a-h-op7 Rodman versus Stephens Background Facts: On March 1, 1999 Ms.

Marcia Rodman went to the emergency room of the Mt. Washington Hospital around 8 PM. Ms. Rodman complained of severe abdominal pain, which she had been experiencing for approximately 12 hours. Early in the day Ms. Rodman was not alarmed by the discomfort, because her children had the intestinal flu, and Ms. Rodman figured that she was now coming down with it. However the pain worsened during the course of the day. The physician on duty at the hospital’s emergency room was Dr. Robert Stephens, whose specialty was internal medicine. Dr. Stephens had been on the staff at Mt. Washington Hospital for eleven years. Dr. Stephens asked Ms. Rodman about her medical history. Ms. Rodman had not had anything to eat during the prior 24 hours and had vomited three times during that time. Dr. Stephens performed a physical examination and ordered several lab tests. Upon physical examination, Ms. Rodman’s temperature was 100.5, she had a pulse of 106, her blood pressure was 132/76, and there was tenderness in the lower right quadrant of the abdomen. She stated that the pain seemed to ease when she lied down in bed. Upon lab evaluation, she had a slightly elevated white blood count (10,500). Dr. Stephens initially thought that Ms. Rodman had acute appendicitis, but he noted that Ms. Rodman did not have a few symptoms that usually accompany appendicitis. First, lab tests showed that Ms. Rodman did not have a neutrophil count of more than 75%. Second, the pain associated with appendicitis usually starts in the area directly above the stomach and then moves to the lower right portion of the abdomen. In Ms. Rodman’s case, the pain began and remained in the lower right quadrant. Third, Ms. Rodman did not exhibit the symptom called “rebound tenderness.” This is defined as the patient experiencing pain after the doctor applies and then releases some hand pressure on an area of the stomach. Stephens was unsure whether to arrange for a surgeon to perform an appendectomy, because he was not certain concerning the diagnosis of appendicitis at that time. He decided to calculate the “Alvarado Score. To use this score a physician merely adds up points from the physical examination and lab tests. Here’s how the Alvarado Score works. Migration of pain from center to lower right quadrant Anorexia Nausea-vomiting Tenderness in lower right quadrant of abdomen Rebound pain Elevation of temperature White blood count above 10,000 Neutrophils of more than 75% 1 point 1 point 1 point 2 points 1 point 1 point 2 points 1 point

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Therefore Dr. Rodman. decided to sue Dr. Unfortunately Ms. She had to remain in the hospital for 12 days. Unfortunately when the surgeon examined the appendix. Stephens called for a surgeon. Stephens thought that there was some chance that Ms. she had to remain at home in bed for two more weeks. Ms. Alan McCauley. he decided to follow the recommendation of the Alvarado Score. Then you will hear the testimony of Dr. Rodman’s attorney): What are your qualifications. four days of which she spent in the intensive care unit. Stephens was negligent in not making the correct diagnosis of no appendicitis when Ms. The Beginning of the Lawsuit Ms. and loss of wages caused by the extensive infection. Monteith’s Testimony (expert witness on behalf of Ms.” Although Dr. He therefore did not remove it. All persons agree to the facts in this case. Stephens for malpractice. Rodman could then have been spared the expense. Arthur Monteith. Rodman. which incapacitated Ms. you will hear the testimony of Dr. Her score was 7. he noted that it was perfectly healthy. A score of 7 or 8 indicates a probable appendicitis. Ms.If the total points a patient has is 4 or less. Dr. who is testifying on behalf of the plaintiff. The only dispute is whether Dr. the appendectomy was quickly scheduled. no operation would have taken place. and the surgeon began the operation within the hour. Dr. First. Had the correct diagnosis been made. Leslie Maxwell. She returned to work a week later. Stephens calculated the Alvarado Score for Ms. which is “probable appendicitis. the person’s condition is not compatible with the diagnosis of acute appendicitis. Rodman developed a very serious post-operative infection. so there would have been no post-operative infection. There are two “expert witnesses” in the case. pain.] Dr. Dr. Rodman first appeared in the emergency room. suffering. After being discharged from the hospital. Rodman’s attorney. Stephens’ failure to make the correct diagnosis. Rodman) Question (from Ms. Rodman for several weeks. Rodman did not have appendicitis. A score of 5 or 6 is compatible with the diagnosis of acute appendictis. Evidence The following is an edited version of the information that was obtained during the trial. Rodman contacted an attorney to determine what her legal rights were and also to determine if she deserved any compensation due to Dr. [THE DVD STARTS HERE. A score of 9 or 10 indicates a very probable appendicitis. Monteith? 2 . Ms. Stephens. who is testifying on behalf of the defendant.

