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.