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Altoona Hospital Bowel Obstruction 663 831 Verdict

March 22, 2017

Have you been misdiagnosed in Altoona PA? These lawyers got a large medical malpractice verdict against the doctor and a settlement with the hospital. For a free consultation, call 412-471-4300.

 A large medical malpractice verdict in Altoona was obtained by the lawyers of Berger & Lagnese, LLC.

Gertrude Olsick, 75, retired, presented to the Emergency Room at Bon Secours Hospital in Altoona, with a two month history of worsening abdominal pain and constipation and a one week history of nausea and vomiting.  An abdominal x-ray was taken. This x-ray was interpreted by Bon Secours Hospital radiologist Robert Levin as showing constipation. The decision was made to admit Mrs. Olsick to the hospital and Internist Muhammad Naji was assigned to be Olsick’s doctor during her admission.  She was admitted to the hospital at around 5 p.m. Naji issued a series of admitting orders that included narcotic pain medication and an enemas.

According to Mrs. Olsick’s daughter, Dr. Naji saw Mrs. Olsick for the first time between 9 and 10 p.m. that evening by that time, the enema that Dr. Naji ordered had been done without producing a bowel movement.  Dr. Naji examined Mrs. Olsick and issued a new set of orders –a dosage of magnesium citrate (a high-powered laxative) and an additional enemas — none of which rendered any results. On the morning of June 24, Dr. Naji saw Mrs. Olsick and ordered yet another enema and more magnesium citrate, and again Mrs. Olsick did not benefit from the treatment.  At about noon, she began to complain of increased abdominal pain and increased abdominal distention.

Mrs. Olsick’s daughter claimed that her mother’s complaints of pain prompted nurses to attempt to contact Dr. Naji, paging him at 1:15, 1:30 and 1:45; at about 2 p.m. the internist finally responded and was informed of Mrs. Olsick’s condition. Dr. Naji then ordered further pain medication as well as a surgical consult and an abdominal X-ray. (There was a dispute whether Dr. Naji ordered the abdominal X-ray “ASAP”; the physician claimed that he did, whereas the nurses said that he did not.).  In the medical record, a document which Dr. Naji signed off on, the abdominal x-ray order was written as a “today” order. In any event, it was not until 3:30 that the hospital’s radiology department was notified of the X-ray order, around which time the surgeon’s office was notified of the consult. Also at that time, Mrs. Olsick’s condition deteriorated; she began to suffer respiratory distress with respirations of 40 per minute and described in the chart as “hard-labored”; at 3:49 it was noted that her appearance turned ashen color, even blue. At 4:20 the nurses placed a call to Dr. Naji who ordered that Olsick be transferred to the intensive care unit, where she was taken shortly before 5, at which time she was awake, alert, oriented but still in respiratory distress. The abdominal X-ray that Dr. Naji ordered at approximately 2:00 was performed at approximately 5:20, and the film showed that Mrs. Olsick had a massive amount of free intraabdominal air.  By 7:00 p.m., Olsick had become unresponsive.  Shortly after 8, she was taken to the operating room where an exploratory abdominal surgery revealed a perforation in her ascending colon and large amounts of fecal material outside of her colon in her abdominal cavityFollowing surgery, Mrs. Olsick remained unconscious.  Sepsis-related multiple organ failure ensued and she died at 9:06 a.m. on June 26.

Olsick’s daughter, on behalf of her mother, brought wrongful death and survival claims against Dr. Naji, Bon Secours Holy Family Hospital (for corporate negligence and vicarious liability), and Bon Secours radiologist Robert Levin.  Claims were also brought against numerous individuals involved in Olsick’s care before her June 23 admission to Bon Secours. These claims were either voluntarily withdrawn, dismissed or settled before trial.

The lawers for the Olsick family, Joshua Berger and David Paul, argued that Mrs. Olsick had all of the classic signs and symptoms of a bowel obstruction as of the night of June 23 when Dr. Naji saw her – abdominal pain, inability to have a bowel movement, abdominal distention, and nausea and vomiting – and that Dr. Naji therefore needed to put bowel obstruction at the top of the differential diagnosis and do what needed to be done to rule it out at that time.  Instead, Dr. Naji diagnosed Mrs. Olsick as suffering from constipation only and ordered another enema and a dose of magnesium citrate, a high-powered laxative. According to Plaintiff’s expert, not only did Dr. Naji need to strongly suspect bowel obstruction as of the evening of June 23, and thereafter, Dr. Naji also needed to refrain from giving magnesium citrate because in a patient with a bowel obstruction, magnesium citrate will greatly increase the amount of pressure inside the colon thereby increasing the likelihood that the bowel obstruction will lead to a bowel perforation.

