A patient died following a medication mixup in an understaffed medical ICU. A large settlement was reached on behalf of the RN who administered the wrong dose of the wrong medicine.

A cholecystectomy patient alleged that mishandling of her post-operative calls to the surgical practice and lack of follow-up caused her post-operative complications. Like many cases, how the surgical practice communicated with the patient after a complication occurred was a key aspect.

Parents alleged that a delayed diagnosis of a foreign body in their child’s nose caused preventable nosebleeds, nasal infection, nasal septal perforation, and the need for surgery. The malpractice claim named the pediatric group, two pediatricians, and a pediatric nurse practitioner, and was settled in the low range.

A patient sued her hand surgeon, claiming the surgical approach increased the chance that their finger wouldn’t fully heal from a prior fracture. The defense leaned on contemporaneous clinical notes and documentation of the consent process to achieve a defense verdict.

A 68-year-old male was admitted to the hospital after falling on ice and feeling short of breath. Two days after discharge, the patient arrived by ambulance at another hospital in septic shock. The patient filed a claim against the hospital, alleging that the failure to communicate a critical lab result required readmission and several weeks of follow-up treatment.

A 30-year-old woman experiencing her first pregnancy, presented to the Labor and Delivery unit. She was given the wrong drug and required an emergent C-section. The “five rights” of medication administration focuses on individual factors and not necessarily on system flaws. Many organizations are also promoting just culture, which encourages reporting near-misses and patient safety events, and focuses on psychological safety and promoting a non-punitive reporting culture.

A patient was imaged for abdominal pain, but the radiologist saw and reported an incidental finding of a nodule on the lower lung that was not pursued or revealed to the patient for 2 years. The cancer had metastasized, and the patient died from lung cancer 18 months later.

The patient’s family alleged that improper management of the patient under anesthesia resulted in cardiorespiratory arrest, permanent brain damage, and a persistent vegetative state. While the cause of the patient’s cardiac arrest is uncertain, the CRNA failed to note which medications and doses were administered during the procedure, and the case was settled for more than $1 million.

When hospitals and medical practices face charges of discrimination from employees, the consequences can include litigation, large payments, morale problems, and less quality care for the patients they serve. How an employer responds can make all the difference in outcomes. Based on closed claims in the Harvard medical system, two cases illustrate that point. We interview Megan Kures, of Hamel, Marcin, Dunn, Reardon and Shea, who offers some principles to follow.

One thing that seemed to be missing in this particular evaluation was a formal differential diagnosis that may have been present in the physician’s brain, but wasn’t documented, and there’s no evidence that it was really thought about.