Whether we can represent you or your loved one in a medical malpractice lawsuit depends on several factors.

Is there provable medical negligence?

First and foremost, it depends on whether the doctor, nurse, or hospital violated the medical standard of care.  The medical standard of care in Pennsylvania is simply whether the healthcare professional acted in a reasonably careful fashion like how other doctors or nurses would have acted in the same or similar circumstances. A violation of the standard of care is considered negligence in Pennsylvania. Without negligence, there is no case that we can handle.

When we say there is no case without negligence that is because it is the law in Pennsylvania.  Under Pennsylvania law, a prerequisite to filing a medical malpractice is receipt of a certificate of merit.  Pursuant to Rule 1042.3 we must secure a letter from an appropriate licensed medical professional (i.e. a doctor or nurse in the same medical specialty as the potential defendant) stating, “that there exists a reasonable probability that the care, skill or knowledge exercised or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm.”  Without a certificate of merit, your lawsuit will inevitably be dismissed.

Did the negligence cause harm?

Second, if we review your case and determine that there was a violation of the standard of care, we next must determine whether it caused any harm damages. You have probably heard the saying, “no harm no foul,” the same applies to medical malpractice lawsuits.

If there was negligence but no real injury, then there is no case to prosecute. This is because the law in Pennsylvania requires proof that the alleged medical negligence caused actual harm.  If there is no causation of harm in your case, then we cannot handle your case because by law we cannot prosecute your malpractice claim.

Are there significant injuries?

Third, there must be significant injuries or a death for us to handle your lawsuit. The reason we require significant damages is because medical malpractice cases are extremely difficult to win, extremely time intensive for our lawyers to prosecute, and extremely expensive for us to work up properly.  Furthermore, the last thing that our firm wishes to do is take you through years of litigation only to bring about a settlement offer or a jury verdict that, after reimbursement of attorney fees and costs, leaves you with little to no money.

The exception to the rule of catastrophic damages or death as our threshold criteria for handling your case is if the fault at issue in the case is clear cut and indefensible (e.g., the doctor operates on the wrong part of your body).  In practice, most medical malpractice lawsuits an argument can (and will) be made by the defendant doctor, nurse, or hospital that, in fact, they were not negligent and/or their actions did not cause any harm. But sometimes medical malpractice occurs that is so obvious that it is indefensible. In such cases, the work necessary to prove the case and money needed to work the case up are not as significant as is typically the case. Therefore, in clear-cut medical malpractice matters we are sometimes able to handle matters that have legitimate but not catastrophic injuries.

Are we the right firm for your case?

Fourth, you the client, play a significant role in whether we choose to handle your case. Our firm is dedicated to helping people in need who have turned to the civil justice system for the right reasons. We do not handle frivolous cases and we do not work with people who are motivated solely for the gain of money alone. Of course, money is a significant part of the lawsuits we undertake, but the purpose of the money is to improve our clients’ lot in life. But the civil justice system is not a lottery, and we will not represent people looking to game the system.  The purpose of the money is to provide lost income, future medical care needs, and make up for what has been taken in the way of pain, suffering, humiliation and the ability to enjoy your life as you did before the injury. Sometimes the money serves as a symbol that the wrongdoer was held accountable, and justice was served.  We are honored to help people who are seeking accountability, but we are not interested in people who are trying to exact vengeance or carry out a vendetta.

We also only work with people who appreciate what we do and trust us.  If we foresee a problematic relationship with you, we will decline to handle your case and recommend another good firm who may serve as a better fit.

At Lupetin & Unatin, we take our job of representing those injured by medical malpractice seriously.  We focus our practice on those cases where we feel we can make a real difference for really deserving people.  We appreciate the people we work for.  Even if we decide not to handle your case, we will do our best to explain the reasons why and, if appropriate, refer you to another firm who may be able to help.

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A potential lawsuit arising from the misdiagnosis or failure to treat a heart attack is often based on a similar scenario: a patient presents either to a doctor’s office, an urgent care clinic, or an emergency department with a history of chest pain.  In addition to chest pain or tightness, the patient may report symptoms such as pain radiating into one arm, nausea, sweating, or shortness of breath.  If treating health care providers fail to recognize the patient may be having heart attack and order appropriate testing, the small window of time for life-saving treatment may be lost forever.

Was It Malpractice?

In order to evaluate whether a patient was a victim of medical malpractice related to misdiagnosis or late treatment of a heart attack, we will need to gather several key pieces of information, including:

• The patient’s age
• The symptoms the patient or their loved one reported to the doctor or the hospital;
• The patient’s medical history, including whether the patient had a history of diabetes, high blood pressure (aka hypertension), or high cholesterol;
• The patient’s smoking history, if any; and,
• The patient’s family medical history, including whether their immediate family were diagnosed or treated for coronary artery disease.

The next step of our investigation is to learn what if any tests were performed by the doctor or the emergency room.  In the office setting, if a family doctor or primary care physician suspects their patient may be at immediate risk of a heart attack, the best course of treatment is usually referral to the emergency room.

Once a patient presents to an emergency room with chest pain or other related complaints, the nurses and attending physician should carefully obtain the full history of the patient’s symptoms, their personal and family medical history, and the patient’s vital signs.  In addition, there are two diagnostic tests every doctor in the emergency room should consider ordering if they suspect a patient may be suffering from an acute coronary event like a heart attack. These tests are an electrocardiogram and Troponin.

