HSCI 3520: Legal Issues in Healthcare Case Studies
For each of the case studies below, please answer the following questions.
1. What are the facts of the case?
2. Is this case a negligent tort, intentional tort, strict liability (products liability) or criminal?
3. If negligence tort, is it malpractice?
a. What standard of care is required?
b. Are all the elements required in a negligence suit present?
4. Who would you consider to be the potential plaintiff and defendant?
5. How would you argue for the plaintiff?
6. What evidence would you present?
7. How would you defend the defendant?
8. What are your defense options?
9. If you were on the jury, what would your finding/s be, based on only the facts as presented and the classroom discussion?
10. If you find the defendant responsible, what damages would you award, and for what reasons? If the award was provided in the case study, how much was the award and for what reasons?
11. What are your options if you, as plaintiff or defendant, are unhappy with the jury’s decision?
CASE 1: Hiring Practices
Joe Clay, a nurse is hired sight unseen over the telephone by Home Again Nursing Home. Mr. Clay falsely stated in an employee application that he was licensed as an LPN. His licensure was not verified by the employer. He had committed 56 criminal offenses of theft. While at the nursing home, he assaulted a resident and broke his leg.
CASE 2: Surgery: Sponge and Instrument Count
Dr. Smith owns the local “Outpatient Surgery Center.” He instructs employees to count all instruments and surgical sponges following a surgical procedure prior to closing the surgical site. Annie, an employee, failed to conduct the count following Mr. Bill’s surgery. Two months later, Mr. Bill, suffering from extreme abdominal pain was noted to have several sponges and an instrument in his abdomen. He had developed a massive infection.
CASE 3: Failure to Follow Instructions
Sarah Smith has a minor surgical procedure under general anesthesia at ABC Surgery Center. She was instructed not to drive home after release. Her daughter Leslie picks her up. On the way home Leslie stops for donuts. Meanwhile, her mother moves to the driver seat. Upon leaving the parking lot, Sarah hits Carol Jones’ car. Mrs. Jones sustains a broken arm and sues ABC for releasing Sarah before she is completely recovered from the anesthesia.
CASE 4: Defective X-ray Unit
Mindy, an x-ray technician, places Candice Murray on the table of the hospital’s newly manufacturer installed x-ray unit. While in the control room, Mindy hears a crash. She rushes to the patient and finds that a section of the x-ray unit fell on Candice, further injuring her already broken leg. Candice sues the manufacturer (RadX) for negligence.
CASE 5: Defamation of Character
In 2007 Dr. Carlotti, a successful cosmetic surgeon, performed a number of procedures on Ms. Petta, a singer, including a rhinoplasty. Ms. Petta was unhappy with the outcome of her surgery and launched a website which claimed that Dr. Carlotti was not board-certified. Records showed he was board-certified by the American Board of Oral and Maxillofacial Surgery. She also claimed he was being investigated by the Arizona Board of Medical Examiners. Dr. Carlotti did not have any disciplinary record with the Arizona Board. Ms. Petta’s actions took a toll on the practice of Dr. Carlotti and he stated that “I was dealing with somebody who had the intent of destroying me professionally, personally and on every level. I went from a very successfully surgeon to pretty much out of business.” Dr. Carlotti successfully sued his former patient receiving a jury verdict of $12 million.
CASE 6: Defamation of Character
Dr. Navneet Sharda sued a fellow cancer specialist, saying the other doctor had defamed him by criticizing his character and medical expertise. Sharda says the relationship soured when primary care doctors started sending patients for initial consultations to him instead of Kaushal. The tension erupted when they disagreed about treatment methods for patients, he said. Sharda said one dispute led to an angry phone call from Kaushal, who said: “I’m going to teach you a lesson and drive you out of town.”
Sharda started his solo practice in 2001 and says things were going well until 2003, which is when he believes Kaushal began bad-mouthing him to other doctors. A 2004 letter written by Kaushal was obtained in the case and says that Sharda “has uncontrollable and nonstop ways of doing unethical, unwanted, unheard, nonconventional and unacceptable ways of doing radiation therapy.” The letter accuses Sharda of “going out of his way to give radiation therapy when it’s not necessary and/or without looking at the needs of the patient.” Kaushal also writes that he has tried to prevent Sharda from getting privileges at a hospital and that Sharda has an “unfavorable history with many of the radiation and medical oncologists.”
Sharda says he’s spent about $300,000 in court costs to squelch rumors that he claims were started by oncologist Dr. Dhan Kaushal. He says Kaushal’s defamation went on so long and was so widespread in the local medical community that it ruined his radiation oncology practice, which is dependent on referrals from other physicians. He’s not sure his practice will survive. On August 17, a Clark County District Court jury sided unanimously with Sharda in the defamation case, awarding him $60,000 in damages.
