Cardiac Arrest Due to Avoidable Pulmonary Thromboembolism
Lawsuit Against Northwest Hospital Center | September 16, 2020
On September 16, 2020, WVFK&N attorneys Keith Forman and Jermaine Haughton filed a medical malpractice claim on behalf of the family of a woman who died as a result of an avoidable pulmonary thromboembolism.
The complaint alleges that on December 23, 2019, the patient was diagnosed with a fracture in her right ankle. She was a 38-year-old with no history of significant health complications at that time. A closed reduction of the fracture was performed, and an ortho-glass splint (or immobilizing cast) was placed on the fractured ankle. The physician’s recommendations included: No weight bearing RLE with crutches; ice and elevation; and to follow up with the orthopedic surgeon on call in 7 days. The discharge instructions stated in all capital letters: “ABSOLUTELY NO WEIGHT ON YOUR LEFT LEG.” No anticoagulants were prescribed at that time. She was scheduled to undergo an elective surgery on January 8, 2020. The patient went to Patient First-White Marsh for a pre-operation physical examination on January 4, 2020. Her BMI was noted to be 58.7, rendering her severely morbidly obese. The pre-op history showed that the patient had no pre-existing heart or lung condition, and that she was “pretty healthy.” Her right ankle was again listed as “Immobilized.” An EKG was machine read as “abnormal” and the physician agreed with this finding. The “Northwest pre-op PE form, lab work, and EKG were faxed [with] confirmation to Northwest [Hospital] pre op test center on [January 5, 2020]” (three days prior to her scheduled surgery). As such, the providers at Northwest on the day of surgery knew or should have known that the patient was severely morbidly obese, had an abnormal EKG, had been immobilized on her right lower extremity for over two weeks, and had not been prescribed anticoagulants (blood thinners) in that time period. Likewise, the providers knew or should have known that these factors placed the patient at an increased risk for the development of a deep vein thrombosis (“DVT”) and, with the impending use of a tourniquet during her surgery, high risk for a displaced clot and pulmonary thromboembolism–a potentially deadly condition. On the day of surgery, the anesthesiologist documented that the patient’s baseline heart rate was 88 beats per minute four days prior, and noted that her heart rate was now tachycardic into the “130s.” the patient was hypotensive with a systolic blood pressure of 98 (down from 124). In addition, a nursing note indicated that the patient was experiencing back pain at that time. Back pain, tachycardia, and hypotension are all recognized in the medical literature as signs and symptoms of a DVT. No DVT evaluation was performed, however, the patient was given lactated ringers and versed which can mask possible DVT. It was a violation of the standard of care to superficially make the patient “stable enough to proceed for surgery” without a complete evaluation of her signs, symptoms, and risk factors for DVT and/or pulmonary thromboembolism. The patient underwent anesthesia induction and was intubated at 10:03 a.m. Two minutes later, at 10:05 a.m., her pulse sharply declined to 80beats per minute and, inversely, her blood pressure rose to approximately 140/90. Moreover, her oxygen flow declined from 12.1L/mm to 1.5 L/mm. As such, her hemodynamic instability had become even more pronounced at 10:05 a.m. No action was taken to discontinue the surgery or provide immediate resuscitation to the patient at that time. The anesthesia monitor confirmed that the patient lost her pulse at 10:15 a.m. As such, the standard of care required the initiation of a Code Blue emergency resuscitation at that time. This action was not taken. At 10:17 a.m., the surgery team performed a procedure “Time Out” to verify the correct patient, procedure, and body part. At 10:18 a.m., the attending anesthesiologist was “in the room” and the patient was “given 1 mg of epinephrine at this time.” Epinephrine is a medication used to treat life-threatening hemodynamic instability. The procedure was finally aborted at 10:23 a.m., and a Code Blue emergency was called at that time. The emergency response team arrived at 10:25 a.m. The patient was finally pronounced dead at 11:14 a.m. An autopsy concluded that the cause of death was “Pulmonary Thromboembolism Due to Right Lower Extremity Deep Vein Thrombosis Due to Right Ankle Injury.”
The lawsuit alleges, among other things, that the doctors failed to fully investigate the woman’s recent medical history which led to the pulmonary thromboembolism that caused her death.
The action is pending in the Circuit Court for Baltimore County, Maryland.