Docs Misdiagnose Aneurysm and Patient Dies; Must Pay $29M; More

Wayne J. Guglielmo, MA

June 19, 2023

Two Boston doctors associated with Salem Hospital, a clinical affiliate of Massachusetts General Hospital, must pay nearly $29 million to the family of a man whose aortic aneurysm and dissection went undiagnosed and untreated, as a story posted on, among other news sites, reports.

On the morning of January 13, 2018, Joseph Brown awoke with shortness of breath and upper abdominal pain, which eventually spread to his chest and back. Taken to Salem Hospital's emergency department (ED), Brown was seen by Steven D. Browell, MD, an emergency medicine specialist.

Browell ordered tests that ruled out both a heart attack and a pulmonary embolism. He called for a blood test, which indicated that the patient's white blood count was elevated. Suspecting an infection, Browell ordered that Brown be admitted to the hospital.

Accepting Brown's admission was William D. Kenyon, MD, a hospitalist, who also examined the patient and concurred with Browell's probable diagnosis. The patient was then sent to the medical floor.

There he underwent additional testing, including a chest x-ray, which proved negative except for one finding: a "mild hazy interstitial opacity that could represent a small airway inflammation or developing/early pneumonia." Because Brown had reported that he had punctured his foot several days earlier, he also underwent a foot x-ray, which showed a possible foreign body. It was thought that that might be the source of his infection.

Neither Browell nor Kenyon had completely ruled out a possible aortic aneurysm and dissection. Brown's symptoms, after all, were in some ways suggestive of those conditions. Then again, he was very young — only 43 at the time — and his pain, while severe, didn't correspond to the "searing" pain that, at trial, Kenyon described as typical of an aneurysm and dissection. As the hospitalist testified at trial, Brown had "a constellation of nonspecific symptoms" and an "unusual presentation of a rare condition," typically seen in patients aged 65 and older.

Given these factors — and the results of Brown's tests, lab studies, and physical exam — Kenyon didn't think that the case warranted a CT scan to rule out an aortic aneurysm or aortic dissection.

By early the next morning, though, Brown's shortness of breath and pain had intensified significantly. The on-duty doctor ordered a CT scan, which showed "a massive aneurysm at the beginning of [the patient's] aorta and a dissection extending through most of his aorta."

Brown was flown to Boston to undergo emergency surgery. En route to the helicopter, his aorta ruptured, stopping his heart and causing his death.

During the 8-day trial, each side introduced expert witnesses. Speaking for the plaintiffs, experts in cardiothoracic surgery and emergency medicine testified that the treating physicians were negligent in failing to order a CT scan on January 13. Had they done so, the patient would have almost certainly undergone surgery earlier, which would have prevented his death.

Experts for the defense saw things differently. They testified that, given the evidence, it was reasonable and appropriate for Browell and Kenyon to have treated their patient for an infection rather than an aneurysm or dissection.

The jury found the defense's arguments unconvincing, however. After deliberating 3 hours, it awarded the plaintiffs $20,000,000, to be paid out over time largely to Brown's two daughters, who were aged 12 and 18 when he died. Including interest, the total award is close to $29 million.

In a statement following the verdict, lead plaintiff's attorney Robert M. Higgins, of Lubin & Meyer, in Boston, said the takeaway from the case was, "If you just treat people based on what the likelihood is, statistically, you're going to miss a lot of life-threatening conditions. And that's what happened in this case."

Urologists Typically Prevail in BPH Suits

Malpractice claims following surgery for benign prostatic hyperplasia (BPH) tend to be limited in scope and are typically resolved in favor of the surgeon-defendant, as a study in The Cureus Journal of Medical Science makes clear.

The study — conducted by a team of researchers that included Joao G. Porto, MD, of the Desai Sethi Urology Institute, University of Miami — investigated whether such surgeries pose a significant malpractice risk for urologists.

With information gleaned from two well-known legal databases, the team used a variety of key terms to identify BPH-related claims from January 2000 to December 2021.

Within this universe of claims, researchers identified several significant trends:

  • Among BPH-related procedures, transurethral resection of the prostate was the most frequently identified (37%);

  • Among the most-often cited reasons cited for a claim, allegations of inadequate postoperative care were the most common (33%);

  • Of possible postsurgical complications, those that led to the greatest number of suits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%); and,

  • Not unexpectedly, the specialist most frequently named in a suit was a urologist (57%).

Interestingly, in all but two of the claims, the verdict favored the doctor-defendant. In the two cases in which the plaintiff prevailed, each involved unexpected and serious postsurgical complications.

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