Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Delayed Treatment for Postsurgical Breathing Problem
At age 54, a man underwent cervical diskectomy and fusion at the defendant hospital. Six hours after being taken to the postsurgical floor, the plaintiff began to experience swallowing and breathing difficulties.
An hour and 10 minutes later, a nurse contacted the in-house intensivist to intubate the patient. During the attempted intubation, the man’s throat was lacerated, and the bleeding made intubation impossible. During this time, his blood oxygenation saturation dropped to 35%. The emergency department (ED) physician was called to the bedside, and a temporary airway was established. An emergency tracheostomy was then performed.
The man was eventually discharged, but his original cervical spine surgery site became infected. He required a second surgery for debridement and removal of a titanium plate that had been placed during the original procedure. After five weeks’ administration of antibiotics through a peripherally inserted central catheter line, the patient’s infection was cleared.
The plaintiff alleged emotional distress while he was choking and claimed to have sustained hypoxic brain damage, which resulted in short-term memory problems; he was unable to return to work for nearly one year after the original surgery. The plaintiff claimed that the floor nurse was negligent for not having alerted a doctor as soon as he began to have respiratory difficulties. The plaintiff claimed that the nurse made false chart entries after the event, reporting that he had tried to call the surgeon; the plaintiff maintained that no call was made. The plaintiff also claimed that the surgical site infection resulted from the throat laceration, which allowed bacteria to be delivered to the area.
The defendant denied any negligence by the floor nurse and contended that his chart entries were accurate and timely. The defendant argued that bleeding and hematoma were risks associated with cervical spine surgery. The defendant also claimed that the laceration was a risk of intubation, especially in light of the plaintiff’s jaw clenching in reaction to the administration of the short-acting IV anesthetic etomidate.
According to a published account, a defense verdict was returned.
Barium Swallow Might Have Made a Difference
Shortly after undergoing bariatric surgery, a 43-year-old woman began to exhibit signs and symptoms of an intra-abdominal infection. By then, the patient’s surgeon had departed for a long holiday weekend, leaving a covering surgeon in charge of her care. The covering surgeon ordered a “blue-dye test,” but no leak was detected; a barium swallow, which is considered more accurate, was not performed.
The patient’s condition deteriorated. During a chance call to the hospital, the surgeon who had performed her operation learned that the woman was doing poorly. He returned quickly and immediately performed a second surgery. By then, the abdomen could not be closed, due to the extensive infection and development of compartment syndrome. The patient developed multiorgan system failure and died the day after her second surgery.
The plaintiff claimed that the covering surgeon ordered a test that was not definitive, that he should have ordered the barium swallow, and that he should have been prompted by the infection to initiate the second surgery.
The defendants claimed that infection is a well-known and potentially fatal risk of bariatric surgery, and the decedent had been so informed. The plaintiff countered that considering the known risk for infection, a barium swallow should have been conducted before the patient was too ill to recover.
According to a published account, a $750,000 settlement was reached.
Tear in Superior Vena Cava—Before or After Suicide Attempt?
A 54-year-old woman with suicidal ideation presented to a hospital emergency department (ED) complaining of chest pain, after a failed suicide attempt with a combination of heroin, cocaine, and methadone. She was admitted under the care of the defendant internist, and a cardiologist (also a defendant) was consulted. The patient’s admission hemoglobin level was within normal range but dropped significantly within two days. When she experienced acute renal failure and shock, she was moved to the ICU, where she received copious amounts of fluid to raise her blood pressure. After being discharged from the ICU, she underwent a cardiac catheterization, which revealed no structural damage to the heart.
The next day, the woman went into cardiac arrest and died despite resuscitation efforts, including placement of a central line by way of the internal jugular vein. Autopsy revealed a 1,700-g blood clot in the right chest and a large tear in the superior vena cava as the source of the bleed. The medical examiner associated the perforation with instrumentation, such as a central catheter.
At trial, the medical examiner testified that the perforation had occurred days before the woman’s death and that the clot was approximately five days old. The plaintiff claimed that chest x-rays should have been performed; they would have demonstrated the massive blood clot. The plaintiff also charged that the defendants were negligent in failing to diagnose and treat the bleed with transfusion and thoracentesis.
The defendants claimed that the decedent was dehydrated and malnourished due to drug use, that the drop in her hemoglobin level shortly after admission was the result of rehydration, and that the cause of death was an unpredictable and untreatable arrhythmia related to drug use. The defendants claimed that the clotted blood represented fresh hemorrhage and that the tear in the decedent’s vena cava occurred during resuscitation efforts.
According to a published report, a defense verdict was returned.
Heparin Allergy Detected Late, Bypass Grafts Occluded
A woman was taken to a hospital complaining of chest pain, with pain and numbness in her left arm. Tests indicated that she had experienced a myocardial infarction (MI). The woman was prescribed several medications, including heparin.
The next day, it was determined by cardiac catheterization that the patient had three arteries with significant blockage. The decision was made to perform triple cardiac bypass graft surgery. The procedure was performed a few days later by the defendant cardiovascular surgeon. During the operation, the patient was given 12,000 units of heparin.
The day after her surgery, the patient was allowed to sit up in a chair and later walked down a hallway. By that evening, however, her left leg had become swollen and turned blue. A Doppler study revealed multiple blood clots in her upper leg, indicating deep venous thrombosis (DVT). The surgeon consulted with another physician regarding the DVT, but no testing was ordered for other possible conditions.
The patient was discharged home after a few days, only to be readmitted 12 days later with complaints of chest pain and pitting edema in her left leg. She was diagnosed with post–coronary artery bypass MI with an elevated platelet count and abnormally high levels on coagulation studies. The patient was placed on heparin and nitrates. A second cardiac catheterization revealed that all three bypass grafts had occluded. The right coronary artery was opened by angioplasty, and a stent was placed. Plans were made to operate on the grafts on the remaining two occluded arteries.
A short while later, another cardiologist ordered a test for heparin-induced thrombocytopenia (HIT). The result was positive, and this information was relayed to the defendant cardiovascular surgeon. He did not consult with a hematologist/oncologist regarding the potential effect of HIT on the planned surgery. He performed the operation, although no machine was available to monitor ecarin clotting time (ECT). Instead, the surgeon substituted the anticoagulant hirudin for heparin. The woman died during the surgery.
The plaintiff claimed that the defendants were negligent in failing to diagnose a heparin allergy earlier and for failing to treat the decedent properly after the allergy was detected. The plaintiff claimed that the defendant had never performed a nonheparin bypass surgery before and alleged lack of informed consent for the procedure, considering his failure to inform the decedent or her family about his inexperience with nonheparin bypass surgeries or the unavailability of an ECT-monitoring machine. The defendants denied any negligence.
According to a published report, a defense verdict was returned.