$1,000,000.00 VERDICT AGAINST TREATING PHYSICIAN ONLY - MEDICAL MALPRACTICE - FAILURE TO DIAGNOSE AND TREAT CHRONIC ADRENAL INSUFFICIENCY - FAILURE TO MAKE APPROPRIATE REFERRAL - EIGHT YEARS OF PAIN AND SUFFERING - WRONGFUL DEATH AT AGE 46.

Philadelphia County

The plaintiff in this wrongful-death/survival action alleged the defendant family physician failed to diagnose and treat chronic adrenal insufficiency or to make an appropriate referral. The plaintiff claimed the lack of treatment over an eight-year period resulted in the decedent’s death. An endocrinologist, who performed a consult in 1991 and allegedly failed to follow up his treatment of the decedent, was also named as a defendant in the case. The defendants denied the decedent suffered from adrenal insufficiency and maintained she was appropriately tested and followed.

In 1991, at that age of 29, the decedent was admitted to the hospital with a diagnosis of pneumonia and dehydration. During the course of this admission, the plaintiff’s experts testified, the decedent exhibited clinical signs and symptoms consistent with adrenal insufficiency. An endocrine consult was requested from the codefendant endocrinologist, who tested the decedent’s cortisol (the hormone released by the adrenal glands) with a result of 1.7 ug/dl. The plaintiff’s expert endocrinologist testified the decedent’s cortisol level was diagnostic of adrenal insufficiency.

The plaintiffs contended the decedent’s cortisol test results were not properly recognized nor followed up by the defendant endocrinologist. The decedent was discharged from the hospital several days later. The defendant endocrinologist contended the decedent was discharged with instructions to follow up with him. However, the defendant endocrinologist had no further records of any contact with the decedent nor any effort on his part to contact her.

Instead, the decedent presented to the defendant family physician within days of her hospital discharge. Plaintiff’s counsel called both defendant doctors, as if on cross examination, as the first two witnesses in the plaintiff’s case-in-chief. The defendant family physician admittedly advised the decedent that a follow up visit with the endocrinologist was not necessary, although she was free to see the endocrinologist if she so desired.

Over the next eight years, the decedent was seen by the defendant family physician and colleagues in the defendant’s medical practice on more than 40 occasions. For the majority of these visits, the plaintiff argued, the decedent complained of fatigue, weakness, anorexia, low blood pressure, nausea, vomiting, diarrhea and other such longstanding problems for which there was never a firm diagnosis. The plaintiff’s family medicine expert testified that these symptoms are characteristic of adrenal insufficiency and should have been recognized as such by the defendant family physician.

The plaintiff contended the defendant failed to refer the decedent to an endocrinologist despite the presence of these symptoms and the fact that she also suffered from a hypothyroid condition which could have benefited from similar specified care.

In May 1999, the decedent again experienced a respiratory infection which progressed to pneumonia and she was admitted first to one hospital then transferred on an emergency basis to the Hospital of the University of Pennsylvania, where she died on May 15, 1999. The cause of death was listed as “sepsis.”

The plaintiff contended the decedent’s death was caused by long-standing but undiagnosed chronic adrenal insufficiency. The plaintiff’s experts testified that adrenal insufficiency is a serious medical condition which is potentially fatal when undiagnosed and untreated. But with proper treatment, plaintiff’s experts contended adrenally insufficient patients can enjoy normal lives and life expectancies.

The plaintiff alleged that laboratory studies from the decedent’s final hospital admission documented markedly decreased serum cortisol readings diagnostic of adrenal insufficiency.

The decedent was survived by her husband, two adult children and a grandchild for whom she cared on a daily basis while her daughter worked.

The defense argued that the decedent’s adrenal glands were described on autopsy as “unremarkable,” indicating she did not have adrenal insufficiency. The defendants maintained they tested the decedent for adrenal insufficiency, and the condition was ruled out by a normal response to ATCH infusion over a 24-hour period. The defendant’s endocrinologist testified that the decedent’s cortisol test result of 1.7 ug/dl was not diagnostic of adrenal insufficiency. The defendants contended that the decedent’s death from overwhelming sepsis was not caused by adrenal insufficiency.

The jury found the defendant family physician 100% negligent and found the codefendant endocrinologist not negligent. The plaintiff was awarded $1 million in damages, all on the survival claim.

REFERENCE

Plaintiff’s family practice expert: Yvette Rooks-Worrell from Baltimore, Md. Plaintiff’s neuropathologist: Wayne K. Ross from Lancaster. Defendant’s endocrinologist: Eli Goren from Blue Bell and Joseph Fisher from Huntingdon Valley. Defendant’s critical care specialist: Paul Marik from Pittsburgh. Defendant’s pathologist: Emanuel Rubin from Philadelphia.

Fazio vs. Defendants. Case no. 01-05-659; Judge Gary DeVito, 12-17-03.

Attorney for Plaintiff: Mark W. Tanner of Feldman, Shepherd, Wohlgelernter, Tanner and Weinstock in Philadelphia. Attorney for defendant family physician: William H. Pugh, IV, of Kane Pugh, Knoell & Driscoll in Norristown. Attorney for defendant endocrinologist: Michael O. Pitt of James P. Kilcoyne & Associates in Plymouth Meeting.

COMMENTARY:

The plaintiff’s case against the defendant family physician hinged on the assertion that the symptoms exhibited by the decedent were clearly characteristic of adrenal insufficiency and should have been recognized as such by the defendant. The jury may have given weight to the length of time (eight years) that the opportunities presented for the defendant to diagnosis the cause of her symptoms or to make a referral. The plaintiff’s experts educated the jury regarding the function of the adrenal glands in releasing cortisol to assist the body in overcoming stress and illness and the effects of a deficiency of this hormone. The plaintiff’s expert was ab le to quote from Harrison’s Internal Medicine, which characterizes the symptoms of adrenal insufficiency as “an insidious onset of slowly progressive fatigability, weakness, anorexia, nausea, vomiting, weight loss, hypotension and occasionally hypoglycemia.” This text may have allowed the jury to confidently make the connection between the classic signs of adrenal insufficiency and the decedent’s documented symptoms.

The plaintiff argued that the defendant’s failure to diagnose and treat this very manageable condition caused the decedent eight years of suffering from chronic fatigue and gastrointestinal distress and ultimately caused her death in 1999. Additionally the plaintiff’s case was bolstered by evidence showing that the decedent’s chronic illness posed a heavy burden on her family. The decedent was not employed outside the home and the entire damage award was for the plaintiff’s survival claim.

The defendants made no offers to settle the case.