CASE 7: Wrong Medication
Mr. Stanley refills his drug prescription at Discount Drugs, where he has been a customer for 10 years. Prior to taking his nightly dosage he noticed the pill appeared larger than normal. He phone Discount Drugs and explained his concern. The pharmacist assured Mr. Stanley, by stating that generic drugs sometimes are larger because the formula fillers but that the medication dosage in his drug was correct. Mr. Stanley took the drug as prescribed and never woke up. The dosage given was five (5) times that which had been prescribed. The container from which the pharmacist filled Mr. Stanley’s prescription had been mislabeled by the drug manufacturer (Pharma C).
CASE 8: Product Liability
Plaintiffs Martha Salazar and her husband Felix Salazar sued Boston Scientific alleging she was injured by its Obtryx sling device. After a two-week trial, the jury found that Boston Scientific was negligent in designing the Obrtyx device and that negligence was a proximate cause of Salazar’s injuries. The jury also found that Boston Scientific failed to provide adequate warnings to doctors about the risks associated with the device. Finally, the jury found gross negligence, permitting the recovery of punitive damages.
What are the three legal theories that an injured party can use when filing a lawsuit against a seller, manufacturer or supplier of a medical product?
CASE 9: Mislabeled Pain Patches – Res Ipsa Loquitur
A manufacturer mislabeled a box of Duragesic patches (a powerful pain reliever), marking the box as containing 25mg patches, but the box contained 100mg patches. The patient placed a patch on her back to provide relief of her severe back pain. Instead of receiving the 25mg dose, she received the 100mg dose, which is four times the recommended amount. He went into a coma and eventually died.
Describe the three elements that must be established to use Res Ipsa Loquitur for a product liability case. How is this applied in this case?
CASE 10: Healthcare Fraud
Paul D. Cardwell was the Chief Executive Officer at Powell Valley Healthcare, Inc. Beginning about March 2011 and continuing through September 2011, Cardwell and his co-defendant entered into a conspiracy to defraud Powell Valley Healthcare of $847,844 through a fraudulent billing scheme. As a result of the investigation, on January 27, 2014, in Cheyenne, WY, Cardwell was sentenced to 121 months in prison, three years of supervised release and ordered to pay $1,698,644 in restitution. Cardwell pleaded guilty to conspiracy to commit mail and wire fraud and conspiracy to commit money laundering.
Is this case a tort, a criminal case or both? Explain your answer utilizing the evidence presented.
CASE 11: Corporate Structure and Legal Issues
The Mrs. Condon, underwent a routine mammogram in July 2008. The mammogram revealed suspicious lesions in her right breast. Dr. Moore performed a biopsy at the AA Medical Center (AAMC). Dr. Williams, who was a pathologist working for Dr. Weisburger, a pathology corporation providing contract pathology services to the hospital, performed an evaluation of the tissue. Dr. Williams reported noncancerous lesions in the right breast of Mrs. Condon. Dr. Moore advised Mrs. Condon that she did not have cancer but advised her to undergo frequent mammograms. Mrs. Cordon began experiencing inflammation of her right breast, and then consulted with Dr. Moore in February 2010. Dr. Moore performed another biopsy. Mrs. Condon was advised that the biopsy results indicated invasive carcinoma of the breast. As a result of the diagnosis, Mrs. Condon underwent a bilateral modified radical mastectomy. Mrs. Condon brought a malpractice action against Dr. Williams and AAMC. The suit alleged malpractice on the part of Dr. Williams for failure to properly diagnose a biopsy as breast cancer. On the eve of the trial, Dr. Williams agreed to a $1 million settlement with the plaintiff. The circuit court entered judgment on a jury verdict in favor of the plaintiff, AAMC appealed, claiming that the release of the agent Dr. Williams served to act as a release for AAMC.
CASE 12: Corporate Negligence
Darling broke his leg and was treated at Charleston Community Hospital’s emergency department. His leg was put in a cast, but the cast cut off his circulation due to improper casting and this led to an infection in his leg. As a result, this lead to a partial amputation of his leg. Darling sued Charleston Community Hospital for negligent hospital treatment due to the improper casting and the medical mismanagement of the infection that resulted in part of his leg being amputated. He was awarded damages of $110,000. Standards for hospital accreditation and the state licensing regulations demonstrated that the medical profession regarded it as both desirable and feasible that a hospital assume certain responsibilities for the care of the patient, contrary to Charleston Community Hospital’s assertion that they were not responsible because they were a not-for profit hospital.
