Medical Malpractice ­ Failure To Diagnose Subarachnoid Hemorrhage - $1,000,000

Injuries alleged: Brain damage
Court: Withheld
Amount of settlement: $1 million

Case Summary:
The plaintiff, a 52-year-old resident of Lowell, went to a walk-in clinic complaining of the 'worst headache of his life,' which had come on suddenly. The headache also caused some decreased short-term memory, nausea, vomiting and intermittent photophobia. The physician at the walk-in clinic appropriately referred the plaintiff to a nearby emergency room and called ahead to alert the emergency room physician of his findings.

As directed, the plaintiff went promptly to the emergency room where he was seen by defendant number 1, an emergency room physician, who ordered a CT scan and sinus films. Defendant number 2, the radiologist, read the CT scan study and concluded that there was 'no evidence of any acute intracranial abnormality.' Notwithstanding the history of sudden onset of severe headache described as the 'worst headache of his life,' with associated vomiting and memory impairment, defendant number 1 failed to perform a lumbar puncture but told the plaintiff (and noted in his chart) that the plaintiff was to return in 72 hours for a lumbar puncture if not feeling better. His diagnosis was 'probable muscle tension headache.'

Three days later, the plaintiff returned as directed and saw defendant number 3, an emergency room physician at the same emergency room. The emergency room record indicated that the plaintiff had been seen three days before and that the headache was back the way it was, if not worse. Notwithstanding the notation in the chart by defendant number 1 that the plaintiff was to have a lumbar puncture if not better, defendant number 3 failed to perform a lumbar puncture or any other diagnostic tests. Instead, his sole diagnosis was 'headache, question etiology.' He prescribed Tylenol No. 3 and suggested the plaintiff be seen in follow-up by a neurologist.
As suggested, two days later, the plaintiff was seen in follow-up by defendant number 4, a neurologist. In spite of the documentation of a sudden, severe headache at its worst in the beginning and which did not build up over time, as well as noting the fact that the plaintiff had no previous history of severe headaches, defendant number 4 diagnosed probably viral meningitis and failed to perform a lumbar puncture or examine the CT scan which had been taken locally five days earlier. Defendant number 4 advised the plaintiff to continue with the Tylenol No. 3 and to rest but that he should return to the emergency room for an immediate CT scan and lumbar puncture if his symptoms returned. Defendant number 4 saw the plaintiff once again six days later and noted that the headache seemed to be almost completely resolved and again advised the plaintiff that he 'should immediately go to an emergency room for a CT scan and lumbar puncture' if he ever got another headache that was as severe and of sudden onset. Regardless of this recommendation, defendant number 4 failed himself to perform a lumbar puncture despite the ongoing symptoms.
Two weeks later, the plaintiff awoke with a headache and was found to be unresponsive and was taken to a local hospital. CT scan demonstrated a subarachnoid hemorrhage. He was transferred to another hospital for emergent neurosurgical intervention where he underwent aneurysmal clipping. The plaintiff was then discharged to a rehabilitation hospital for 1 1/2 months where he was noted to have significant cognitive and motor delays due to his neurologic injury.

The plaintiff was unable to return to work as a rooming house manager where he was earning approximately $20,000 per year and has remained at home under the care of his wife. He continues to suffer from a severely impaired short-term memory and other cognitive deficits.
Plaintiff's counsel was prepared to present the testimony of experts in the fields of emergency room medicine and neurology, who had opined that defendants 1, 2, and 4 deviated from accepted standards of care at the time causing a delay in diagnosis of the plaintiff's subarachnoid hemorrhage from which he was suffering when he first presented to the emergency room. The plaintiff also was prepared to present the testimony of a neuroradiologist regarding the CT scans taken on that day, which were read as 'normal' but, indeed, showed clear evidence of subarachnoid hemorrhage. The plaintiff was also prepared to present the testimony of a neurosurgeon who had opined that earlier diagnosis of the plaintiff's subarachnoid hemorrhage would, more probably than not, have resulted in a successful outcome.

Due to a number of problems that arose during the course of pre-trial discovery, the Superior Court assigned a discovery master who recommended mediation. One week prior to the scheduled mediation, the case was resolved for $1 million.