Legal battle after kidney stones lead to amputation

June 2, 2009 2:52:32 PM PDT
When Lisa Strong, now 45, went to the emergency room in the early morning hours with back pain from a kidney stone she hardly imagined that she'd leave four months later as a quadruple amputee.

"I was on a respirator in the ICU and I don't remember the first 10 days," said Strong, of Davie, Fla. Her then-husband and two young children had waited anxiously for a diagnosis or any good news as Strong battled septic shock, lived through surgery and then survived multiple heart attacks.

She got a diagnosis, "but at that point they didn't know I would be losing my hands and feet," said Strong.

Over the next month Strong watched the black "line of demarcation" as doctors called it inch up her fingers and toes signaling just how much of her limbs she would lose.

"My hands were black, it was as if I stuck them in a fire. The line moved very slowly, and it was very painful burning," said Strong. "I thought if I exercised a lot I could get life back into my limbs."

That was in 2004. Five years later Strong's tale of miscommunication, missed opportunities and tragedy has taken another twist.

Broward County Circuit Judge Charles M. Greene has thrown out a jury's 2006 not-guilty verdict in Strong's malpractice suit against nurses and three doctors in charge of Strong's care. According to the National Center for State Courts, judges set aside less than one-half of 1 percent of jury verdicts in civil trials nationwide in 2005, the most recent year for which complete statistics are available.

Now the emergency room physician and the doctor who admitted her to the hospital must again explain exactly what happened during the 16 hours after Strong claims she said she had a kidney stone, and doctors diagnosed her with a kidney stone.

"I walked into the hospital and told the triage nurse I have a kidney stone, I have a history of kidney stones and that I was a 10 on the 1 to 10 pain scale," said Strong. "After I talked with the triage nurse I started throwing up & I don't remember a lot after I started throwing up."

Lawyers agree on a rough timeline of events. Strong came into the hospital between midnight and 2 a.m., vomiting and with a fever and she told the nurse about her pain and her kidney stones.

By 4 a.m. the emergency room physician saw her and ordered an ultrasound. By 5, Strong had gone into septic shock -- the body's fighting attempt to keep the brain and vital organs alive.

Strong then bounced from an emergency room doctor's care, to the care of an off-site internist, to waiting for three hours more for a doctor's care, to a doctor who showed up late for a shift, to a surgeon's care and then into an exploratory abdominal surgery that did not diagnose the problem.

Finally, around 4:30 p.m. the next day, two doctors used a CT scan to diagnose Strong with a kidney stone that had been blocking her kidney and causing the deadly infection to circulate in the blood stream.

In the end, all agree Strong ended up waiting too long in the hospital for hours on vasopressors -- medicine that would save her life, but endanger her limbs the longer she went without a proper diagnosis.

A jury decided neither the nurses, nor the surgeon, nor the emergency room physician Dr. Laurentina Kocik, nor the internist Dr. Jason Strong, was to blame.

But Judge Charles Greene disagreed. In his order to overturn the jury's decision, he wrote, "While all defendants argued that Dr. Sharma (a doctor not sued in the case) was negligent and that her negligence caused injury to plaintiff, the jury heard evidence that both Dr. Kocik and Dr. Strong were negligent."

In those early morning hours, Dr. Kocik had stabilized Strong just before the end of her shift, and telephoned internist Dr. Strong, who was ending his shift off of hospital grounds around 6:30 a.m., lawyers for the two said.

"That's very normal, that it was over the phone," said Mark Rosen, attorney for Dr. Strong.

All lawyers agreed on that point. But what was said, assumed, or not said during that phone call has been a matter of intense debate.

Dr. Kocik claimed she said over the phone that she thought the patient likely had a kidney stone rather than a gall bladder problem, but Dr. Strong said he heard the patient likely had a gall bladder problem, not a kidney stone, according to Judge Charles Green's order on the plaintiff's motion for a new trial.

"Dr. Strong's theory was that for some reason, after 30 years experience, Dr. Kocik was dumb and didn't know how to talk on the telephone," said James Nosich, attorney for Dr. Kocik.

Whatever was said, even more confusion ensued after the doctors hung up the phone -- each ended their shifts with no new doctor taking charge.

Green wrote "that no doctor was administering care to plaintiff because Dr. Kocik had gone off shift and left the hospital: Dr. Strong never came to the hospital; and Dr. Sharma arrived about three to four hours late for the start of her shift."

Nosich said the statue of limitations has passed for Strong to also sue Dr. Sharma, whose first name was not given by lawyers involved.

But as she waits for the possibility of the next trial, Str

ong said she hopes her trial will somehow help another person in the future.

"Hopefully, it's that this never happen to anybody again," said Strong. "I'm just hoping that some good will come out of all this."

Dr. Marie Savard, an ABC News medical contributor, said that while patients can't control everything, there are some key tactics that can be used to prevent delays and avoid an emergency room misdiagnosis.

"Never go it alone, identify what I call a health buddy somebody -- who's going to be that squeaky wheel," said Savard.

Savard said it's important for patients to realize that they are their own advocates in the healthcare system and one of the best things they can do is to take charge of their personal medical records.

"We often say 80 percent of the accuracy of your diagnosis comes from your past history," said Savard.

Unfortunately, Savard said most people don't have cradle-to-grave medical records, or any medical records that would be readily accessible to the emergency room staff. Savard said calling your family doctor and trying to involve him or her is a good first step in getting the right diagnosis. An alternative would be to bring a copy of some medical records with you.

"I always say, it's your health that's on the line. Mistakes are made. Doctors are human, at the end of the day this is not like a pilot, where you trust the pilot 100 percent of the time with your life," said Savard. "Her [Lisa Strong] insurance card got her in the door, it's your personal information and your advocate who you know that can save your life."

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