumbar spine were ordered. The x-rays revealed a compression fracture of the L-2 vertebra and a burst compression fracture at L-4. The emergency physician consulted an orthopedic surgeon, and the patient was admitted to the hospital. The radiologist read the computed tomography (CT) scan of his hip and pelvis. There was no fracture, but an abnormality was noted in the retroperitoneum. The radiologist recommended a nonemergent CT of the abdomen for further evaluation. The next day, while the patient was awaiting spine surgery, he complained of an “upset stomach.” His vital signs were abnormal, and he was transferred to the intensive care unit (ICU). Later that evening, he experienced a drop in blood pressure, increased respiratory rate and heart rate, and subsequently, an arrhythmia. A Code Blue was called an hour later, but he could not be resuscitated. An autopsy determined that his death was due to severe lacerations of the greater omentum and transverse colon, with 1800 mL of blood in the abdominal cavity.
The patient's family sued the treating physicians and claimed that the intra-abdominal lacerations were caused by the fall from the ladder and that they bled slowly for 2 days. The family also claimed that the radiologist was negligent for failing to review the spine x-rays, which would have helped her recognize that there was blood in the abdomen. The family further alleged that the emergency physician failed to suspect intra-abdominal bleeding on examination and failed to order a STAT abdominal CT and a trauma consult. The emergency physician denied that the standard of care required her to order a STAT CT and a trauma surgery consult because there was no indication that the patient hit his abdomen in the fall and his vital signs were stable in the ED. The radiologist contended that she did not know that the patient had fallen from a height and that she was only asked to rule out a hip fracture. The defendant physicians claimed that the internal lacerations were caused by aggressive cardiopulmonary resuscitation after the cardiac arrest in the ICU.
A jury found in favor of the family and awarded them $1.27 million in damages.
Unknown County, Illinois Circuit Court, No. 13L-843.
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