PATIENT DIES FROM PULMONARY EMBOLISM AFTER KNEE FRACTURE

The plaintiff’s decedent, age 40, suffered a fracture of his tibia after being struck by a tree. He was evaluated in an emergency department, diagnosed with a fracture and referred to an orthopedist. Over the course of the next several days he experienced chest pain, coughing and shortness of breath and consulted with his PCP who arrived at a presumptive diagnosis of pneumonia and admitted him to the hospital for observation and treatment.

On the second day of his hospital admission a venous Doppler study revealed a deep venous thrombosis in his lower extremity. He was placed on anticoagulation therapy. Lab work revealed compromised kidney function thus a CT of the chest with contrast, which could definitively diagnose pulmonary emboli, was contraindicated. The decedent’s overall medical condition continued to worsen and his physicians continued to work under the presumptive diagnosis of pneumonia.

On the fourth day of admission, the decision was made to perform an open lung biopsy to diagnose the source of the decedent’s continued decline. Heparin therapy was stopped in an anticipation of the surgery. On the day of the scheduled surgery, it was determined that decedent needed to undergo dialysis. The surgery was postponed until the following day. The Heparin was not restarted and the decedent suffered a pulmonary embolus prior to the performance of the surgery the next morning, resulting in his death.

Plaintiff contended that the presumptive diagnosis of pneumonia was wrong and that decedent was showering premonitory pulmonary emboli which ultimately culminated in the fatal pulmonary embolus. Plaintiff further contended that studies should have been performed to rule out pulmonary emboli prior to stopping the Heparin and that the open lung biopsy should not have been ordered. Additionally, the Heparin should have been resumed when the surgery was postponed.

Defendants contended that there was no evidence to suggest the existence of premonitory pulmonary emboli either clinically during the decedent’s hospitalization or based upon autopsy findings and that decedent was, in fact, suffering from pneumonia and progressive multi system organ failure and that he was going to die without the PE. Defendants further contended that it was unlikely that the PE originated from the previously diagnosed DVT in the lower extremity and that, in fact, it originated at the site of the placement of the dialysis catheter which was necessary to stabilize him for surgery. Defendants further contended that no one could say that the PE would not have occurred if the Heparin had been restarted.

Beneficiaries were decedent’s wife and three adult children. The case settled for $1,700,000. The law firm of Pierce & Thornton retained two critical care pulmonologists, a thoracic surgeon, a general surgeon, a forensic pathologist and a PhD economist to prove their client’s case.