Electrocardiogram (EKG or ECG)

A standard EKG involves 12-leads attached to the chest that measure the electrical activity of the heart.  The impulses generated through the leads generate waveforms like those seen in the familiar EKG report (see illustration).  Physicians are trained to interpret EKG waveforms and identify abnormalities that could mean the heart muscle isn’t receiving enough blood flow.  One common type of EKG abnormality often associated with an especially severe type of heart attack is known as an ST Elevation.

Troponin

Doctors can order a lab test which measures the amount of a protein in the blood called Troponin. The level of Troponin found in the patient’s blood can help doctors determine whether heart muscle was recently damaged or still in the process of being damaged due to a heart attack.

The next step of our investigation is to find out the diagnosis and treatment the hospital or doctor provided for the patient.  Ideally, a patient with signs or symptoms of a heart attack will be seen by a cardiologist in the emergency department or admitted to the hospital, often to for emergency treatment.  The treatment of a patient in the midst of a heart attack is often time-sensitive.  If blocked coronary arteries are not opened up and blood flow to the heart restored, a patient may lose their life.  When a patient has lost their life due to the delayed diagnosis of a heart attack, and we find that a doctor or a hospital made a mistake, often a lawsuit will be warranted.

In some cases, a patient will survive in spite of receiving inappropriate or late treatment for a heart attack.  If a patient survives in spite of the delayed diagnosis or treatment of a heart attack, and is further evaluated by a cardiologist weeks or months down the line, we would need to learn whether the cardiologist ordered an echocardiogram.  An echocardiogram is a test that uses ultrasound to measure the heart’s ability to pump blood throughout the body.  One important echocardiogram result, the ejection fraction, can help us understand whether the patient suffered permanent heart damage or faces heart failure as the result of medical malpractice.

We don’t expect you to know every detail of the events surrounding an unexpected and horrific event like a heart attack.  The information above is only a guide to help you help us put the pieces together.  If we suspect you or a loved one were irreparably harmed by a heart attack and deprived of the medical care you deserved, we will obtain medical records on your behalf.  Please contact our firm for a free case evaluation.

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Most people who visit a hospital emergency department believe that the physicians, nurses and physician assistants who treat them are employees of the hospital.  However, that’s often not the case.  And worse yet, if a doctor or nurse in the emergency department makes a serious mistake and harms a patient, the hospital may try to deny responsibility for the acts of their hospital staff.

Like any other employer, hospitals need to recruit experienced people to staff their emergency departments.  When hospitals need help finding qualified physicians, they often turn to companies whose sole purpose is recruiting physicians and advanced practitioners to staff hospital emergency departments.  These staffing agencies specialize in connecting hospitals with “locum tenens“ physicians. A locum tenens physician is a physician who usually works for different hospitals for sporadic periods, such as blocks of one or two weeks every month or every other month.  It’s not unusual for a locum tenens physician to live temporarily in multiple towns while they work in different hospitals from month to month, and meanwhile call a far-off city their home.

Locum tenens physicians don’t tell patients or their families they’re not employed by the hospital.  Naturally, patients expect emergency department physicians and staff to be employees of the hospital.  People who are harmed by medical negligence expect hospitals to take responsibility for the doctors they bring within their walls to care for patients.

There’s nothing wrong with doctors who choose to do locum tenens work.  In fact, these doctors are often filling a gap in availability of qualified doctors in rural areas.  Nevertheless, in the event that a locum tenens physician makes a serious error which costs a patient their life, hospitals don’t hesitate to defend the case by claiming the physician was not an employee of the hospital.  Hospitals and the attorneys hired by their insurance companies will argue they have no responsibility to compensate the spouse or family for the negligence of a physician who was simply placed at their hospital from a staffing company.  Instead, hospitals will point the finger at the locum tenens staffing company.

Fortunately, a statute that establishes certain rules for medical malpractice claims in Pennsylvania known as MCARE Act, makes a hospital responsible for the acts of a health care provider like a locum tenens physician if:

“(1) a reasonably prudent person in the patient’s position would be justified in the belief that the care in question was being rendered by the hospital or its agents”; or,

(2) the care in question was advertised or otherwise represented to the patient as care being rendered by the hospital or its agents.

40 Pa. Stat. Sec. 1303.516(a)(1)- (a)(2)

Pennsylvania law recognizes patients who present for treatment to an emergency department are justified to believe their doctors and nurses are providing care on behalf of the hospital.  See Capan v. Divine Providence Hospital, 430 A.2d 647, 649-50 (1980).  Still, when hospital attorneys point their fingers at locum tenens staffing companies, an attorney presenting a medical malpractice trial in Pennsylvania cannot forget to introduce the important, albeit obvious evidence of the patient’s beliefs about who was providing care to them in an emergency department.

Hospitals should be accountable for the doctors, nurses or physician assistants who treat their patients.  Hospitals will not hold locum tenens physicians accountable to safe medicine if they can escape accountability when these same physicians provide substandard medical care.

If you or a loved one were injured as the result of medical care arising in an emergency department, it is critical you have attorneys you can trust identify all responsible parties, including a locum tenens staffing company. It will also be important for your attorneys to understand whether a locum tenens staffing company controlled the work of the individual physician or advanced practitioner. Too often, the involvement of locum tenens staffing companies is overlooked, and an important source of money to pay for the full and fair extent of harm caused by the medical negligence.

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Many medical malpractice lawsuits result from delays in diagnosing and treating patients suffering acute compartment syndrome.  Compartment syndrome is an emergency medical condition that can result in paralysis, limb loss or death, if not treated in time.

