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L. H., a minor v Anonymous Physician/Medical Center

Dr. Fagel obtained a settlement of $8,800,000 on behalf of a 3 month old child who now has a debilitating bowel condition after numerous physicians and hospital staffers failed to diagnose and properly treat her ischemic bowel. Before her visit to the defendant hospital, the child had a history of prior bowel obstructions, one of which required surgery. The child first visited the pediatrician on March 10 with complaints of vomiting and was sent home with a prescription of gastric reflux medicine. Later in the day, after no improvement, the mother took the child to the ER. No laboratory work was ordered, but an abdominal x-ray was obtained, which the ER doctor read as normal. The ER doctor discharged the child home at 12:45 a.m., but on the way back from the hospital she vomited again and was returned to the ER. The same doctor saw the plaintiff once again but told the mother to take her home without giving the child a full examination. The next morning, a radiologist reviewed the ER x-ray from the night before and noted that it showed dilated loops of bowel. In accordance with hospital policy, the radiologist filled out a form showing a discrepancy in the interpretation of the x-ray and the ER director left the mother a voicemail and sent her a registered letter saying she should contact her physician. However, the letter did not reach the mother until 18 days after it was sent.

The child’s condition did not improve so the mother brought her back to the hospital at 8:45 a.m. on March 12. Another ER physician noted that the child was vomiting bile, had a distended abdomen with increased bowel sounds and was not able to ingest fluids. An x-ray was obtained showing a partial bowel obstruction so the physician requested a surgical consult. The defendant surgeon saw the child and diagnosed a small bowel obstruction, but never reviewed the x-rays or ER records. He ordered for an NG tube, which was placed and initially suctioned green bile, but began suctioning brown secretions by midnight. At 2:15 a.m. on March 12, the nurse called the surgeon and informed him that the tube was draining a dark, foul smelling substance. At 4 a.m., the child’s heart rate began to rise but the pediatrician recorded that all vital signs were stable. At 7:10 a.m., the surgeon informed the nurse that he would be taking the child to surgery at 8:00 a.m. Over the course of the next 50 minutes, the child was noted to be lethargic and pale with an escalating heart rate.

The surgery eventually began shortly after 9 a.m. The surgeon noted that the small bowel was so ischemic (lack of blood and oxygen) that he removed all but three inches of the bowel. The child was transferred to UCLA Medical Center, where she later had further surgery to remove dead bowel tissue at the site of the previous surgery. The plaintiff is now neurologically normal, but has such severe short-bowel syndrome that she requires Total Parenteral Nutrition. She cannot digest solid foods and will require intravenous feeding for the remainder of her life.

Although the defense contended that the plaintiff’s condition was unavoidable and that all care was within standard, Dr. Fagel was able to show that the defense was responsible for the plaintiff’s injuries for a variety of reasons. First, he claimed that the defendant ER physician was negligent for misreading the March 11 x-ray and sending the child home. The hospital nurses were also negligent for failing to recognize the child’s deteriorating condition on March 13 and should have notified the surgeon about these significant vital changes. In addition, the pediatrician was negligent for not diagnosing bowel obstruction sooner and contacting the surgeon earlier. Finally, the surgeon was negligent for not taking the child to surgery sooner and for removing too much of the bowel during the surgery. Had he devoted more effort and time to the procedure, more than three inches of viable bowel could have been saved. All in all, a series of errors on the part of numerous medical professional delayed the surgical procedure that could have prevented the tragic outcome. If the surgery had been performed 3-4 hours earlier, the bowel would have been less necrotic and a greater amount could have been saved, which would have allowed the plaintiff to live a normal life.