Ref. # 34497
A 59 year old West Virginia veteran presented to the ER of a community hospital complaining of rectal pain and blood in his stool for one week. Medical history included hypertension, fibromyalgia, rheumatoid arthritis, myocardial infarction, peptic ulcer disease and hemorrhoids. Acid and culture tests were taken. The patient was prescribed Septra DS and instructed to return in three days for the results. Two days later he returned to the ER due to intense pain. A rectal exam indicated slight tenderness on palpitation of the left lateral wall but no fluctuant area palpable. An abscess was ruled out with the diagnosis of a bladder infection. The patient was advised to continue with antibiotics and consult a surgeon within 48 hours. Two days later he was taken by ambulance to the VA hospital due to urinary and rectal pain with bleeding. He was discharged with a prescription for Darvocet. Ten days later he returned to the VA ER due to pain so extreme he could neither sit nor stand. He was advised to continue with Darvocet and take sitz baths twice daily. Three days later he was admitted to the community hospital due to dull left chest pain and shortness of breath. Testing showed no evidence of myocardial infarction. The diagnosis was gastroesophageal reflux disease. The next day a surgeon was consulted. A rectal exam revealed fluctuance of the left wall with tenderness. Ten hours later the patient underwent surgery for incision and drainage of bilateral ischiorectal abscesses. 750cc of pus was removed. Post-op the patient became hypotensive and suffered cardiac arrest. Resuscitative efforts were unsuccessful. A medQuest colon-rectal surgeon opined the patient clearly had an abscess during his second visit to the community hospital. Standard of care requires assuming an abscess until proven otherwise. There was a negligent failure to consult a surgeon. With appropriate treatment including an incision-and-drainage and IV antibiotics the patient more likely than not would have survived.