This article explains:

1. What is Compartment Syndrome?
2. How is Compartment Syndrome Diagnosed and Treated?
3. Compartment Syndrome Medical Malpractice
4. Compartment Syndrome Lawsuit Value – Jury Verdicts and Settlements

What is Compartment Syndrome?

Compartment syndrome is a painful, emergency condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment.

The muscle groups of the human limbs are divided into sections, or compartments, held together by strong membranes called fascia.  Increased pressure within a muscle compartment reduces the circulation of blood to the muscles and nerves within that space.  This decreased blood circulation leads to a lack of oxygen which leads to muscle and nerve death if not treated in time.

Compartment syndrome may occur suddenly, often following trauma, or as a chronic syndrome, frequently seen in athletes, that develops more gradually. Compartment syndrome usually occurs in the legs, feet, arms or hands, but can occur in any enclosed compartment of the body.

Acute compartment syndrome is a surgical emergency.  The medical standard of care requires that compartment syndrome be treated immediately.

Who is Most at Risk of Developing Compartment Syndrome?

Compartment syndrome can happen to anyone of any age.  While crush injuries and traumatic impacts can lead to compartment syndrome, bone fractures account for approximately 75 percent of cases of ACS. To make matters worse, fracture treatment (e.g., setting a displaced fracture) can increase compartment pressure and the risk for ACS. 

What are the Signs and Symptoms of Acute Compartment Syndrome that Doctors Must Watch For?

The signs and symptoms of ACS generally appear in a stepwise fashion, but the order of specific findings varies from patient to patient.

Important clues for doctors to take note of, include rapid progression of symptoms and signs over a few hours and the presence of multiple findings consistent with the diagnosis in a patient at risk.

Repeat patient evaluation is important for patients at risk for compartment syndrome. When a doctor suspects a patient may suffering from a developing compartment syndrome, the doctor should confirm the condition by measuring the patient’s compartment pressures.

Classic symptoms of acute compartment syndrome include:

1. Pain out of proportion for the injury (early and common finding);
2. Severe pain with passive movement of the affected body part;
3. Paresthesias (abnormal sensation often described as “pins and needles”).

Examination findings suggestive of acute compartment syndrome include:

1. Pain with passive stretch of muscles in the affected compartment (early finding)
2. Tense compartment, sometimes described as a firm “wood-like” feeling
3. Pallor (pale discoloration of skin) from vascular insufficiency (uncommon)
4. Decreased sensation
5. Muscle weakness (onset within approximately two to four hours of ACS)
6. Paralysis (a late finding that may suggest irreversible nerve damage)

How is Compartment Syndrome Treated?

With timely diagnosis and appropriate treatment, the complications of compartment syndrome (paralysis, muscle death, and amputation) can be prevented or minimized.

As soon as a doctor suspects a patient is suffering from compartment syndrome, all external pressure sources should be relieved. Any dressing, splint, cast, or other restrictive covering should be removed.

Elevation of the effected limb should be avoided.  Instead, the limb should be placed level with the heart to help avoid reductions in blood flow into the compartment.

Pain medications may be given with caution, but excessive pain control can mask the signs of compartment syndrome.  Low blood pressure should be treated with IV fluids.

A fasciotomy (procedure where the fascia is cut to relieve pressure) of all involved compartments is the definitive treatment for ACS in the great majority of cases.

How Do Healthcare Providers Commit Medical Malpractice Related to Compartment Syndrome?

Medical malpractice arises when the patient’s medical providers fail to diagnose and treat the compartment syndrome before irreversible ischemia sets in despite obvious signs and symptoms of ACS.

There are various reasons why healthcare providers may negligently fail to timely diagnose and treat compartment syndrome including:

1. Failing to perform a proper differential diagnosis.
2. Wrongly concluding that a patient does not have enough signs and symptoms of ACS for the patient to have the condition.
3. Disregarding a patient’s complaints.
4. Failing to obtain a complete history from the patient and missing important information that may have led to a diagnosis.
5. Failure to perform a complete medical examination of the patient.
6. Failure to perform serial evaluations of the patient in a timely fashion to monitor the development of new and different signs and symptoms indicative of ACS.
7. Failing to consult with an appropriate specialist who may be better able to make the correct diagnosis.
8. Failing to obtain a compartment pressure measurement.
9. Failing to relieve external sources of pressure such as a cast or splint.
10. Overmedicating a patient with narcotics so as to mask the patient’s pain complaints.
11. Miscommunications between care providers within a hospital.

How Can Patients with Compartment Syndrome Know if they were Injured by Medical Malpractice?

If, as a result of compartment syndrome, the patient suffered paralysis, extensive muscle tissue death, amputation or died – there is a good chance these injuries were due to medical malpractice.

On the other hand, the mere fact that a patient developed compartment syndrome and needed a fasciotomy does not necessarily mean there was medical malpractice.

How do Doctors and Hospitals Defend Compartment Syndrome Medical Malpractice Lawsuits?

We usually see the same defenses raised by the defense in every compartment syndrome lawsuit we prosecute.

First, the defense will argue that the patient’s signs and symptoms were not consistent with or indicative of a compartment syndrome to justify why the diagnosis was not made in time.  This typically involves the defense focusing in on whatever sign or symptom of compartment syndrome the patient did not present with.  There are a constellation of signs and symptoms that can indicate a patient may be developing or suffering from a compartment syndrome.  For example, the “5 P’s” are often associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements).  Though a patient does not need to have all of these signs for a doctor to properly form a differential diagnosis that includes compartment syndrome doctor (in fact it is unusual for a patient to manifest every single sign at the same time) – the defense will nevertheless harp on the one or two signs or symptoms the patient did not have to paint a picture that the patient’s presentation was not consistent with compartment syndrome.

