MRSA epidural abscess (Case #257)

• Medical Probability: 6 / 10
• Medical Error Summary: On day 66 of hospitalization developed a MRSA infection, how was treated and whether current treatment guidelines were applied? If MRSA infection was not properly treated, then this can justify why sh...
• Causation Probability: 6 / 10
• Causation Summary: If the MRSA infection was initially not treated per standard of care, then there may be a malpractice case
• Expert Summary: Has seen hundred of MRSA infections with epidural abscess, being a associate professor of medicine keeps me with most recent updated guidelines of MRSA infection
• Similar Summary: Every week I have seen a case like this for the last decade. When no treated properly, MRSA may cause these complications.

Delay in treatment of p. falciparum malaria -- did it make a difference? (Case #265)

• Medical Probability: 3 / 10
• Medical Error Summary: The suspicion for malaria was done within first 24h of seeing the patient, the smears was read correctly, the malarone order was done since it is the only available medication in the hospital and the ...
• Causation Probability: 2 / 10
• Causation Summary: I do not believe so. Causation would be if nobody would have thought about malaria until splenectomy.
• Expert Summary: Expert on tropical medicine, certified in the us
• Similar Summary: All the time since i am consulted for all malaria cases in the hospital for the last ten years

SBO – Intra-op small bowel tear w/ Rapid Deterioration, Sepsis, and Death w/in 36 Hours (Case #312)

• Medical Probability: 3 / 10
• Medical Error Summary: Tear of SB may happen during surgery when trying to open up the adhesions. It is a complication of surgery, not a medical error. The antibiotics were given same day even after tear (2h or so) which is...
• Causation Probability: 1 / 10
• Causation Summary: The initial injury during colonoscopy is unfortunately a rare complication but occurs. N/V may be secondary to recent surgery and possible adhesions. Patient went to surgery but unfortunately got a te...
• Expert Summary: I am a tenure associate professor of medicine in a tertiary academic medical center and i see these cases quite often in the hospital. I provide consultations for ID complex surgical cases.
• Similar Summary: Once a week or so we see these type of cases.

Possible cellulitis post FemPop, hx of CKD and elderly, given Cefepime and develops metabolic encephalopathy and passes away. Toxicity? (Case #371)

• Medical Probability: 2 / 10
• Medical Error Summary: Dose of cefepime was appropriate for the significant infection and the neurotoxicity from cefepime is very rare. Patient had other comorbidities to explain her worsening clinical syndrome and mental s...
• Causation Probability: 1 / 10
• Causation Summary: You cannot say cefepime caused her altered mental status without measuring cefepime levels in CSF. Patient had also other risk factors to have worsening renal failure which may cause per se metabolic ...
• Expert Summary: I see these patients every day with cefepime, and i practice ID in high-complex cases for the last 20 years
• Similar Summary: I see these cases on a daily basis

Post cervical laminectomy, possible delayed diagnosis of CSF infection (Case #441)

• Medical Probability: 3 / 10
• Medical Error Summary: I see a lot of these cases. The use of JP drain is to remove the remaining fluid caused by inflammation in the cervical area. This was likely left in purpose due to high risk factors for poor healing ...
• Causation Probability: 2 / 10
• Causation Summary: All steps were followed under standard of care. There is no deviation of SOC.. all the procedures were done properly, no need to culture the drain on second admission. Culture was then properly done w...
• Expert Summary: I see hundreds of these cases during my career as ID specialist. In addition, the bacteria and candida that grew from the JP drain seems to be gut flora and likely the patients had poor compliance in ...
• Similar Summary: I see these cases All the time The major problem on this back surgeries is that the back gets contaminated easily due to patients position in bed or contamination due to poor maintaince of JP drain

Patient did well after surgery. 3 days later CT showed massive aspiration. Plastic found in left bronchi. Died two weeks later of hypoxic respiratory failure. (Case #458)

• Medical Probability: 4 / 10
• Medical Error Summary: An intra-abdominal sepsis from a bowel perforation on an elderly patients carries a high risk for mortality upfront. 1liter of pus is a major source of inflammation of the whole body. The plastic foun...
• Causation Probability: 4 / 10
• Causation Summary: Doctors did the surgery, cleaned out, washed out, broad spectrum ATBs. OG tube was clipped but then released and draining. This likely was ordered by the surgeons, clipping the OG may have a good reas...
• Expert Summary: I am an attending physician in infectious diseases for over 15 years in academic setting.
• Similar Summary: I see these cases every month in my practice in the hospital (tertiary medical center).

**Req IM practicing as Primary Care expert** Questionable finding on ultrasound not investigated. (Case #465)

• Medical Probability: 6 / 10
• Medical Error Summary: The US in Nov 2022 showed a tumor/mass and there is no documentation of further work up by the ordering physician.
• Causation Probability: 6 / 10
• Causation Summary: Not doing any further work up for this tumor since nov 2022 (assuming PCP knew about it) it may be considered an error. Physicial exam in march 2023 was "normal" or this was also an error? Any other d...
• Expert Summary: 15 years seeing patients as a physician I have to follow up all results that i ordered on patients and calling them. I do not think i would ever not paid attention to a mass in an US. At least, i wo...
• Similar Summary: I have found incidental findings on patients like lymph nodes, and a follow up is always needed to determine growth or resolution.

Potential negligent treatment of acute pancreatitis resulting in multiorgan failure. (Case #575)

• Medical Probability: 7 / 10
• Medical Error Summary: Not calling the consultants with a severe pancreatitis by level of lipase and also patient was hemoconcentrated by the hematocrit levels, requiring higher level of care such as ICU.
• Causation Probability: 5 / 10
• Causation Summary: Pancreatitis has unexpected results but at the end they call for consultants so difficult to say there was a causation to cause injury because they did call consultants at some point.
• Expert Summary: 15 years expereince in care of nosocomial infections and ICU/ID care.
• Similar Summary: Once a month we see cases like this.