For more than 20 years, CRICO has analyzed claims and suits from the Harvard medical community to understand causes of error. We have learned that 67% of claims fall into four high risk areas: Diagnosis, Obstetrics, Surgery and Medication.
Lessons in preventing tragic patient misunderstandings and multi-year legal entanglements.
In a lawsuit naming four physicians, the patient’s estate alleged negligent failure to restart anticoagulation after surgery, resulting in a stroke and ultimately, her death.
A young patient with multiple visits for the same complaints needed an accurate diagnosis sooner to survive.
A typical urgent care decision needed a simple re-thinking in this fatal PE case.
The patient sued his oncologist and the hospital, claiming they mismanaged his post-op recover when a stent was left behind for a year, leading to complications that required additional surgery.
A pediatric practice struggled to satisfy the family of a boy after two years of appropriate primary care. What did they learn about communicating with patients and their families over routine medical matters?
OB case: communication between the primary provider and a phone consultant needed more clarity and changes in the patient's status needed a stronger response.
Radiology Fall Risk
Medical malpractice cases are often lost when a defendant clinician does badly at trial or during the deposition.
Failure to supervise and confirm orders led to a preventable death and a search for system-level changes to how NPOs are communicated.
When a patient returns over and over again with the same symptom complex, the providers really need to start to think, "am I missing something?"
Fixated on flu symptoms, the nurse missed available information that indicated the patient should have been brought to urgent care to prevent an unnecessary tragedy.
A Psychiatric patient kills self with opioid prescribed by an internist for restless leg syndrome.
An 8-year-old girl experienced a tenfold dosing error of clotting factor, requiring admission and observation due to increased risk of stroke.
An 8-year old girl was treated over three years for a condition she never had.
A fuller history or a record check might have helped this physician add MI to the differential diagnosis.
Fetal bradycardia forced an emergency C-section, but the family claimed the care team should have been more prepared.
Providers find extra challenges diagnosing stroke in the primary care office.
Case: Multiple providers and the patient delayed a diagnosis of obstruction, resulting in lost kidney function
Case Study: Response to spine surgery complication injured the patient and relationships.
Nobody followed up on this patient?s lung nodule before it was too late.
MD suggested screening mammogram, but patient declined, got cancer, and sued.
Despite multiple visits to her PCP, a 30-year-old woman without a spleen was never given prophylactic antibiotics or told the risks of a high fever.
Even though the patient identified a lump on her breast, it took more than a year to diagnose cancer. Family history-taking and proper imaging were lacking. CRICO interviews one of the authors of a Harvard breast care management algorithm, Michelle Specht, MD, to consider how following such a guideline could have helped the gynecologist and radiologist--and ultimately the patient.
As in many missed MI cases, the primary care physician did not order an EKG. Thomas Sequist, MD, of Atrius Health, describes where some of these cases typically go wrong, and how using a Framingham Risk Score can help with the evaluation process in the office practice.
A young woman presented to Labor and Delivery at 39.6 weeks with ruptured membranes and irregular contractions; a vaginal delivery was complicated by shoulder dystocia after prolonged induction of labor, resulting in a baby with low Apgars, respiratory distress, neonatal seizures, and permanent cognitive and developmental deficits. A lack of close collaboration between the nurse midwife and the covering obstetrician was blamed for a slow response to worrisome fetal heart rate tracings.
Medication error in the ER was preventable. Culture and communication problems compounded an error that required several surgeries and amputation.
Fragmented primary care in a large group practice that only treated the patient's acute problems before his death, missed several opportunities at better control of cardiac risk factors.
A top surgeon mistakenly performed carpal tunnel instead of trigger release procedure after multiple interruptions and personnel shift changes in OR.
Nation's "first malpractice crisis" resulted in 1821, after a horse fell on a man and the surgeon waited a month to visit his patient to see if his attempted hip reduction worked.
Lack of collaboration and poor documentation among the factors in large settlement with severely compromised infant.
The surgeon orchestrated a great recovery from a massive bleed that resulted in blindness, but the patient sued for answers.
The patient was under 50 and lack of communication between the PCP and GI about a sigmoidoscopy order contributed to a diagnostic failure.
Armed with its own malpractice data, a large group practice builds on an existing electronic record system to ensure that when its doctors order a referral, the referral actually takes place. (Audio file updated 03/22/2012)
The surgeon postponed removing a catheter fragment, and then forgot about it.
The patient and his wife felt that the surgeon was not forthcoming with an explanation of what happened and seemed indifferent to the impact on his patient, following conversion to an open procedure and large blood loss.
A patient safety audience hears about how outside industry might fix a process breakdown before or after a wrong drug error.
A five-month-old girl was referred to the emergency department for evaluation of intermittent fevers and lethargy.
A documented discussion of risks and benefits of PSA testing may have prevented allegation of malpractice.
Protocols might have helped move conflict up chain of command, and improved monitoring.
Communication and documentation flaws compromised a case that featured allegations of poor assessment and monitoring both pre-op and post-op.
Systems could have helped one doctor to consider colon cancer screening, and another doctor to follow up on a referral.
Care required better resident supervision, closer follow-up on ordered test.
A female patient wasn't screened for colon cancer, despite routine involvement with three physicians.
Postoperative decline required communication to bring the attending's wisdom to the bedside.
Despite several evaluations in the ED and PCP office, the cause of pulmonary symptoms eluded providers, led to unnecessary surgery, fear of cancer--and a mid-range settlement.
A case where a sign-out checklist or documentation of an order may have prevented the patient's poor outcome.
An office practice lacked systems to screen every patient over 50.
In this case, the liability was clear, and the institution and its malpractice insurer worked closely with the plaintiff, to reach a relatively speedy resolution for the patient.
Even though the cause of a brain hemorrhage was difficult to prove, the case was settled because management of the second twin's delivery was so difficult to defend.
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