Second, the defense will blame the outcome on the trauma that led to the compartment syndrome.  The defense will argue that the patient’s ultimate outcome – muscle death, paralysis or amputation – was going to happen regardless of the delayed or misdiagnosis i.e., nothing would have changed the outcome.  The defense will also argue that the preceding injury as the cause of the patient’s symptoms that happened to be similar to those of compartment syndrome or that would make it impossible to diagnose compartment syndrome.  For example, the defense will argue that because the key sign of compartment syndrome, extreme pain, could have been due to the initial injury the misdiagnosis was excusable.

Third, the defense will look for any angle to blame the ultimate outcome on a delay that was not the defendant’s fault i.e. the patient took too long to get to the hospital.

How Much Money is a Compartment Syndrome Medical Malpractice Lawsuit Worth?

Because every case is different – degree of negligence and injuries – there is no single answer for what your case may be worth for settlement or jury verdict. It is helpful, however, to look at the facts of other compartment syndrome lawsuits that have resolved through settlement or jury verdict to get a sense of what your case may be worth.

Compartment Syndrome Case #1

In a case handled by our office, a 7-year-old female broke her arm at home practicing gymnastics.  On presentation to the hospital, the patient was noted to have suffered a severe fracture to her right arm just above the elbow that required surgery.  Over the course of several hours leading to surgery, the patient slow lost sensation and motor function in her right hand.  The pulses in her wrist were diminished as well.

Following surgery, the surgeon noted that the child’s pulses in her right wrist had not returned nor had her motor or sensory function.  Despite this concerning presentation, no other treatment was provided to the patient, and she was discharged home the next day, with instruction to return for follow up in 2 weeks.

At her 2 week follow up, the surgeon discovered that the patient remained without any motor function or feeling in her right hand.  The surgeon diagnosed her with suffering from a subacute compartment syndrome.  The child went on to develop contractures in her injured hand that caused her fingers to curl up.  The child’s family sought a second opinion from a different surgeon who quickly discovered the child had sustained a vascular injury from the original fracture which led to a compartment syndrome in her right arm that was not timely diagnosed.  The second surgeon took the patient back to the operating room and discovered that much of the tissue in her patient’s forearm had died.  Ultimately, the child was left with a non-functional hand that will have stunted growth in the future.

We filed a medical malpractice lawsuit against the original hospital and surgeon.  We alleged that the child had obvious signs of compartment syndrome before and after her initial surgery that were neither diagnosed nor treated.  This delay led to irreversible damages to our client’s right forearm.

The defendants contended that the child’s presentation because highly unusual, especially, given her lack of pain out of proportion.

The case settled without a trial for $4,500,000.

Compartment Syndrome Case #2

In the case of People v. Harper, filed in Michigan, the plaintiff was a woman in her 40s who presented to the hospital with signs and symptoms (left sided body weakness) consistent with a stroke.  In response to her possible stroke, the patient was treated with blood thinners.

During her hospital admission, the patient developed compartment syndrome that was not treated in time.  The patient ultimately had to have her arm amputated.

The plaintiff’s experts argued that vascular surgery doctors who had been called upon to assess plaintiff’s arm for possible compartment syndrome were professionally negligent because they failed to recognize and appreciate signs of compartment syndrome.  Specifically, the doctors failed to measure the patient’s compartment pressures in the arm and failed to closely monitor the patient’s arm. The plaintiff proved that due to the defendants’ negligence, her arm deteriorated until she lost full function of the arm. The tissue damage was too extensive to save the arm and, ultimately, plaintiff suffered an amputation of her left arm.

The Defendants argued that the plaintiff did not have typical signs of compartment syndrome and that pressure measurements were not required. The Defendants also asserted that the patient had an underlying blood disorder that was so extensive that even prompt identification of compartment syndrome would not have changed the outcome.

The jury returned a verdict of $1,500,000.

Compartment Syndrome Case #3

In a Massachusetts medical malpractice lawsuit, the plaintiff contended she lost her leg due to a negligent delay in treating her compartment syndrome.

In June 2004, the plaintiff, a 72-year-old woman with a history of diabetes, hypertension, vascular disease and carotid artery surgery, underwent a right knee replacement performed by two of the defendant surgeons.

Following her surgery, the plaintiff complained of decreased sensation in her right leg, swelling in her knee, and weakness, numbness and pain in her knee, hamstring, thigh and foot. She continued to have persistent unrelieved right leg and foot complaints, which progressed to complete foot drop and impaired blood flow in her leg.

After the plaintiff developed the foot drop, the defendant neurologist examined her and considered a diagnosis of compartment syndrome, but no further work-up was initiated at that time.

For the next two days, the defendant surgeons failed to perform surgery to relieve the compartment pressure in the plaintiff’s leg.

Ten days after the initial surgery, the defendant surgeons brought the patient back to the operating room for surgery to relieve the pressure in her anterior and deep posterior compartments.  Unfortunately, the compartment syndrome had caused irreversible tissue, muscle and nerve death, as well as extensive vascular compromise, making it impossible to save the patient’s leg.

The patient underwent an above-the-knee amputation of her right leg.

The plaintiff’s experts contended the defendants were negligent for failing to timely recognize and treat the plaintiff’s signs and symptoms of compartment syndrome and vascular compromise, despite her complaints of numbness, pain, weakness, loss of sensation and foot drop in the days following her surgery.  The plaintiff experts also opined that her right leg could have been successfully treated and salvaged had she received the proper surgical care and treatment.

