Identifying System Flaws: Closed Claim Abstract




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Summary: Twenty-year-old Patrick Dwight suffered from multiple birth defects, an undescended testicle, and mild diabetes insipidus. Patrick was admitted for right hip replacement surgery by a surgeon who'd done his left hip three years prior. Four days post-op, Patrick became somnolent, began having seizure-like activity, slipped into a coma, and developed aspiration pneumonia.