Nursing

his week students will complete an APA paper to address the following case study.

Mr. Corley Case Study:

Walter and Sheila Corley were married on January 20, 1984.   At the time, they lived in Texarkana, Arkansas.   Their son Jerry was born in July 1985.   Later that year, the Corleys separated and were divorced.   Sometime thereafter, the Corleys reconciled and resumed living together, holding themselves out to others as a married couple.   In February 1988, the Corleys moved to Mr. Corley’s hometown of Ferriday, Louisiana.   The Corleys were remarried in December 1988.

Neurofibromatosis, a disease of the peripheral nerves of the body, is a condition marked by the presence of numerous neurofibromas, which are tumors or growths arising from the Schwann cells which form the covering membrane or sheath of a nerve fiber.   Persons with neurofibromatosis frequently have café au lait spots of varying sizes on their bodies as well.   In addition, people afflicted with neurofibromatosis experience a significantly increased risk of developing cancer.

In 1978, Mr. Corley was diagnosed with neurofibromatosis and had four neurofibromas removed from his head, arm, hip and leg by a physician in Texarkana.   Thereafter, a few months prior to his return to Louisiana in 1988, Mr.  Corley, who had no other known health problems, began experiencing low back pain.

On February 11, 1988, Mr. Corley sought medical treatment from Dr. Maurice Gremillion, a family practitioner in Ferriday.   On that date, Mr. Corley complained that he had been experiencing low back pain and abdominal discomfort for approximately four months.   He also noted that he had intermittent right shoulder pain and trouble sleeping.   At Mr. Corley’s request, Dr. Gremillion ordered a total work-up which included x-rays of the lower spine, chest, kidneys and gall bladder, as well as an upper GI series.   Dr. Gremillion also prescribed Flexeril, a muscle relaxer, and Anaprox, an anti-inflammatory pain medication.   Dr. Gremillion, feeling that Mr. Corley should be seen by a specialist, then gave him a written referral to E.A. Conway Medical Center in Monroe for an orthopedic evaluation.

E.A. Conway, which is part of the L.S.U. system, is a teaching facility staffed by permanent, full-time physicians as well as by doctors who are employed on a temporary, rotating basis as interns and residents following their graduation from medical school.   The general operating procedure of E.A. Conway at the time of Mr. Corley’s presentment was that all new patients, even those who have referrals to a specific service or department, first go through the emergency room.   At that time, a patient is charted and evaluated by an emergency room physician.   From there, the patient is either treated or referred to a specific clinic for further follow-up.   In most cases, patients see different doctors each time they report to the hospital or one of its clinics.

On March 2, 1988, Mr. Corley, accompanied by Sheila Corley, reported to the E.A. Conway Emergency Room. The Corleys presented admitting personnel with all of Mr. Corley’s records from Dr. Gremillion, including the x-rays and other test reports.   Dr. Bruce Fuller, an emergency room physician, took a history from Mr. Corley and reviewed Dr. Gremillion’s notes and the x-ray reports.   He also conducted a routine physical examination and had x-rays made of Mr. Corley’s low back.   Notwithstanding the presence of several growths and café au lait spots on Mr. Corley’s back and torso, Dr. Fuller was unaware that his patient had neurofibromatosis.

Dr. Fuller found everything to be within normal limits and it was his impression that Mr. Corley was suffering from low back pain based on minimal subjective complaints of pain.   Dr. Fuller continued Mr. Corley on the medication prescribed by Dr. Gremillion and made an appointment for him with the Orthopedic Clinic on March 16, 1988.

On that date, Mr. Corley was seen in the Orthopedic Clinic by fourth year resident McIntyre Bridges.   Dr. Bridges does not recall looking at or reading the x-rays or reports from Mr. Corley’s previous examinations.   Dr. Bridges conducted a physical exam, which was normal, and started Mr. Corley on a conservative course of treatment for low back pain.   Dr. Bridges’ notes from this date indicate his awareness of Mr. Corley’s neurofibromatosis.

Mr. Corley was next seen on April 20, 1988 by Dr. David Mehta.   At the time, Dr. Mehta was doing a surgical internship and was rotating through the Orthopedic Department.   Dr. Mehta’s notes reflect that his physical exam of Mr. Corley was normal, but that he felt that Mr. Corley had a posture problem and referred him to physical therapy for correction of his posture.   Again, the notes do not reflect whether Dr. Mehta reviewed any of Mr. Corley’s previous medical records, x-rays or reports.

On September 14, 1988, Mr. Corley was seen by fourth year surgical resident Keith White.   On that date, Mr. Corley noted that his pain had worsened and was occasionally affecting his walking.   Dr. White’s examination yielded no objective findings of low back pain, but he did notice several café au lait spots indicative of neurofibromatosis so he ordered a CT scan of Mr. Corley’s low back to rule out any neurofibroma changes in the nerve roots.   Dr. Ellis, a radiologist at E.A. Conway, interpreted the CT scan as showing arthritis consistent with fibrosis or spinal stenosis and possible edema of the right L-5 nerve root, which, according to Dr. White, may or may not have been the cause of Mr. Corley’s back pain.   As with Drs. Bridges and Mehta, Dr. White did not review any of the previous medical records, x-rays or reports.   Mr. Corley’s last visit to E.A. Conway was September 21, 1988.   On that date, Dr. White reviewed the results of the CT scan with Mr. Corley, continued him on an anti-inflammatory drug and encouraged him to continue his back exercises.   Dr. White instructed Mr. Corley to return to the clinic in three months.

Thereafter, on October 26, 1988, Mr. Corley, plagued by constant back pain and beginning to experience difficulty breathing, consulted Dr. Rick Maxwell, a chiropractor, who did a full spinal x-ray which revealed a markedly diminished right lung area.   Dr. Maxwell sent Mr. Corley to his father, also a chiropractor, who confirmed that there was a potential problem with Mr. Corley’s right lung and recommended that he see a pulmonary specialist.

On October 31, 1988, Mr. Corley presented to Dr. Gremillion complaining of chest congestion and shortness of breath.   Dr. Gremillion diagnosed him with bronchitis and implemented treatment accordingly.   Mr. Corley returned to Dr. Gremillion on November 14, 1988 with complaints of shortness of breath and marked weight loss.   Subsequent diagnostic testing confirmed the presence of a very large mass in Mr. Corley’s right chest.

Prior to his death on January 23, 1990, Mr. Corley received radiation and chemotherapy treatment at LSU Medical Center in Shreveport.