In their defense, the surgeons denied that the plaintiff had developed compartment syndrome and argued that the tissue, nerve and vascular compromise in the plaintiff’s right leg was caused by a rare vascular condition that had developed post-operatively as a result of her history of vascular disease.

This lawsuit settled for $1,500,000 before trial.

Compartment Syndrome Case #4

In another medical malpractice case filed in Michigan, the plaintiff, a 52-year-old married female dental hygienist, claimed permanent disability and deformity as a result of her doctors’ alleged failure to diagnose compartment syndrome following surgery. Defendants disputed the claim but settled the case for $738,000 prior to trial.

The defendant surgeon performed open reduction surgery for a tibial plateau fracture on plaintiff at defendant hospital. The plaintiff complained of severe pain after the surgery, even though she was receiving morphine. It was noted in her hospital records that she had loss of motor function following surgery. Defendants diagnosed her with tourniquet palsy, a condition related to the surgery, and she was released. Plaintiff presented at a follow-up appointment with complaints of pain and was diagnosed with compartment syndrome.

The plaintiff alleged that the defendants failed to diagnose compartment syndrome and failed to timely perform an immediate decompression by a fasciotomy, which is the standard of care. The plaintiff’s expert testified that defendants missed the 8- to 12-hour window of opportunity to correct the compartment syndrome. The plaintiff claimed the defendants should have removed the dressing and taken a pressure reading on the interior anterior compartment when the muscles that dorsiflex the foot were not working following surgery. She also maintained that she was examined only once after surgery by defendant’s resident and the attending physician did not properly supervise the resident or perform his own exam. Plaintiff claimed permanent disability and disfigurement and her spouse sought damages for loss of consortium.

The defendants contended the plaintiff did not have the classic signs and symptoms of compartment syndrome and it was appropriate to assume that her pain was the result of tourniquet palsy. They argued that they met the standard of care and defendant resident was appropriately monitored.

Though the compartment syndrome lawsuits described above all resulted in substantial settlements or verdicts, most reported compartment syndrome lawsuits resulted in a defense verdict or zero recovery for the plaintiff.

The medical malpractice lawyers of Lupetin and Unatin focus much of their practice on helping patients injured by medical malpractice, including compartment syndrome, get the justice and compensation they deserve.  If you or a loved one has suffered a catastrophic injury caused by compartment syndrome, we encourage you to call us to find out if you have a medical malpractice case.  We will speak with you and investigate your case at no charge.  We will provide you answers to your questions.  We only get paid if we take your case and make a recovery.

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With great excitement we announce a changing of the guard at Meyers Evans Lupetin & Unatin.

Effective July 1st, 2021, our law firm will continue on as Lupetin & Unatin, LLC.

After dedicating the last 45 years to advocating on behalf of those injured by corporations, hospitals and doctors, attorneys Jerry Meyers and Charles “Chuck” Evans have decided to step away from their respective roles with Meyers Evans Lupetin & Unatin, LLC. Jerry has decided to hand the reins over to partners Brendan Lupetin and Greg Unatin while Chuck will assume the position of “special counsel.”

For some time now we, Brendan and Greg, have served as the driving force and lifeblood of the firm. Through hard work and dedication, we have achieved phenomenal settlements and jury verdicts for our clients.

We will do everything we can to do the same for you.

It is our great honor to officially take up the mantle of firm leadership and guide the firm to new heights of representation for our clients, you, that we serve.

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A lot? Great, that is ideal. Now – how much do you trust his handwriting? How much do you trust the 22-year-old scribe who transfers the doctor’s charting? And how much do you trust the pharmacist, and the pharmacy tech? With your life, maybe. You are, after all, a fully-fledged adult. But try to picture how comfortable you’d feel when the stakes are a bit higher.

Try to picture how you’d feel if the prescription was for your child.

Imagine this: your son or daughter has a fever of 102 degrees, and has complained of body aches for the last 5 days. Though lucid, your child has begun to lose energy and is having trouble sleeping. You call into work and arrange time to rush your kid into urgent care.

After a 2-hour wait and a 20-minute exam, the clinic doctor hands you a written prescription for amoxicillin, an antibiotic frequently used to treat bacterial infections in pediatric patients. The doctor notices you look stressed, and mentions casually that these infections are extremely common and curable. You remain unconvinced as your child slumps listlessly on the exam table.

Without a word, you turn to leave and power walk with your child in tow back through the waiting room. A triage nurse calls after you, “The pharmacy is downstairs!” You shepherd your kid into the pharmacy, hoping upon hope that this medicine will help this infection become a distant memory within days. You get to the pharmacy counter, hand over the scrap of prescription paper to the pharmacist. He squints at it for an uncomfortable 10 seconds, then shrugs, and tells you it will be filled in 30 minutes.

Your breath stops.

Among all the fear-ridden moments of this day, this is perhaps the scariest.

If your child is sick, there are medications available to treat a myriad of diseases. But nobody can account for the ever-looming spectre of human error that will conspire to fill that orange prescription bottle with the wrong medication.

Pediatric medication errors are a regularity in clinics across the United States.

We’re not talking about mistakes akin to dispensing 29 pills for a one-month supply.

A study by Harvard Medical Practice reported that just under one-third of adverse drug events (ADEs) in a sample of medicated patients were associated with death or long-term disability.

One Adverse Drug Event Prevention Study found that, overall, approximately 6.5 percent of adult admissions experience ADEs, and one-third of those were due to avoidable medication errors. And this risk only increases with pediatric patients.

