Our client, a retired small business owner, was suffering from nausea and abdominal pain for several days before being transported to Sentara Leigh Hospital ER on the late afternoon of March 16, 2017. The ER attending physician was employed with Emergency Physicians of Tidewater (EPT) and ordered a blood test, a CT scan of her abdomen, and kept her in the emergency department from about 5:00 p.m. until 12:30 in the morning. The patient record reflected no ultimate diagnosis but the doctor provided patient instructions for her to follow up with her PCP and to see a gastroenterologist for her abdominal pain even though the CT scan was negative. In fact, our client was suffering low-moderate hyponatremia, which is a medical condition caused by abnormally low sodium in the body, and the blood test flagged the low sodium result of 122 but no medical intervention occurred, despite the serious potential consequences of hyponatremia, which can be life threatening.

During a deposition conducted by our law firm, the defendant ER doctor – for the first time – claimed she verbally explained to our client and her husband that the blood test came back showing moderate hyponatremia, though our client’s husband denied in his later testimony this ever occurred. However, no part of the emergency room patient records reflected that the doctor noted the low sodium blood test result, diagnosed hyponatremia, or had given specific patient instructions about the dangers of low sodium. Pat followed up with her PCP as directed and at the office visit on March 22nd never mentioned low sodium or hyponatremia and, the physician’s assistant with the PCP also never made any notes about “low sodium.”

About 11 days after she left the emergency room without being diagnosed, on March 28th, Pat was discovered neurologically unconscious by husband, on the floor of their kitchen, having suffered a seizure in her home. Blood was running down her face from a cut above her right eye, and it appeared she had fallen and smashed her head on the hard floor, before suffering what was diagnosed as a closed head injury, concussion, with a confirmed traumatic brain injury. The rescue squad took her back to the same Sentara Leigh emergency department where the earlier blood test was done, and now revealed her sodium was 114 which is categorized as “profound hyponatremia.” Because of the serious brain injury, she was transferred to Sentara Norfolk General Hospital where the brain damage was treated over a course of many days and, the doctors struggled to restore her sodium level to a normal level, and carefully restored a normal sodium level over more than a week. Doctors are careful not to elevate the sodium too quickly, as this can also cause brain damage. The CT scans of her brain revealed subdural hematoma, intraparenchymal bleeding, and a 3-to-5-millimeter shift of her brain from the right toward the left side of her skull verifying her traumatic brain injury (TBI). She was hospitalized for about 11 days and then transferred to Harbors Edge rehabilitation facility where she was taught how to walk, again, how to talk and form words more confidently without undue delay, and how to restore functions of daily living. She also underwent outpatient therapies for the next several months but was left with serious cognitive deficits and the permanent effects of her brain injury. She suffers memory loss and could not recall any details of the first ER visit where the ER doctor claimed to have “verbally” diagnosed her low sodium condition.

Key Legal Strategies

One of the key issues to develop with our expert witness emergency physicians was the standards of care for maintaining an ER patient record, given that nothing about a hyponatremia diagnosis was found in the medical record. They advised us that besides taking a history and physical, a doctor must correlate the test results, provide a written diagnosis of important medical conditions, and provide written patient instructions that disclose the key medical conditions that have been discovered or diagnosed. These doctors advised us that the patient medical chart was deficient, and the patient should have been admitted to the hospital to medically adjust the low sodium condition back to normal, which could take days, not hours. Both the retained emergency physicians, one from northern Virginia, and one who practiced at Duke in North Carolina, stated that the ER doctor failed to follow the standards of care by not recording the diagnosis, by not noting the important hyponatremic condition at the time of discharge, and not providing this information in the written patient instructions. A neurologist also testified that her March 28th seizure resulted from the undiagnosed hyponatremia.

The ER doctor and her group retained two emergency physicians from Washington, D.C. to testify that she did not violate any standards of care in question, and the defense called two or three physicians who testified that our client did not suffer a hyponatremic seizure on March 28th. All doctors, however, admitted our client suffered a traumatic brain injury, but the defense contested that it was a “seizure” or a result of the severe hyponatremia at all.

Outcome

The trial lasted 8 days and involved more than a dozen witnesses. The ER doctor and her group continued to maintain that she provided appropriate ER patient care and a verbal diagnosis of hyponatremia, and questioned whether the seizure was “something else” and not a hyponatremic seizure, pointing to other possibilities. The expert witness doctors for our client testified that profound hyponatremia was clearly diagnosed upon her admission to Sentara Norfolk General Hospital and that the medical evidence strongly indicated the hyponatremia event or seizure led to her striking her head on a hard surface, which in turn caused her permanent TBI related cognitive deficits.

The jury deliberated over 8 hours before returning a $1.6 million verdict on October 1, 2021, in favor of our client.