Why is this case corporate negligence?
Can the doctrine of Respondeat Superior be used in this case? Please explain utilizing the evidence in this case.
CASE 13: Misdiagnosing Accident Victim
A police department physician examined an unconscious man who had been struck by an automobile. The physician concluded that the patient’s insensibility was a result of alcohol intoxication, not the accident, and ordered the police to remove him to jail instead of the hospital. The man, to the physician’s knowledge, remained semiconscious for several days and finally was taken to the hospital at the insistence of his family. The patient subsequently died. An autopsy revealed massive skull fractures.
Did the physician commit malpractice?
CASE 14: Physician Liability – Failure to Make a Timely Diagnosis
Jane Doe, had been exposed to HIV as a result of a sexual contact. The Ms. Doe consulted her physicians Drs. Katz and Wyatt, but they failed to diagnose her condition as being positive for either HIV or AIDS. The disease weakened her immune system, and she developed pneumonia and was admitted to a hospital. She was eventually diagnosed with AIDS. The Ms. Doe’s infectious disease expert, Dr. Hill, claimed that proper diagnosis prior to her acute episode would have provided greater opportunity for improved long-term treatment. The physician’s admitted that they negligently failed to timely diagnose the patient’s condition. Jane Doe’s expert witness, Dr. Lutz, testified from his review of the patient’s medical record that the patient’s diagnosis could not have been determined based on the symptoms as described in the record. Dr. Lutz never examined the patient and based his determination on the documentation contained in the medical record, however he did agree that if the patient’s immune system had not been totaled destroyed then preventative treatment could have resulted in a longer life span.
The civil district court entered judgment on jury verdict of $700,000 in general damages, which included pain and suffering, mental anguish, disability, and the loss of the enjoyment of life, in addition to $314,000 for medical and special damages.
CASE 15: Physician Liability-Diagnosis
In Gates v. Hargiss, a malpractice law suit was brought against Dr. Hargiss, an ophthalmologist for failure to disclose to Mrs. Gates that her test results for glaucoma were borderline and that her risk of glaucoma was increased considerably by her high blood pressure and myopia. In addition, Dr. Hargiss failed to perform a field vision test and did not dilate and examine the eye. He assumed that the patient’s problem of difficulty in focusing and issues with her vision as being related to her contact lenses. Mrs. Gates was eventually diagnosed with glaucoma.
What are the three requirements that the plaintiff must meet in order to prove that Dr. Hargiss failed to order the proper diagnostic test? Explain utilizing the evidence in this case.
CASE 16: Telephone Medicine Costly
Mr. Lauren was taken to the hospital emergency department (ED). The hospital personnel contacted the physician, Dr. Attwood, by phone. He returned the call and prescribed a Phenergan injection. Dr. Attwood did not go to the hospital and had not been given Mr. Lauren’s vital signs when he suggested such an injection. Furthermore, he failed to order any blood or urine tests. Hospital records revealed that Mr. Lauren’s glucose level was 507 at the time of admission. Mr. Lauren went into respiratory failure & eventually died.
Was the physician liable for practicing telephone medicine? Explain your answer.
CASE 17: Assault in the ED
Mrs. Lane was sitting in the hospital’s ED waiting room when a teenage boy, D.G., arrived with his mother. After they had all sat in the waiting room for a short period of time, D.G. walked up to Mrs. Lane and began to hit her on her right arm and shoulder. Mrs. Lane’s son-in-law, who had accompanied her to the emergency room, jumped to her aid and struck D.G., knocking him to the floor. The attack stopped and nothing further happened. Mrs. Lane suffered some injuries as a result of the attack.
Is the hospital liable for Lane’s injuries? Explain your answer.
CASE 18: Failure to Record Patient’s Care
Mrs. Pellerin went to the emergency department at Lakeland Medical Center complaining of chest pain. An emergency department physician, Dr. Gruner, examined her and ordered a nurse to give her an injection consisting of 50 mg of Demerol and 25 mg of Vistaril. The nurse testified that she did not recall giving the injection, and did not deny giving it and her initials are present in the emergency department record. The nurse admitted that she failed to record the site and mode of injection in the emergency department records. She stated that she may have written this information in the nurse’s notes, but these notes were not admitted into evidence. The plaintiff testified that she felt pain and a burning sensation in her hip during the injection. The burning persisted afterward and progressively worsened over the next several weeks. The pain spread to an area approximately 10 inches in diameter around the injection site and the plaintiff stated that she could not sleep on her right side, work, perform household chores, or participate in sports without having pain. She also testified that she had a lump around the injection site and her skin was numb in that area.
Is this negligence? Explain your answer utilizing the evidence.