Newborns, toddlers, kids, preteens, adolescents and young adults all grow at accelerated rates, as does their ability to metabolize certain medications. These growth spurts require more complex calculations to determine correct medication dosages, which creates more chances for medical negligence.

Indeed, rates of potential ADEs in pediatric patients can range up to 3 times the amount as those for adult patients. These adverse events can involve any link in the chain of labor required to hand over a filled prescription to the patient — ordering, transcribing, dispensing, nurse administering, and patient monitoring.

Research by Kaushal et al. found that, frequently, the chief cause of ADEs (of which there are many) can be traced back to errors made by the prescribing physician. Moreover, the largest proportion of those ADEs were linked to incorrect dosing. With such a systemic problem targeting perhaps the most vulnerable population, the urgency for a solution has never been higher.

Pharmacology Exploded in Popularity in the 1950s

In the decades since then, researchers have had a lot of time to document potential solutions to this problem of rampant medication errors. Among the most effective methods studied in recent years is the digitization of the prescription-writing process. A meta-study of pediatric medication errors found that “computerized provider order entry with clinical decision support” reduced medication errors by a minimum of 36 percent, and a maximum of 87 percent. In other words, patients experienced far fewer avoidable ADEs when clinical decisions were backed by a software safety net designed to correct for the variabilities in individual patients.

All human bodies share obvious biological similarities. But there arises exceptional challenges for physicians when the nuances of an individual’s age, physical development, etc. demand treatments that aren’t typically thought of as appropriate for most patients. This is especially true of fast-developing pediatric patients. With thorough (and costly) implementation, healthcare facilities now have the capability to significantly curb the rates of pediatric medication errors.

However, for many clinics in the U.S., these precautions still have not been implemented, and patients can become victims of antiquated treatment practices. In 2008, healthcare workers in Colorado set a precedent for the largest medical malpractice in the state’s history, owing to a dosage error that left the newborn patient brain damaged and in need of round-the-clock care. According to Reuters, the victim was born with a congenital heart defect, which prompted doctors to schedule reparative surgery 4 days after her birth. Prior to the procedure, the newborn patient received the wrong dose of the drug prostaglandin. Her heart stopped for 33 minutes while medical staff attempted to resuscitate her. The cardiac arrest deprived the patient’s brain of oxygen for such an extent that her brain was irreparably damaged. Children’s Hospital Colorado was eventually found liable for $17.8 million, testifying to the extent of seemingly small mistakes in medicating pediatric patients.

In many ways, the medical risks of ADEs in pediatric patients are magnified many times over. Organ systems are still developing throughout the entire 18 years of pediatric care, which means that harm caused by incorrect dosing or wrongfully-prescribed medications can incur permanent damage. In the case of this Colorado newborn, 1 mistake incurred immeasurable damage to the child and her family. Cases like this illustrate the severe possibilities of a single misstep in pediatric care. Though we all must concede that nothing is 100 percent within our control, you can advocate on your child’s behalf to ensure your doctor, your treatment team, and your healthcare facility assumes the necessary extreme diligence in medicating your child.

Sources:

• Coffman, K. (2015, April 04). Family of Colorado infant given wrong DRUG Dose AWARDED $17.8 Million. Retrieved February 12, 2021, from Reuters.
• Rinke ML, Bundy DG, VELASQUEZ CA, Rao S, Zerhouni Y, LOBNER k, Blanck jf, Miller MR. interventions to Reduce Pediatric MEDICATION errors: A systematic Review. pediatrics. 2014;134(2):338-360. (n.d.). Retrieved February 13, 2021, from Pubmed.

• Stratton, K., Blegen, M., Pepper, G., & Vaughn, T. (2004, December 25). Reporting of medication errors by pediatric nurses. Retrieved February 12, 2021, from Science Direct.
• Rinke, M., Bundy, D., Velasquez, C., Rao, S., Zerhouni, Y., Lobner, K., . . . Miller, M. (2014, August 01). Interventions to reduce pediatric medication errors: A systematic review. Retrieved February 13, 2021, from American Academy of Pediatrics.

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As birth injury lawyers we regularly hear these questions asked by mothers concerned about the wellbeing of their newborn. So let’s discuss what a cesarean section (c-section) is, when it should be performed and what can happen to your baby if a c-section is not timely performed when indicated.

What is a C-Section?

Even though c-sections are invasive surgical procedures, they currently comprise nearly 33 percent of births in the U.S., according to UpToDate. C-section rates have skyrocketed in wealthy countries because they provide a time-tested solution to certain pathologies that present in vaginal births.

Modern medicine has given doctors the gift and the curse of having to decide on a method of delivery in childbirth. Today, cesarean section births are carefully orchestrated procedures where a physician delivers a baby surgically via incisions in a mother’s abdomen and uterus.  But for most of human history, the decision to opt for a c-section over a vaginal birth was a necessary last-ditch effort to prevent the death of a mother in labor. Before antiseptics, antibiotics, anesthesia, and midwifery became common in American hospitals, the risks of complications from c-section surgery far outweighed the benefits in all but the most urgent cases.

When Should a C-Section be Performed?

Today, because of dramatically lower risks associated with this surgery, c-section is more frequently than ever before the safer option for mother and baby.  While there remain opposing considerations for and against c-section births, doctors are obligated to weigh the medical and ethical pros and cons of both kinds of deliveries, for both the mother and the fetus.  You have a right to be informed about these considerations so you can understand the medical decision-making process and voice your own desire whether to have your baby born via c-section.

