Missed Diagnosis of Large Kidney Stone Results in Death

The following excerpt from a Notice of Intent to File Claim, or more commonly called, “Notice of Intent to Sue,” is a recent case that the litigators at Erlich, Rosen, Bartnick & Cook P.C., have begun on behalf of one of our clients. If you wish to discuss a medical malpractice claim please contact ERBC at either www.ERBCLaw.com or 1-800-595-0506 for a free consultation.

Factual Basis For Claim

Plaintiff age 61 presented to Defendant Hospital through the emergency department on November 19, 2007 with complaints of right sided flank pain and right upper quadrant pain which had been ongoing for one week and was dull, consistent, worse with sitting or standing, localized and accompanied by shortness of breath and vomiting. Upon arrival at the emergency department, Plaintiff was seen by an emergency room physician who ordered an acute abdominal series with chest films due to Plaintiff’s complaints of abdominal pain and right sided flank pain. These films were interpreted by a radiologist at 6:31 p.m. on November 19, 2007 as showing non specific abnormalities that required further work up. There was apparently a shift change in the emergency department at Defendant Hospital as the follow up testing was ordered by a different emergency medicine physician. He ordered a CT of the abdomen with contrast which was interpreted at 10:54 p.m. on November 19, 2007 by a second radiologist.

The CT of the abdomen done on November 19, 2007 consisted of 80 separate cuts/images and was performed at 10:24 p.m. The radiologist specifically found that the “kidneys are unremarkable”. Apparently, the emergency room doctor never reviewed the CT scan images himself as no diagnosis of kidney stone was made by either of these doctors. In fact, Plaintiff was suffering from an enormous 13mm x 8 mm kidney stone in her right kidney which is clearly visible in images 38, 39, and 40 of the November 19, 2007 CT scan. Her large kidney stone went undiagnosed by both doctors but her acute abdominal pain persisted, prompting the emergency department to admit Plaintiff to the care of one of their internists, with the nonspecific diagnosis of acute abdominal pain.

Plaintiff was admitted to Defendant Hospital on November 20, 2007 under the care of an internist picked by the hospital. Plaintiff had a history of gastric bypass surgery 20 years earlier and the differential diagnosis was questionable small bowel obstruction.

On November 23, 2007, an acute abdominal series was performed and interpreted by a third radiologist. His report was typed and put into the chart at 2:57 p.m. on November 23, 2007. He indicated in his findings that, “A 1.3 x 0.8 cm radiodensity overlies the right mid abdomen, which likely relates to a right renal calculus.” His impressions were as follows:

1. The radiographic bowel gas pattern is nonspecific, but could relate to a mild ileus. A mechanical bowel obstructive process is possible, but considered less likely.
2. Right renal calculus.

The radiologist’s findings and impressions were sent to the ordering internal medicine physician. He ordered a surgical consult from a gastroenterologist who saw Plaintiff on November 25, 2007. His consult notes reference the findings from the abdominal CT scans of November 23, 2007 and acknowledges the presence of a right renal calculus. The gastroenterologist performed an EGD which found the small bowel to be “unremarkable” as well as the rest of the mucosal examination being “unremarkable”. He prescribed medications and observance of the patient. Plaintiff was discharged later that day on November 26, 2007 by the hospital provided internist without any treatment of the large 13 mm x 8 mm right-sided kidney stone or even any mention of the presence of the kidney stone or need for further workup explained to the Plaintiff.

A discharge summary for Plaintiff’s November 20, 2007 through November 26, 2007 hospitalization under the care of the hospital provided internist was not dictated until December 27, 2007, one month later. The discharge summary was dictated by a nurse practitioner for the doctors signature. There is absolutely no mention of the renal calculus in the discharge summary and instead the diagnosis was a small bowel obstruction treated conservatively even though the EGD findings were “unremarkable” with no obstruction being found and therefore, the discharge summary contained the wrong diagnosis. This is not surprising since it was dictated by a nurse practitioner one month after the fact and not by the doctor himself.

