Articles Posted in Failure to Diagnose

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Failure to diagnose an acute thoracic aortic dissection (TAD) represents one of the most catastrophic errors in emergency medicine. Despite being a rare condition—with an estimated annual incidence of 3–4 cases per 100,000 people—its mortality rises by approximately 1–2% per hour after symptom onset if untreated. This white paper examines the intersection of clinical oversight and medical malpractice, focusing on failure to rule in or rule out an aortic dissection during initial emergency presentation. Drawing from clinical literature and legal precedent, it explores diagnostic standards, systemic failures, and medico-legal accountability.

Introduction

An aortic dissection occurs when a tear in the intimal layer of the aorta allows blood to enter the media, creating a false lumen and threatening rupture or organ ischemia. Early recognition is essential, as delayed or missed diagnosis accounts for up to 38% of pre-hospital deaths. In the context of medical malpractice, the failure to consider or exclude aortic dissection in the differential diagnosis of acute chest pain is among the most litigated errors in emergency care.

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Executive Summary

Differential diagnosis is the backbone of safe and competent medical practice. It is not merely a clinical formality. It is a structured, legally significant process that requires physicians to consider, prioritize, and rule out potential causes of a patient’s symptoms. When a life threatening condition appears on a differential diagnosis, the standard of care requires that it be affirmatively ruled out within a reasonable time frame. Failure to do so may constitute medical negligence.

This white paper examines the legal and medical intersection of differential diagnosis, index of suspicion, and malpractice exposure. It explains how breakdowns in clinical reasoning lead to preventable harm and why such failures frequently form the basis of claims handled by a misdiagnosis lawyer or failure to diagnose lawyer. It also highlights the role of experienced counsel such as Goldberg & Goldberg LLC and trial attorney Ian Alexander in litigating these complex cases.

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Birth asphyxia and hypoxic ischemic encephalopathy represent two of the most serious medical conditions associated with preventable birth injury. In Cook County Illinois and throughout Chicago Illinois, these conditions continue to raise both medical and legal concerns when failures in obstetric care contribute to long term neurological damage.

This white paper examines the medical relationship between birth asphyxia and hypoxic ischemic encephalopathy, outlines risk factors and standards of care, and discusses how families in Cook County Illinois can seek accountability through experienced legal representation such as Goldberg & Goldberg, LLC. The goal is to provide a clear, evidence based framework for healthcare professionals, legal practitioners, and affected families.

Introduction

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Introduction: Protecting Your Newborn’s Rights After a Birth Injury

Bringing a child into the world is supposed to be one of life’s happiest moments, but when complications occur, especially if your newborn suffers an injury at birth, shock and uncertainty can follow. For many families, birth injuries lead to significant emotional and financial challenges. If you suspect your child has suffered an injury during delivery, knowing your next steps can make a world of difference.

As a trusted Chicago Illinois personal injury law firm, Goldberg & Goldberg has helped countless families navigate the complexities of birth injury claims. In this guide, we break down what you need to do immediately, how to protect your child’s health, and why legal support is critical.

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Understanding the Real Meaning of Trial Work

Trial work is more than standing before a jury and delivering sharp arguments—it’s the art and discipline of guiding a case from uncertainty to clarity. At its heart, trial work is a blend of preparation, persuasion, and performance. It’s the work that tests a lawyer’s instincts, judgment, composure, and command of the law.

Good trial work has always been about more than theatrics. The real craft lies in understanding how facts, people, and law interact once a case steps into a courtroom. A trial lawyer lives in that intersection, translating complexity into narratives that judges and juries can not only follow, but believe.

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For over 50 years the lawyers at Goldberg & Goldberg, LLC have represented the victims of Birth Injury and Birth Trauma caused by the hands of doctors and hospitals.  Over that period of time, we have learned a thing or two about birth injuries, how they occur, what impact they have on the victim over a lifetime and how to litigate birth injury cases.  This blog post is an effort to educate the families of the victims of birth trauma on how to proceed with a birth injury or birth trauma lawsuit.

