More details are emerging from the record breaking malpractice case. Let’s look at the medicine behind the case:
On Aug. 9, 2000, Navarro, who was a professional basketball player in his native Philippines, entered University Community Hospital-Carrollwood with a headache, nausea, dizziness, confusion and double vision. He described a personal medical history of hypertension, diabetes and elevated cholesterol plus a family history of strokes to the triage nurse. A different nurse than the triage nurse also noted he was unsteady on his feet.
Certainly, stroke is high on the differential with the visual changes and risk factors. Plenty of other disorders can also present this way as well, with stroke needing to be ruled out first. Head CT would be the initial test of choice.
When Navarro spoke with Herranz in the examination room, he mentioned the sudden onset of a headache earlier that day and that he had felt a “pop” in his head.
According to the 2005 second amended complaint, Herranz did not complete an adequate medical history of Narvarro, nor did he do a complete or adequate neurological exam.
Navarro spent about 5 1/2 hours at UCH-Carrollwood, during which time he had two CT scans of his brain and was diagnosed with “sinusitis/headache” by Austin, prescribed Vicodin for the pain and an antibiotic by the doctor and sent home. He was not told to watch for any stroke symptoms.
So he had two CT scans – which I assume were negative, since he was discharged. A “sudden onset/pop in the head” description of the headache can be suggestive of a bleed, perhaps a subarachnoid hemorrhage. Mr. Navarro certainly had many risk factors for this (including hypertension and possible family history). Normally, the head CT is very sensitive for this within the first 12 hours, but declines over time. Minor bleeds also would reduce the sensitivity. If there continued to be a strong suspicion of a subarachnoid bleed, as I think there should have been in this case, a lumbar puncture should have been performed – despite a normal head CT.
The suit alleged that Navarro presented classic stroke symptoms that Austin should have noticed. It further said that CT scans are not adequate diagnostic tools for ruling out the type of stroke Navarro had.
Hindsight. If we all knew the diagnosis beforehand, of course it would be easier to pick the correct test.
Early the next morning, Navarro woke with a severe headache, slurred speech, nausea, confusion and trouble walking. He was readmitted to the UCH-Carrollwood Emergency Room at 6:05 a.m. Upon his return, he was labeled “urgent,” but doctors still had not diagnosed a stroke. It wasn’t until he was transferred to Carrollwood’s sister hospital, UCH-Fletcher, that afternoon that surgery was finally performed. By then, the stroke had already left him paralyzed with mental disabilities. During surgery, he slipped into a four-month coma. He is now confined to a wheelchair.
By now, the stroke symptoms are clear. Discharge home with antibiotics/Vicodin was a bad move, needless to say. The reports didn’t say what kind of bleed it was. However, the delay in diagnosis has already happened with tragic results. Two areas where malpractice could have been avoided:
1) admit, neurology consult, MRI – which may have added sensitivity for finding the bleed;
2) lumbar puncture despite a normal head CT – which could have also detected the bleed. A clinical suspicion of a subarachnoid hemorrhage would have been needed.
Update:
That being said, I can see where the ER doc was coming from. Two negative head CTs during a 5 1/2 ER visit is par for the course. There are many who would discharge the patient after two negative head CTs.
For every stroke/bleed that you do the neurology consult/MRI/LP workup on, there are thousands where the cause really would be a sinus headache. Talking to a few ER docs, the admit/neurology consult/MRI approach certainly will be the preferred method going forward. “I can’t leave anything to chance” are the words floating around the ER today after this chilling verdict.
Overlawyered with continuing coverage.
