COPD Arrest After Central Line
Case #129
A 70-year-old man with COPD presented to the ED with shortness of breath.
He was admitted to the ICU.
His condition worsened overnight.
The following morning the intensivist put in a central line (right IJ).
A chest x-ray was obtained to confirm placement.
He went into cardiac arrest shortly thereafter and died.
The family sued, naming the intensivist and his employer as defendants.
The main argument in this case revolves around the chest xray.
The plaintiff argues that he had a pneumothorax and died because he never had a needle decompression or chest tube.
The defense argues he simply had subcutaneous emphysema, and that decompression of his chest was not indicated.
The plaintiff’s expert opinion is shown here:
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The defense hired several experts to counter these claims.
Neither side made any offers to settle the case, at least as documented in the public records. There may have been offers behind closed doors.
Regardless, a settlement could not be reached.
Update:
The lawsuit was taken to a jury trial.
The jury returned a verdict for the defendants.
The defense disclosed how much they paid the 2 expert witnesses who testified at trial.
The radiologist was paid $9,175.
It appears that the pulmonary/critical care expert was paid in several installments.
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MedMalReviewer Analysis:
The most frustrating thing about this case is that neither side published the actual chest x-ray or radiologist’s interpretation.
Nonetheless, I think we can read between the lines. The plaintiff states that there was a pneumothorax, and the defense doesn’t explicitly contradict this. Instead they counter that there was no tension pneumothorax.
I think the most likely possibility is that the patient had a small pneumothorax seen on x-ray. The argument then becomes if the patient subsequently developed a tension pneumothorax that was mismanaged, or died from another cause.The plaintiff’s expert claims that a CT has to be done to localize a pneumothorax. This is false, and in many cases would just serve to delay decompression. Its ironic that this expert is criticizing pneumothorax management while suggesting actions that are below the standard of care.
The verdict for the defendants is another example of the fact that doctors usually win when a lawsuit gets taken to trial. The threat of a plaintiff’s verdict is always present, but juries still look kindly on physicians. More often than not, the defending physician wins.
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Are you kidding me!?! I mean, without the CXR we can only speculate what happened, but this "expert witness" is a total clown! First of all they don't even understand what barotrauma means and is using that term inappropriately which makes me wonder if they are an idiot. Then they make this wild accusation that the doctor should have gotten a CT which confirms that they are, in fact, an idiot.
If I were the defendants lawyer my questioning towards the radiologist would have been along the lines of how many pneuomothoraces they have diagnosed, how he can tell it is a tension pneumo on the film. How many pneumo's has he treated? How many chest tubes placed? How often a simple converts to a tension. How often a tension pneumo results from a central line. How often a copd bleb looks like a pneumothorax. What can happen if a chest tube is erroneously placed in a bleb etc. He was the wrong plaintiff's expert for this case. Can't comment within reason beyond the radiographic interpretation. I would even argue if the icu doc could read the xray why are radiologists needed? Wasn't it the radiologist who missed the ptx and failed to communicate with the icu attending?