The Defendant internist did not address the issue of the 13 mm x. 8 mm right-sided kidney stone found by, and reported out by the radiologist on November 23, 2007. Plaintiff was simply discharged home with medication for her gastric issues with absolutely no knowledge that she even had a large kidney stone or that it needed further medical care and treatment.

Plaintiff continued to have abdominal pain and returned to the emergency department at Defendant Hospital on February 6, 2008 with complaints of shortness of breath, pneumonia type symptoms and swelling. She came under the care of the emergency physician who ordered chest x-rays which showed her lungs to be clear bilaterally. Rather than find the cause of Plaintiff’s symptoms, the ER doctor simply recommended that she go home, get some rest, eat some soup and if she felt worse, come back. The ER doctor did not avail herself of the typed medical records on the Defendant Hospital computer system for Plaintiff regarding her November, 2007 hospital admission. Had she done so, she would have seen both the November 23, 2007 radiology report findings of a large 13 mm x 8 mm right-sided kidney stone as well as the November 25, 2007 consult by the gastroenterologist who referenced the right renal calculus in his report. Had she done so, the ER doctor would have ordered an abdominal series which would have diagnosed the presence of the right renal calculus and treatment could have been provided to Plaintiff at that time. Instead, Plaintiff was discharged home.

On March 27, 2008, Plaintiff had endured the pain long enough from her kidney stone and presented this time to the emergency department at Defendant Hospitals’ Main Campus complaining of sharp pain in her right upper quadrant and right flank which is exactly what she complained of in November of 2007 at Defendants’ satellite hospital. Plaintiff was admitted to this hospital where she was finally diagnosed with a large right-sided kidney stone which had previously been seen and read out by the radiologist back on November 23, 2007. At this point in time, the kidney stone had become infected and Plaintiff was septic and went into the ICU on a ventilator. Her prognosis was very grim and she unfortunately expired on March 29, 2008 from acute pyelonephritis with perirenal abscess and urosepsis due to E. coli from the necrosis caused by the large untreated kidney stone.

As a direct and proximate result of the original radiologist’s failure to observe and report out the presence of an enormous kidney stone plainly seen on the November 19, 2007 CT scan images, Plaintiff’s source of her abdominal pain went undiagnosed and untreated. His negligence in incorrectly reporting out that Plaintiff’s kidneys were “unremarkable” on the CT scan images, when in fact, images 38, 39, and 40 clearly show the presence of an enormous kidney stone, proximately resulted in leading the treating physicians away from the correct diagnosis of right sided renal calculus and instead lead them to focus on the wrong diagnosis of a potential small bowel obstruction. The ER physician’s failure to personally review the CT scan films which he ordered on November 19, 2007 proximately resulted in his failing to diagnose the presence of a right renal calculus and this led to his failure to order the appropriate urological and general surgery consults necessary to treat this condition. The failure to properly observe and diagnose the presence of a large right renal calculus by both the radiology and emergency medicine services on November 19, 2007 proximately resulted in Plaintiff being admitted to the hospital with an incorrect diagnosis of suspected small bowel obstruction which then resulted in her being worked up for a nonexistent condition rather than for the correct condition she was actually suffering from, i.e., a large right sided kidney stone.

As a direct and proximate result of the Internal Medicine doctor breaching the standard of care, Plaintiff’s large 13mm x 8mm kidney stone found on the November 23, 2007 x-ray went untreated and Plaintiff was not made aware of its presence. As a result of failing to treat the large kidney stone with either lithotripsy or surgical intervention, the large sized kidney stone lodged itself in claimant’s anatomy causing blockage, necrosis and infection. Therefore, as a result of Plaintiff’s doctors failing to diagnose and treat the kidney stone by way of referral to the appropriate surgical specialist, it became embedded, causing blockage and resulting in necrosis and infection which then caused acute pyelonephritis, perineal abscess and urosepsis. The acute pyelonephritis and urosepsis resulted in claimant suffering multi-organ failure and resulted in her death on March 29, 2008.