Approximately 55 percent of c-section cases are due to one of three medical indications — 1) failure to progress during labor, 2) nonreassuring fetal status, 3) or fetal malpresentation. Collectively, these are the most common medical causes to recommend an abdominal birth, although there are several other, less-frequent causes such as abnormal placentation, maternal infection, and particularly heavy babies, to name a few.

After all is said and done, the mother has a great deal of say on which delivery method to move forward with. However, in a situation as time sensitive as assisting a mother in labor, physicians are obligated to make timely diagnostic decisions before the window closes to ensure a healthy delivery.

As a birthing mother, family member or a patient advocate, it is necessary to familiarize yourself with the medical protocols that provide a safety net from medical negligence and avoidable birth injuries. Because maternal preference usually swings in favor of vaginal deliveries, doctors cannot defer to c-section births in the face of any and all abnormal presentations. In order to deliver the most diligent medical care, medical staff must ensure timely intervention of c-sections in order to preserve the health and future of newborns’ lives.

According to UpToDate, there is a general consensus that planned c-sections should be scheduled for either the 39th or 40th week of pregnancy, unless preterm delivery is a medical necessity. Since fetal lungs are some of the last tissues to mature in utero, performing a c-section delivery prior to the 39th or 40th week is associated with higher instances of respiratory problems. However, timely c-section deliveries can save the fetus from a myriad of complications associated with vaginal births.

If and when a c-section is decided on as the method of delivery, it is protocol to A) administer antibiotic prophylaxis, B) test baseline hemoglobin and hematocrit levels to estimate if blood and oxygen supplies will be adequate for both the mother and the baby during surgery, and to C) have an anesthesiologist consult with the mother prior to delivery. For at-risk women, thromboprophylaxis, or, the administration of medication to prevent blood clotting, should be administered.

In a perfect world, vaginal childbirth would be the preferred mode of delivery, but in many cases c-section births may be the safest option because of emergency complications stemming from labor.

What can happen if a C-Section is improperly delayed?

As a medical malpractice law firm that regularly prosecutes birth injury lawsuits, it is our job to discover when medical staff have failed to perform due diligence at the cost of their patients. Specifically, when a doctor fails to order a c-section birth until after either the fetus or the mother has been medically harmed, the damage is typically permanent.  There are numerous jury verdicts which serve as examples of what can happen when doctors fail to timely or properly deliver via cesarean section.

For example, in 1996 a Wisconsin Supreme Court verdict ruled in favor of a patient whose baby suffered spastic quadriplegia after doctors insisted on a trial of labor over a timely c-section delivery. Prior to the delivery, the patient agreed to a vaginal birth after cesarean (VBAC, after previous 2 c-section births) although a 3rd c-section remained a viable option throughout the labor. This case is illustrative of a trend dating back to the early 80s of doctors attempting to curb c-section rates in favor of vaginal births. Maternal preference for vaginal deliveries and/or VBAC tend to be higher than for elective c-sections, which further complicates matters for doctors who are obligated to respect maternal wishes while balancing risks of malpractice suits which more often materialize following trials of labor.

In a more recent suit in 2019, medical staff from Presence St. Joseph’s hospital in Illinois was put on the hook for $23.5 million to a mother whose newborn suffered severe brain damage after medical staff deferred a c-section delivery despite indications of fetal distress.

Finally, in another birth injury medical negligence lawsuit, a mother’s newborn baby suffered brain damage and was subsequently diagnosed with cerebral palsy after doctors allegedly decided not to pursue a c-section delivery when that was still a viable option. Medical staff reportedly deemed that the fetus was nonviable and that termination of the pregnancy was an option when in fact, the baby was viable and should have been promptly delivered by c-section.  The mother and her legal team proved to a jury that earlier delivery c-section would have avoided some or all of the baby’s catastrophic injuries.

Although physicians are frequently under pressure from opposing influences (common maternal preference for vaginal births versus fears of malpractice suits) it is incumbent upon them to distinguish points in time during deliveries when it is necessary to intervene to spare serious medical harm to the fetus, and to the mother. As medicine has evolved, OBGYN practitioners have needed to adapt more and more to the needs of 2 patients simultaneously – mother and baby. Any and all treatment decisions need to be viewed through this lens, with the mother adequately informed of what the doctor believes is the safest delivery option.  Failing to consider and recommend the safest delivery option, be it vaginal birth or c-section, can result in life-altering injuries to the newborn that warrant a medical malpractice lawsuit.

The Pittsburgh lawyers of Lupetin and Unatin have helped many children and families forced to endure avoidable injuries during childbirth, including lives forever altered from delays in performing a c-section.   If your child was harmed during their mother’s labor or immediately after birth, and you have questions you need answered, contact our office.  We will investigate with no charge to you unless a lawsuit is filed and we earn you a recovery.

If you believe that you or a loved one is a victom of medical malpractice, contact us for a free case evaluation.

SOURCES

Barry S. Schifrin, Wayne R. Cohen, The effect of malpractice claims on the use of caesarean section, Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 27, Issue 2, 2013, Pages 269-283,ISSN 1521-6934

(http://www.sciencedirect.com/science/article/pii/S1521693412001654)

Berghella, V. (2021, January 7). Cesarean delivery: Preoperative planning and patient preparation [PDF]. UpToDate.

FIEGER LAW WINS $23.5 MILLION MEDICAL MALPRACTICE VERDICT [PDF]. (2021, January 7). Southfield, MI: Fieger Law.