Against Bon Secours Hospital, the lawyers for the Olsicks argued that the hospital’s policies and procedures with respect to abdominal X-rays and surgical consults were deficient. With respect to its surgical consults, the hospital had an “urgent” policy that meant a consult had to be carried out within 24 hours.  The lawyers asserted that the policy did not include or take into account situations in which a consult was needed immediately. They also argued that Bon Secours’ nursing staff was negligent in failing to keep Dr. Naji timely and fully informed of Olsick’s declining condition, both during the morning and afternoon of June 24, and in failing to get a physician to Mrs. Olsick’s bedside after she developed respiratory distress.  According to the plaintiff’s nursing expert, the hospital’s nursing staff should have notified their supervisor at the time that Mrs. Olsick developed difficulty breathing to manage the patient’s nursing care and to further ensure the immediate presence of a physician at the patient’s bedside. Instead, the nurses allowed nearly four hours to elapse from the time the patient was first noted to be having difficulty breathing to the time a physician actually appeared at the patient’s bedside, during which time her condition greatly deteriorated.

As to Bon Secours Hospital’s radiologist, Dr. Levin, plaintiff’s radiologist expert testified that the x-ray done in the Bon Secours Emergency Room on June 23 clearly showed a bowel obstruction and the film should have been interpreted as a bowel obstruction, yet Dr. Levin failed to read it as such.

Defendants denied the allegations. Dr. Naji maintained that he relied upon Dr. Levin’s interpretation of the June 23 abdominal x-ray, which Dr. Levin said showed constipation.  Since Dr. Levin said nothing in his report about a bowel obstruction, Dr. Naji had no reason to suspect that Mrs. Olsick had a bowel obstruction. Dr. Naji testified that he did not suspect bowel obstruction, and that he should not have been expected to suspect bowel obstruction, until he received the nurse’s report of increased abdominal pain and abdominal distention at 2:00 p.m. on June 24, at which time he issued the orders for a surgical consult and abdominal x-ray.

Naji’s gastroenterologist expert said that there was no reason for Dr. Naji to have suspected a bowel obstruction as of the evening of June 23 and the morning of June 24 because the abdominal x-ray came back negative.    According to Dr. Naji’s expert, it was acceptable for Dr. Naji to have ordered enemas and multiple doses of magnesium citrate in order to clean out Olsick’s constipated colon, because that is the proper course of treatment for constipation.

Counsel for the hospital maintained that its policies and procedures adhered to the standard of care. The hospital criticized Dr. Naji’s care, since its nurses were calling him frequently on June 24 to apprise him of Mrs. Olsick’s condition. The hospital’s nursing expert maintained that the nursing staff acted appropriately and to the best of their ability. The hospital’s general surgeon expert testified that, given Mrs. Olsick’s two-month history of abdominal pain and constipation, Dr. Naji should have immediately suspected a bowel obstruction the moment he saw her on the evening of June 23.  According to the expert, Dr. Naji should have obtained a surgical consult on the evening of June 23, and he should have never administered magnesium citrate given the strong likelihood that Olsick had a bowel obstruction.

Dr. Levin’s radiologist expert opined that the defendant’s interpretation of the abdominal x-ray was within the standard of care.

During the course of the trial, Bon Secours Hospital and Dr. Levin settled confidentially with plaintiff.

The plaintiff’s general surgeon expert testified that Mrs. Olsick’s ascending colon was perforated secondary to distension. She would have survived had she been operated on any time before 7 p.m. on June 24; by this time, the stress of the sepsis became insurmountable.

The jury found that Bon Secours Hospital and Naji were negligent in falling below the applicable standard of medical care, whereas Dr. Levin was not negligent.  Dr. Naji’s negligence was found to be a factual cause of harm to plaintiff, whereas the hospital’s negligence was not, and 100-percent causal negligence was attributable to Dr. Naji. The jury awarded $663,891.03 to plaintiff due to Dr. Naji’s negligence.

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