In this medical malpractice case, a patient sued an emergency room physician and a radiologist for their substandard evaluation and treatment of supraglottitis, an infection of the epiglottis and surrounding supraglottic structures. In June 2016, the plaintiff presented to a rural Southwest Virginia hospital with complaints of a sore throat. Among other studies, the ER physician ordered a CT scan of her neck. A radiologist interpreted the CT scan to reveal acute supraglottitis with no abscess. The radiologist’s CT report also stated, “Recommend outpatient follow up to ensure resolution after treatment.”

To treat her supraglottitis, the plaintiff received an administration of IV antibiotics. After its administration, the ER physician examined the plaintiff and concluded that she had improved.

Subsequently, she was discharged home with instructions to follow-up with her primary care physician. Forty-six hours later, the plaintiff returned to the hospital’s ER via ambulance. The plaintiff underwent a second CT which revealed additional narrowing of the airway and abscesses in her throat. During the admission, the patient’s condition worsened, an she underwent intubation and a tracheotomy.

Because of her worsening condition, her providers arranged for her to be transferred to another hospital. Prior to transfer, she underwent a drug screen which was positive for methamphetamine.

After the plaintiff was transferred, she underwent surgical drainage of the abscess. The plaintiff’s operative culture revealed MRSA, a staph.infection. During her hospitalization, she received extensive in-patient antibiotic therapy to treat her abscesses. Additionally, multiple medical records from the facility referenced statements from the plaintiff that she had smoked and injected methamphetamine

The plaintiff retained two ER experts on the standard of care, one radiology expert on the standard of care, and one otolaryngology expert in the standard of care, causation, and damages. The plaintiff’s ER experts opined that the ER physician breached the standard of care when he discharged the plaintiff.

They opined that the standard of care required the plaintiff’s ER physician to admit the patient to the hospital, continue IV antibiotics and arrange for an otolaryngology consultation. The plaintiff’s otolaryngology expert opined that had an otolaryngologist been consulted, the patient would have received antibiotics that included coverage for MRSA prior to any culture revealing that the pathogen was present. As a result, the patient would have avoided the development of the abscesses and their sequelae, intubation, tracheotomy and further hospitalizations.

The plaintiff’s radiology expert opined that the radiologist breached the standard of care when he documented “Recommend outpatient follow up to ensure resolution after treatment.” He opined that the standard of care required radiologists to provide clear recommendations for treatment if they take it upon themselves to make such recommendations to the clinician. In his deposition, the defendant ER physician admitted that the radiologist’s documentation regarding outpatient follow-up influenced his decision to discharge the patient.

Both defendants retained experts on the standard of care, causation and damages. The defendants’ otolaryngology experts opined that the’ standard antibiotic treatment of supraglottitis does not include coverage for MRSA as it is an uncommon cause of the condition and that a culture would not have timely identified that pathogen. As a result, the patient would have undergone the same general course of treatment and had the same outcome.

The defendants also all ged that the plaintiff’s drug use was the source of her MRSA and supraglottitis. A motion in limine to exclude such argument and evidence was scheduled to be heard at the time of settlement. During the mediation, the plaintiff provided  medical literature to the defendants  which indicated that around  2014, supraglottitis treatment recommendations began to include MRSA coverage as part of the initial antibiotic therapy. The case settled, with the help of the mediator, two weeks after the mediation’s conclusion.

Type of action: Medical Malpractice

Tried before: Mediation

Name of judge or mediator: Hon. J. Michael Gamble (Ret.)

Date resolved: Jan. 9, 2019 Verdict or settlement: Settlement Amount: $375,000

Attorneys for plaintiff: Anthony M. Segura, Roanoke; Jonathan Rogers, Floyd

Source: Virginia Lawyers Weekly