An infant with vomiting and bloody diarrhea (Case #255)

• Medical Probability: 10 / 10
• Medical Error Summary: Given the patient's symptoms, the evaluation was inadequate. Bloody diarrhea in an infant should have been evaluated further. The initial description of the case stated that an exam was not done. If t...
• Causation Probability: 9 / 10
• Causation Summary: The lack of additional evaluation likely led to a missed diagnosis. The discharge directions, as presented do not provide a list of reasons to return to the emergency department.
• Expert Summary: I am not a great expert because I have not cared for pediatric patients for many years. It is obvious from the description of the case that a deviation of the standard of care took place and was likel...
• Similar Summary: Never. In my current practice, I do not see infants. The youngest patient I see is 14 years old. I have cared for infants in the past, but it has been years.

Delay in diagnosis/treatment of acute appendicitis (Case #299)

• Medical Probability: 9 / 10
• Medical Error Summary: Patient described classic symptoms of acute appendicitis. Given patient’s age, an ovarian etiology is much less likely. A physical exam in office would have likely been consistent with acute appendi...
• Causation Probability: 8 / 10
• Causation Summary: Delay in the diagnosis and treatment of acute appendicitis likely led to the perforation and need for the extensive surgery.
• Expert Summary: I’ve been practicing family medicine for over 25 years in outpatient and urgent care settings. Evaluation and treatment of abdominal pain is a common complaint in most outpatient settings.
• Similar Summary: This is relatively uncommon, but when patients present with right lower quadrant pain, one of the top three considerations should be acute appendicitis.

Death After Bowel Obstruction (Case #345)

• Medical Probability: 9 / 10
• Medical Error Summary: Given the episodes of projectile vomiting, further evaluation should have begun with the first episode. The presence of bowel movements does not rule-out bowel obstruction, nor does bowel sounds. Ther...
• Causation Probability: 10 / 10
• Causation Summary: The bowel obstruction clearly led to this patient’s death.
• Expert Summary: I testified in a similar case earlier this year. That case was a post-operative case at a skilled nursing facility.
• Similar Summary: I do not work in LTC facilities at this time. However, I do see patient in my office with similar histories and risk factors for bowel obstruction.

Young male primary MD gives colon cancer screening kit, he is not notified of positive results until 19 months later. Now has stage 3 cancer. (Case #375)

• Medical Probability: 10 / 10
• Medical Error Summary: Failure to report/discuss positive results is a deviation from the standard of care. Practices should have processes in place to identify and locate outstanding test results.
• Causation Probability: 10 / 10
• Causation Summary: Given the initial positive test, more likely than not, he had a lesion at the time of the first screening test.
• Expert Summary: I have been in practice for over 25 years and regularly order colon cancer screening tests for my patients. I don’t use Cologard often but test for occult blood with stool studies for low risk patie...
• Similar Summary: I order colon cancer screening on a daily basis and manage the results effectively.

Failure to Diagnose and Inform of Tongue Cancer (Case #425)

• Medical Probability: 10 / 10
• Medical Error Summary: Failure to act on an obviously abnormal study is a deviation from the standard of care. Primary care physicians are responsible for the care of their patients and studies ordered from their office and...
• Causation Probability: 10 / 10
• Causation Summary: Failure to act for 3 years after an abnormal study will result in additional harm to the patient.
• Expert Summary: I have extensive experience in primary care expert witness work. I see patients like this regularly.
• Similar Summary: I’ve diagnosed a number of patients with head and neck cancers.

**Req Family Medicine who works as ER provider** 25yo F possible missed post-c-section infection, abnormal CT. (Case #471)

• Medical Probability: 9 / 10
• Medical Error Summary: The abnormal findings on the CT warranted close follow-up. Failure allowed the infectious process to progress.
• Causation Probability: 9 / 10
• Causation Summary: It appears that infection was present on presentation to the ER in December. Failure to adequately address the issue resulted in progression.
• Expert Summary: I am not a good choice for this case because I do not work in an ER.
• Similar Summary: Rarely. I see primarily geriatric patients and adults outside of child bearing age.