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ARTICLE ID 195492

DEFENDANT’S – MEDICAL MALPRACTICE – FAILURE TO DIAGNOSE SEVERE URINARY TRACT BLEEDING – HYPOVOLEMIA – FAILURE TO ADMINISTER TIMELY BLOOD TRANSFUSIONS – CARDIAC ARREST – WRONGFUL DEATH.

Lee County, FL

The plaintiff alleged that the defendant, a pulmonologist/critical care specialist,

rendered inadequate medical care, which resulted in the decedent’s death. Specifically, the plaintiff claimed that a severe urinary tract bleed was not addressed, causing hypovolemia and cardiac arrest. The defendant maintained that the decedent’s treatment met the standard of care, and that his death resulted from unavoidable sepsis and septic shock – not loss of blood as alleged by the plaintiff. The defendant doctor’s practice group was also a defendant in the case on a vicarious liability theory. The surgeon who had performed the decedent’s endarterectomy, and the hospital where he was treated, reached a confidential settlement with the plaintiff during the pre-suit period.

The decedent underwent a carotid endarterectomy to remove significant blockage in the internal carotid artery. During the surgery there was bleeding, which required transfusion of three units of blood. Following the surgery, the decedent demonstrated stroke-like symptoms and was admitted to the hospital’s intensive care unit where he came under the care of the defendant pulmonologist/critical care specialist.

The decedent developed respiratory difficulties, which ultimately required intubation, and he was diagnosed with aspiration pneumonia. Four days post-operatively, the decedent was scheduled to be transferred from the ICU to a monitored bed, but there were no available rooms at that time, so the decedent remained in the ICU. Overnight, the decedent began to pass blood clots in his urine. The ICU nurse contacted the surgeon, who requested a STAT urology consult. The urologist first ordered ice packs to the grain, and then several hours later, ordered the insertion of a three-way Foley catheter, B&O suppository, and H&H to be drawn. The urologist never came to the hospital to examine the patient.

Early the next morning, during rounds, the decedent was seen by the defendant doctor who noted a decrease in hemoglobin from 9.4 to 8.2. The defendant ordered a repeat H&H to be taken every six hours for the next 24 hours, and that if the haemoglobin was below 7.5; the patient was to be transfused with one unit of packed red blood cells.

That repeat H&H, drawn just before noon, showed the hemoglobin had dropped to 6.8, defined by the hospital’s lab as a critical value. The decedent was being given medications, when he appeared confused, demonstrated rapid breathing, his pupils became large and fixed, and a Code Blue was called.

During the Code Blue, the decedent was intubated and CPR was administered, but the heart was never shocked or defibrillated, and the decedent remained unresponsive. After several days, further medical interventions were discontinued, and the decedent died in February of ________. The decedent was survived by his wife of more than 50 years. He was 81 years old.

The plaintiff claimed that the decedent suffered a cardiac arrest caused by hypovolemia (decreased blood volume) due to the severe urinary tract bleeding as demonstrated by the continuing decrease in hemoglobin. The plaintiff asserted that, as a result, the decedent suffered multi-system organ failure due to ischemia, and poor perfusion of the tissues. The plaintiffs’ expert opined that, if blood had been administered sooner, the cardiac arrest would not have occurred and the cascade of events could have been avoided.

Based on the vital signs and the lack of interventions during the Code Blue procedures, the defense maintained that the decedent most likely suffered a respiratory arrest unrelated to any blood loss or hypovolemia. The defense contended that the decedent never actually suffered a true cardiac arrest, and that his tissues were being adequately perfused, even during the code.

The defense argued that the complications and the decedent’s ultimate death were caused by infection and septic shock, not from blood loss. An autopsy demonstrated the presence of pneumonia, a perforated bowel diverticulum, and extensive infection in the abdominal cavity, according to evidence offered.

The defense contended that the findings were consistent with the defense position that the death was caused by sepsis and septic shock.Following an eight day trial, the jury deliberated for one hour and ten minutes, before returning a complete defense verdict.

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