Medicolegal Issues

Pulmonary Embolism Ruled Out in Error

A 28-year-old man presented with a low-grade fever, nonproductive cough, and dizziness. PE was considered but ruled out. How did this case go wrong?

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A 28-year-old man presented to a Maryland hospital emergency department (ED) with a two-day history of low-grade fever, nonproductive cough, and dizziness. He was also tachycardic and significantly hypoxic. After an hour’s wait, the patient saw an emergency physician, who noted complaints of weakness, shortness of breath, and lightheadedness. The differential diagnosis included pneumonia, congestive heart failure, and pulmonary embolism (PE).

After an ECG, chest x-ray, and blood work, the emergency physician diagnosed pneumonia and renal insufficiency. The patient was admitted but within eight hours of arrival at the ED was transferred to another hospital. The admitting physician at the second hospital did not evaluate the patient on admission.

Almost five hours later, the patient got out of bed and collapsed in the presence of his wife. A code was called, but the man never regained consciousness and was pronounced dead about 90 minutes later. An autopsy confirmed a PE as the cause of death.

Plaintiff for the decedent alleged negligence in the clinicians’ failure to diagnose and treat the PE. The plaintiff claimed that with proper treatment, the patient would have ­survived.

The defendants argued that there was no negligence involved and that heparin therapy would not have prevented the patient’s death.

What was the outcome? >>

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