Yu, E. (2019, September 26). ‘Largest Medical Malpractice Verdict In U.S. History’ Awarded To Maryland Woman [PDF]. Washington D.C.: WAMU.

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“It is a really sad case because a wonderful father, son and brother has been left permanently brain injured – and that won’t change. Though not a fix, this verdict will provide the family the money they need to properly care for their son” said attorney Brendan Lupetin.

“This case involved overt negligence. Our client’s injury was completely preventable. But the defendants refused to accept any responsibility at any point which is why we were forced to try this case. Fortunately, the jury saw the truth and held the right defendants responsible.”

This case is among the very first in-person civil jury trials conducted in the state of Pennsylvania since the beginning of the pandemic. Lupetin praised the Blair County Courthouse, saying “the staff and especially Judge Jackie Bernard should be commended for all their hard work that allowed this important trial to go off without a hitch. It was truly seamless from start to finish.

Mr. Miller’s family expressed their profound gratitude to the jurors for holding the hospital and staff 100% responsible for negligence. “All the money awarded will go into a trust fund for our son,” his father said. “His future care was the reason we pursued this.”

Further details of the incident and the trial can be found here and here.

*Jerry Meyers retired from the firm on June 30, 2021.

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• Charles Evans: Personal Injury Litigation – Plaintiffs
• Brendan Lupetin: Personal Injury Litigation – Plaintiffs
• Gregory Unatin: Personal Injury Litigation – Plaintiffs

For over 30 years, Best Lawyers has been regarded as the most credible measure of legal integrity and distinction in the USA. Recognition is based on peer reviews from more than 9.4 million confidential evaluations by top lawyers, including past Best Lawyers honorees.

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You may feel that you have limited control over whether to undergo the procedure at all. Your specialist and your surgeon make the recommendation and you fervently hope it’s the right one.

Surgical procedures usually go smoothly. You wake up sore and feel a little cranky afterward. A few months later you barely remember the experience.

Unfortunately, surgery does carry risk. Just as the stock market can deliver bitter losses along with rewards, surgery can leave you worse off than you were before. In fact, you’ll most likely sign a form called “informed consent,” to acknowledge that the risks were explained to you, and that you understood and accepted them.

In some cases, however, a medical error goes beyond the expected level of risk. In fact, medical regulators have designated some particularly bad outcomes as “never events” – mistakes that should never occur in an accredited hospital setting.

When you experience any serious mistake, along with a huge cost to your body, financial security and even potentially your life, there may be grounds for a medical malpractice case. A medical malpractice lawyer will need to evaluate your individual circumstances, but here are some examples of adverse surgical outcomes that become malpractice cases.

Failing to Treat Post-surgical Complications

This mistake is the most common form of surgical error. Your surgical team should be alert for hemorrhage, infection, or adverse reactions to anesthesia. Without prompt treatment, these complications can lead to a longer hospital stay, invasive treatment, or even death.

Unnecessary Surgery

Your surgeon decides to operate based on a single x-ray or pathology report. She doesn’t seek further lab reports, although any report can be misinterpreted. Alternatively, she may review a slide carefully, not realizing the lab has labeled the slide incorrectly. Either way, you’re treated for a condition you never had.

Organ or Nerve Damage

It’s not uncommon for a scalpel to slip, injuring an otherwise healthy body part. For example, a surgeon might inadvertently cut the bile duct during a routine gall bladder operation.

Often nerves will be encountered very close to the operating area. When the surgeon simply touches a nerve, causing temporary sensitivity, there’s little likelihood of a malpractice case. But a severed or damaged nerve can result in a lifetime loss of function or mobility.

Operating on the Wrong Body Part

Most hospitals today go to elaborate lengths to avoid amputating the wrong limb or extracting a healthy organ. Many have developed pre-op checklists and rituals. Still, mistakes can occur, with devastating consequences for the patient.

Operating on the Wrong Patient

The surgical prep team can slip up and deliver the wrong patient to the surgeon. The mistake seems unlikely, but could occur if the patient has been anesthetized and the surgeon doesn’t look carefully.

Leaving Sponges or Surgical Equipment Inside the Patient

Most hospitals today insist on accounting for every sponge and instrument before and after surgery. They may even x-ray a patient to double-check for missing items. However, lawyers regularly see clients who report complications when the team counts incorrectly or fails to follow this protocol.

Learn More About Surgical Errors

The Making of a Malpractice Case

The above examples illustrate just a few errors that could make a case for significant damages.

As with all malpractice cases, identifying a mistake is only the first step.
Your medical malpractice lawyer will need to know how your life was changed after surgery. Were you left unable to walk, talk, or eat? Did you require additional hospitalization for a long period of time? Were you forced to undergo additional surgery?

Once damages have been established, your lawyer will investigate the cause of the mistake. Was the surgeon negligent or was this incident a common outcome of this type of surgery? Did the surgeon follow standard procedures? Did he take shortcuts? Did she prepare and plan adequately?

You may be asked to see another surgeon, who will evaluate the first surgeon’s work. Your malpractice lawyer will arrange the details and review this surgeon’s report, before concluding whether you have a reasonable chance of claiming damages.

Your Next Steps

If you or someone you care about was gravely injured during surgery and you suspect negligence or malpractice, contact an experienced medical malpractice attorney. You’ll get realistic advice about your opportunities to recover financial compensation. If the incident took place in Pennsylvania, we invite you to contact our law firm for a free case evaluation. We have been dedicated to helping victims of medical malpractice in Pennsylvania for over 40 years.

Contact Us For a Free Case Evaluation

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