Malpractice Chronicle

The patient then underwent echocardiography, which showed mitral valve vegetations and severe mitral regurgitation. The patient was given a diagnosis of endocarditis. He underwent surgery for mitral valve replacement and has been taking warfarin since the surgery.

The plaintiff claimed that the defendant should have ordered a blood culture sooner. The defendant argued that he had ordered more than the required testing in order to reach a diagnosis and that the plaintiff had been referred to the specialist in a timely fashion.

A $500,000 settlement was reached.

Should Emboli, Thromboses Have Been Suspected?
At age 51, a man with a history of type 2 diabetes mellitus and hypertension underwent fusion of a portion of the spinal lumbar region. After a procedure that lasted 10 hours, the patient was kept overnight for observation. During that time he was intubated, sedated, and kept in a paralyzed state. Unstable vital signs, agitation, listlessness, and jerking movements of the body were noted. The patient also attempted to expel the intubation, making optimal ventilation impossible. He was extubated the next morning.

The patient soon developed significant metabolic acidosis and also became hypotensive and asystolic. He was then reintubated and a prophylactic dose of low-molecular-weight heparin was administered. He remained intubated, sedated, and chemically paralyzed.

Later that day the defendant neurosurgeon consulted the defendant pulmonologist regarding management of the patient’s intubation. Four days later, intubation, sedation, and paralysis were discontinued. During the ensuing 11 days, the patient intermittently exhibited symptoms that included persistent shortness of breath, pain from the chest and groin, and tachycardia.

Sixteen days postsurgery, the patient suffered a massive, fatal pulmonary embolism. Autopsy revealed that the main pulmonary arteries were completely occluded by massive organizing thrombi, that the small pulmonary arteries were occluded by several infarcts in the lower lobes, and that an elongated embolus occupied the right ventricle of the heart.

The plaintiff alleged negligence in the failure to diagnose the emboli and thrombi. The plaintiff claimed that the decedent’s postoperative symptoms were indicative of emboli and deep venous thromboses, and that diagnostic testing should have been performed to rule these out.

The defendants claimed that the symptoms were caused by asthma and pneumonia and that the emboli and thromboses developed suddenly, just prior to the patient’s death.

According to a published account, a jury found the two physicians equally responsible for the patient’s death and awarded $1 million in damages. Posttrial motions were pending.