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  1. NOT ALL LAWYERS ARE CREATED EQUAL:  This might sound snobby, and we apologize if it does, but as obvious as this statement is, most people do not know how to spot someone who has expertise in birth injury litigation and someone that doesn’t.  The internet has allowed a class of lawyers to develop that are only interested in advertising their services in order to find cases to refer to other lawyers who actually know how to handle these cases.  In the City of Chicago, there are very few lawyers that have the competency and financial resources to handle a birth injury case.  Internet lawyers advertise for birth injury cases in the hopes of referring them to a lawyer that knows what he/she is doing and getting a percentage of the fee.  These lawyers do not actually handle their own cases.  How do you avoid these lawyers?  Ask the right questions.  Ask them to show you examples of settlements and verdicts that they have obtained as lead counsel.  If it walks like a duck and quacks like a duck, it is usually a duck.  The same can be said about trial lawyers.
  2.  WHY CAN’T I DO THIS ON MY OWN?:  In almost all cases you need a lawyer to handle a birth injury case on behalf of your injured friend or loved one.  Birth Injury cases are some of the most complex and difficult cases a lawyer can handle.  The medicine is complex and the lawyers hired by the hospitals and doctors are sophisticated.  Regardless of what risk management at the hospital might tell you, if you attempt to handle a complex matter like a birth injury case on your own, you will not be treated fairly.  Hire a lawyer early to protect your rights.
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A recent study published in Pediatric Reseach documents the relationship between abnormal PCO2 and unfavorable outcomes in infants suffering from hypoxic ischemic encephalopathy.  The object of the study was to determine if hypocapnia could be correlated with adverse outcomes in infants with moderately severe to severe hypoxic ischemic encephalopathy.

The study utilized 234 instances of hypocapnia to determine if there was independent predictive value in data concerning abnormal PCO2 levels and abnormal outcomes for these children.  The studies authors determined that there is independent predictive value in the relationship between hypocapnia and adverse and unfavorable outcomes.

The authors of the study determined that future studies of normocapnia will be important in determining the extent of the relationship between abnormal PCO2 and adverse outcomes in infants with moderately severe to severe hypoxic ischemic encephalopathy.

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The Illinois Appellate Court, First District has decided that when a plaintiff dies during medical malpractice litigation, even after the statute of limitations has run, the estate can add a wrongful death claim.  Previously, plaintiffs were faced with inconsistent statutes which made this scenario unclear.  In Lawler v The University of Chicago Medical Center Justice Delort, writing for the appellate court, resolved this conflict in favor of justice for the victims of medical malpractice.

The court found that since the defendants were on notice of the claim for medical negligence brought by Ms. Prusak before her untimely death that same complaint was not barred by the expiration of the statute of limitations or repose simply because her death claim did not accrue until after the expiration of the same because the original claim was filed within the statute.

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In 2003 the American College of Obstetricians and Gynecologists(ACOG), along with the American Academy of Pediatrics, published Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology (“NEACP”). This monograph became more commonly known as “the Green Book” and it has been roundly criticized as an attempt by its authors to use “junk science” to create hard an fast “essential” criteria to diffuse obstetrical malpractice claims against Ob/Gyns. In the more than 10 years since its publications its authors have backed off the allegedly essential nature of its core criteria and physicians have been forced to admit that factors like cord blood ph levels above 7.0 can still occur in births where the fetus experiences perinatal asphyxia that is the result of negligence.

Recently, ACOG published an update to the Green Book titled Neonatal Encephalopathy and Neurologic Outcome, Second Edition. This update changes some of the so-called “essential” criteria that expert witnesses have relied upon to defend causation in birth injury cases.

The update defines Neonatal Encephalopathy as a clinically defined syndrome of disturbed neurologic function in the earliest days of life in an infant born at or beyond 35 weeks of gestation, accompanied by early onset seizures and difficulty initiating and maintaining respiration and depression of fetal tone and reflexes. The update relaxes the criteria which obstetricians and pediatricians feel demonstrate the likelihood of peripartum or intrapartum ischemia playing a role in the pathogenesis of neonatal encephalopathy.

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Abbott Laboratories best selling drug, Humira, has been linked to a host of serious side effects, including severe neurological injuries. Abbott’s is on track to sell $15 billion worth of the drug per year by 2015. Abbott already expects to sell close to $10 billion worth of Humira in 2012. Humira is used to treat a variety of rheumatological conditions, including, Rheumatoid Arthritis and Ankylosing Spondylitis as well as Crohn’s disease.

In 2009, Abbott included the following warning in the package insert for Humira under section 5.5 titled, Neurologic Reactions:

“Use of TNF blocking agents, including HUMIRA, has been associated with rare cases of new onset or exacerbation of clinical symptoms and/or radiographic evidence of demyelinating disease. Prescribers should exercise caution in considering the use of HUMIRA in patients with preexisting or recent-onset central nervous system demyelinating disorders.”

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