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Failure to Treat Diverticulitis in ER

Filed under Emergency Room

The Ibb Case

This is a case involving a healthy 54 year-old male, Thomas Ibb, who presented to the Hospital for a CT scan on the advice of his PCP for signs and symptoms of diverticulitis. The CT scan confirmed that Mr. Ibb had acute diverticulitis. After his PCP learned of the CT scan result, she instructed Mr. Ibb to immediately return to the Hospital ER. Mr. Ibb did, however he was never examined by a medical doctor; instead, Mr. Ibb was examined only by a physician’s assistant who discharged him to home. The next day, Mr. Ibb returned to the ER, was examined and admitted for emergency colon surgery (colon resection with colostomy). With proper care and treatment the day before, Mr. Ibb would have avoided this emergency surgery and resulting problems.

On April 11th, Thomas Ibb, a healthy 54-year old male, had an appointment with his PCP. Since Mr. Ibb had symptoms of diverticulitis, including pain, poor appetite, constipation, and urinary symptoms, the PCP scheduled Mr. Ibb for a CT scan on April 13th at a local Hospital.

On April 13th, as instructed, Mr. Ibb had an out-patient CT scan performed at a local Hospital; the procedure ended at 12:01 pm. Shortly thereafter, the CT scan was interpreted by a radiologist. The radiologist’s impression was “findings most consistent with acute diverticulitis.” The results of the CT scan were then telephoned to the PCP. Due to Mr. Ibb’s previous symptoms and the severity of the CT scan results, the PCP called Mr. Ibb and was in disbelief that he was discharged and not admitted. The PCP advised Mr. Ibb to immediately return to the Hospital emergency department.

As instructed, Mr. Ibb went the Hospital emergency department, where he was examined by a Physician’s Assistant (the “PA”). Although there was a physician in the ER that was the PA’s supervising physician, he never examined Mr. Ibb. During his exam, Mr. Ibb suggested to the PA that she should contact the radiologist to discuss his condition. The PA advised Mr. Ibb that instead, she would contact the PCP. The PA then proceeded to examine Mr. Ibb and placed him on antibiotic therapy.

During or around this time, while Mr. Ibb was still in the emergency department, the PCP telephoned Mr. Ibb on his cell phone concerned over his condition. During this phone conversation between Mr. Ibb and the PCP, Mr. Ibb advised the PA that he had the PCP on the phone and suggested that the PCP and the PA speak to one another. According to Mr. Ibb’s testimony, the PCP and the PA then spoke on the cell phone about Mr. Ibb’s condition; the PCP told the PA that Mr. Ibb should be admitted. Rather than admit Mr. Ibb for his acute diverticulitis, the PA discharged him around 7:18 p.m. that evening with prescriptions for Flagyl and Cipro (Mr. Ibb’s pharmacy closed at 7:00 pm, so he could not get his prescriptions filled that night), a restriction to a clear liquid diet for 24-hours, and instructions to follow-up with his PCP in 2-4 days. Although it was undisputed that Mr. Ibb was never examined or seen by a medical doctor during this entire ER visit, the physician signed off on Mr. Ibb’s exam and discharge.

As instructed, Mr. Ibb went home, and the next morning, on April 14th, his pain became more intense. Mr. Ibb’s wife, Patricia Ibb, telephoned the Hospital’s emergency department and was advised that if her husband’s pain got worse, to either take him to his PCP or return to the emergency department.

Later that day, Mr. Ibb’s pain got worse so he returned to the Hospital emergency department. Mr. Ibb’s examination revealed a low grade temperature, severe abdominal pain with peritonitis in all four quadrants, and a white blood count of 25,000 with left shift. Another CT scan of the abdomen was performed which revealed intra-abdominal free air with free fluid and worse inflammatory changes. An emergency surgical consult was called and a surgeon was called to the emergency department.

Mr. Ibb was then taken to the operating room where the surgeon performed an emergency laparotomy and found Mr. Ibb to have a large phlegmonous mass in the left lower quadrant that contained the site of the perforation with numerous diverticula suggestive of a perforated sigmoid diverticulitis. The surgeon also proceeded with a sigmoid colectomy, end colostomy (Hartmann procedure), and insertion of JP drains. Subsequent to the surgery, Mr. Ibb remained in the Hospital Intensive Care Unit for seven days and another three days in recovery.

Due to his age, the risks, and a general fear of another surgery, Mr. Ibb chose to forego the reversal of the colostomy bag, until development of a hernia began to interfere with his colostomy function. A colostomy reversal was subsequently performed years later. As a result, Mr. Ibb has 4-6 bowel movements per day, a weight restriction on things he can lift (which impacts his employment as a general contractor), tenderness of the left abdomen surgery site, and risk of recurrent hernia and small bowel obstructions from adhesions.

We sued the Hospital, the PA, and the supervising ER physician based on their failure to admit Mr. Ibb on April 13th and begin appropriate intravenous antibiotic therapy (a Hospital is vicariously liable for the actions of its employees). This negligence and delay in treatment eliminated a substantial chance that Mr. Ibb would avoid such a drastic colon resection surgery with colostomy and ensuing problems.

After a jury was selected, the case was settled for a substantial sum.