Ms. First. I’d say the diagnosis of appendicitis would have been only “somewhat likely” at that time—not probable enough to go ahead with the operation. the fever was not unusual. I have been practicing in this community for over thirty years. then obeying the Alvarado Score represents “cookbook medicine.” Question: Should an appendectomy be scheduled even if there is a suspicion of appendicitis? Answer: It’s a matter of degree. it is typical. in my opinion. a physician should not schedule an appendectomy. Question: Did Ms. Stephens’ attorney): Isn’t it typical for a patient suffering from appendicitis to have anorexia? Answer: Yes. Stephens meet the standard of care in mistakenly diagnosing appendicitis when Ms. If the appendicitis is not very likely. Third. Ms. and abdominal pain is not unusual with intestinal flu. Second. Rodman appeared in the emergency room on the evening of March 1? Answer: In my opinion he did not. It cannot substitute for the physician’s own good judgment. it is. 3 . Question: Isn’t it typical for a patient suffering from appendicitis to have nausea and vomiting? Answer: Yes. Rodman did not have a neutrophil count of more than 75%. Rodman’s case. did Dr. In Ms. I don’t think the diagnosis of appendicitis could be considered “very likely” on the evening of March 1. If a physician can diagnose intuitively. Question: What is your opinion of the Alvarado Score? Answer: The Alvarado Score is a way of helping a physician make a decision as to the likelihood of appendicitis. the pain began and remained in the lower right quadrant. Furthermore some symptoms that usually accompany appendicitis were not present.Answer: I am a board-certified gastroenterologist. Ms. Question: In your professional opinion.” which is inferior. Rodman did not exhibit the “rebound tenderness. the pain associated with appendicitis usually starts in the area directly above the stomach and then moves to the lower right portion of the abdomen. It merely provides a way of summarizing the information into one score. she did. Rodman have “anorexia?” Answer: Yes. I have been called as an expert witness in two prior court cases. Given the fact that her children had intestinal flu. Rodman’s vomiting and failure to eat were not surprising given the intestinal flu going around in her family. Question (cross-examination from Dr.

Question: In your professional opinion. I have testified as an expert witness in this court three previous times. it can be helpful. Rodman didn’t have appendicitis. Question: Besides the flu and appendicitis. Rodman have a nausea and vomiting? Answer: Yes. These other diseases could be treated even if Ms. Rodman appeared in the emergency room on the evening of March 1? Answer: In my opinion he did. Answer: It is true that ovarian cysts usually require surgery. many of the other possible diagnoses would have 4 .Question: Did Ms. it was. Stephens) Question (from Dr. Dr. McCauley? Answer: I am a board-certified gastroenterologist. There were other possibilities. Rodman did not have appendicitis. Stephens’ attorney): What are your qualifications. it is typical. Did Dr. Even if Ms. McCauley’s Testimony (expert witness on behalf of Dr. she did. Enough signs and symptoms were present for Dr. I have been the head of my department for ten years. Dr. Question: Isn’t it typical for a patient suffering from appendicitis to have tenderness in the lower right quadrant of the abdomen? Answer: Yes. Stephens meet the standard of care in diagnosing appendicitis when Ms. what other diagnoses might have been possible on the evening of March 1? Answer: Acute mesenteric adenitis and ovarian cyst were two other possibilities. Acute mesenteric adenitis generally does not. she did. Dr. Question: Did Ms. Question: Can the Alvarado Score be helpful in diagnosing appendicitis? Answer: Yes. Question: Don’t these require surgery. Question: Wasn’t the Alvarado Score consistent with the diagnosis of appendicits? Answer: Yes. in my opinion. Stephens’ decision to schedule the appendectomy would have helped discover these other diseases. Rodman have tenderness in the lower right quadrant of the abdomen? Answer: Yes. and if so. too. Stephens to have concluded that appendicitis was a likely diagnosis.

