Hematology
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Cases that we have developed and handled range
from delayed diagnosis of juvenile diabetes to failure to
diagnose treatable thyroid cancer by confusing it with
histoplasmosis due to failure to recognize the pulmonary
fibrosis which resulted from the thyroid cancer. We have
successfully handled cases involving failure to properly and
promptly treat diabetic ketoacidosis (a diabetic coma-like
condition) resulting in untimely deaths.
The specialty of emergency room medicine is of
relatively recent origin, certainly since the 1950s. However, it
is of great import in the medical malpractice arena. While many
patients who present to the emergency room of the local or
community hospital probably are not an emergency in the true
sense, there are many critically ill patients who do come to the
ER and who require optimal and sophisticated care without which
they die or are seriously disabled. For instance, failure to
diagnose heart attack, pulmonary emboli (clots), stroke,
aneurysm or other neurological bleeds will probably result in
death or life crippling conditions. Emergency room physicians
not only must be able to recognize the symptoms of these
diseases, but also must know the emergent treatment required by
the standard of care, such as CT scans (computerized tomographic
scan), MRI (magnetic resonance imaging) radiographic studies,
laboratory studies, etc. Fast and accurate evaluation is
necessary and transfer to tertiary care centers must be done
timely and when necessary.
Routinely we find negligence in family
practitioners who fail to recognize the need to refer the
patient to a specialist. This is particularly true where the
family practice doctor is the gatekeeper and must approve the
patient seeing a specialist. The world of HMO's can exaggerate
this problem. While historically family doctors were seldom the
target of a medical malpractice claim, the progression of
medicine and HMO rules and regulations have brought more and
more family practice doctors to the malpractice case. Family
doctors who do not recognize the female patient's needs for a
proper workup as a result of a lump in her breast is a familiar
case. Failing to refer for mammogram, breast ultrasonography and
breast biopsy are significant claims in the last decade.
Prostate cancer diagnosis delay for failing to recognize an
elevated PSA and refer the patient is a frequent claim. The
failure to understand and recognize the signs and symptoms of
coronary artery disease to the extent the patient is at risk for
having a fatal heart attack seems to be on the rise with family
practice. The same hypothesis holds true with lung cancer in the
middle-aged patient who is or has been a smoker.
This special area of medicine includes the
entire digestive system including the esophagus, stomach,
intestines, liver, gallbladder and pancreas.
The areas of concern with gastroenterologists
come in a wide range of negligent acts. Failure to prevent a
bleeding ulcer from causing death, and failure to prevent
nutritional cirrhosis of the liver in cases involving
jejunoileostomy bypasses for obesity resulting in delay of
surgical reversal and death from liver failure are just two
examples.
The treatment of blood disorders and dysfunction
has led to various types of medical malpractice cases. Those
most significant in recent years involve allowing the HIV virus
to invade our blood banks. Prior to that, cases of hepatitis
from blood transfusion were prominent. More interesting is
failure to manage rare clotting disorders or the potential for
clotting disorders, resulting in stroke. Fatal pulmonary emboli
(clots) may have been prevented with proper hematologic consult
and/or proper treatment. The failure to call these "blood
specialists" (hematologists) to consult seems the custom now
days rather than the norm. The failure to recognize DIC
(disseminated intravascular coagulation) has resulted in
untimely and preventable deaths.
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