Two Boston doctors associated with Salem Hospital, a clinical affiliate of Massachusetts General Hospital in the US, have to fork out nearly $29m to the family of a man whose aortic aneurysm and dissection went undiagnosed and untreated, and who died as a result.
Medscape reports that in January 2018, Joseph Brown awoke with shortness of breath and upper abdominal pain, which eventually spread to his chest and back. Taken to Salem Hospital’s emergency department, Brown was seen by Dr Steven Browell, an emergency medicine specialist.
Browell ordered tests that ruled out both a heart attack and a pulmonary embolism. He called for a blood test, which indicated that the patient’s white blood count was elevated.
Suspecting an infection, Browell ordered that Brown be admitted to the hospital.
Accepting Brown’s admission was Dr William Kenyon, who also examined
the patient and concurred with Browell’s probable diagnosis. The patient was then sent to the medical floor.
There he underwent additional testing, including a chest x-ray, which proved negative except for one finding: a “mild hazy interstitial opacity that could represent a small airway inflammation or developing/early pneumonia”.
Because Brown had reported that he had punctured his foot several days earlier, he also underwent a foot x-ray, which showed a possible foreign body. It was thought that that might be the source of his infection.
Neither Browell nor Kenyon had completely ruled out a possible aortic aneurysm and dissection. Brown’s symptoms, after all, were in some ways suggestive of those conditions.
Then again, he was very young – only 43 at the time – and his pain, while severe, didn’t correspond to the “searing” pain that, at trial, Kenyon described as typical of an aneurysm and dissection.
As testified at trial, Brown had “a constellation of non-specific symptoms” and an “unusual presentation of a rare condition”, typically seen in patients aged 65 and older.
Given these factors, and the results of Brown’s tests, lab studies, and physical exam, Kenyon didn’t think that the case warranted a CT scan to rule out an aortic aneurysm or aortic dissection.
By early the next morning, though, Brown’s shortness of breath and pain had intensified significantly. The on-duty doctor ordered a CT scan, which showed “a massive aneurysm at the beginning of (the patient’s) aorta and a dissection extending through most of his aorta”.
Brown was flown to Boston to undergo emergency surgery. En-route to the helicopter, his aorta ruptured, stopping his heart and causing his death.
During the eight-day trial, each side introduced expert witnesses. Speaking for the plaintiffs, experts in cardiothoracic surgery and emergency medicine testified that the treating physicians were negligent in failing to order a CT scan on January 13. Had they done so, the patient would have almost certainly undergone surgery earlier, which would have prevented his death.
Experts for the defence saw things differently. They testified that, given the evidence, it was reasonable and appropriate for Browell and Kenyon to have treated their patient for an infection rather than an aneurysm or dissection.
The jury found the defence’s arguments unconvincing, however. After deliberating for three hours, it awarded the plaintiffs $20 000 000, to be paid out over time largely to Brown’s two daughters, who were 12 and 18 when he died. Including interest, the total award is close to $29m.
In a statement after the verdict, the lead plaintiff’s attorney said the takeaway from the case was, “If you just treat people based on what the likelihood is, statistically, you’re going to miss a lot of life-threatening conditions. And that’s what happened in this case.”
Medscape article – Docs Misdiagnose Aneurysm and Patient Dies; Must Pay $29m (Open access)
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