Of course. Once these symptoms were apparent. Rodman probably had appendicitis. she didn’t. Ms. she didn’t. Question: Isn’t it typical for a patient suffering from appendicitis to have pain “migrate” from the area above the stomach to the lower right quadrant? Answer: Yes. Answer: Yes. and it was in this case. Rodman “probably” had appendicitis. she had a fever. In my opinion the standard of care requires that a physician should operate when this many symptoms were apparent. Rodman had appendicitis and proceeding with the appendectomy. why should a diagnosis of appendicitis have been easy to make on the evening of March 1? Answer: The most important signs and symptoms were present. Stephens to wait until he was “sure” Ms. it is typical. Stephens to the fact that Ms. she’d been vomiting. Question: Isn’t it typical for a patient suffering from appendicitis to have a neutrophil count of more than 75%. Question: Did Ms. Question: In your professional opinion. there is a danger that the appendix might soon rupture. Question: Did Ms. it is typical. Rodman had an elevated white blood count. There’s too much to lose and not much to gain by waiting for a certain diagnosis. Rodman’s attorney): Isn’t it typical for a patient suffering from appendicitis to have “rebound pain. and she hadn’t wanted anything to eat. Rodman had appendicitis? Answer: It’s too dangerous to wait. Question (cross-examination from Ms. Why wasn’t it proper for Dr. 5 . it is. it is helpful. Question: You say that Ms. because the Alvarado Score can indicate whether appendicits is probable.” Answer: Yes. Rodman have a neutrophil count of more than 75%? Answer: No. a ruptured appendix spreads infection throughout the abdomen. she had tenderness in the lower right quadrant of her abdomen.involved an operation anyhow. These should have been sufficient to alert Dr. Therefore there was really little to lose by assuming that Ms. Rodman have “rebound pain?” Answer: No. Question: Isn’t it generally helpful for a physician to obey the diagnosis recommended by the Alvarado Score. Answer: Yes.

He should not be found guilty of malpractice because he asked a surgeon to perform an appendectomy when Ms. Is the Alvarado Score 100% accurate? Answer: No. Stephens is guilty of medical malpractice. Rodman’s case was not difficult. Rodman really did not have appendicitis. Stephens should have known Ms. Ms. Unnecessary surgery causes discomfort and great expense. Dr. Lawyer for Ms. Rodman did not have appendicitis when she first appeared in the emergency room on the evening of March 1. What we do contest is the assertion that Dr. Rodman have pain “migrate” from the area above the stomach to the lower right quadrant? Answer: No. Dr. and there is always the risk of complications. Rodman had several symptoms not consistent with appendicitis. Rodman was unnecessarily exposed to a serious infection due to the unnecessary operation. and Ms. it isn’t 100% accurate. Rodman would have been sent home. Stephens made the correct diagnosis on the evening of March 1. Rodman Ms. Stephens We do not contest the fact that Ms. she didn’t. Question: You testified that calculating the Alvarado Score would have been helpful. plus her very substantial pain and suffering. Rodman should be compensated for her medical expenses. We believe that Dr. Stephens did not meet the standard of care expected of physicians. Therefore we believe Dr. life-threatening infection. The facts are quite straightforward: Ms. We do not contest the fact that she became very ill due to the unnecessary operation. Had Dr. her lost wages. Stephens’ behavior was consistent with the standard of care when he told Ms. which occurred in this case. Ms. Medical malpractice is defined as the failure of a health care professional to exercise on behalf of a patient the knowledge. and there would have been no serious. Judge’s Instructions to Jurors The issue in this case is whether Dr. Stephens is sorry that he did not diagnose her correctly. and skill and standard of care commonly 6 . ability. Arguments to the Jury Lawyer for Dr. Stephens should be held responsible for his failure to diagnose correctly. No one recommends surgery for intestinal flu. Several symptoms often present in cases of appendicitis were present. but he was looking out for Ms. It cannot guarantee the correct answer. Rodman that she had appendicitis. Rodman’s best interests by consulting a surgeon to perform the appendectomy.Question: Did Ms. Rodman first appeared in the emergency room. Stephens is guilty of medical malpractice. Dr. It provides valuable guidance.

because he would not be deserving of any punishment. You should circle the number which indicates your view. On this scale you would indicate how deserving Dr. If you decide that Dr. then you should vote “not guilty of malpractice” on your ballot. Stephens did meet this standard. You should now indicate your verdict for Dr. Stephens is not guilty of malpractice. You should consider the facts of this case and decide if Dr. 7 .applied by similar members of the profession. Stephens is of financial punishment. If you decide that Dr. then you should vote “guilty of malpractice” on your ballot. Stephens is guilty should you go on to the rating scale. Stephens. if you think Dr. Stephens did or did not meet this standard. Of course. Only if you decide Dr. Only if you think he is guilty of malpractice should you use the rating scale. Stephens failed to meet this standard. you would not use the rating scale at all.

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