Good case. The plaintiff expert made a lot of comments that were very questionable. Not only did he not rely on reliable literature in the subject, but he made a point to say the physician should have been overly cautious because of the patient's faith. This was strange considering that this visit was completely unrelated to GIB and her use of coumadin, and ER doc is not the one who chose to put an 88 yo woman with dementia and anti blood beliefs on coumadin. I also find it unlikely that her faith came up since patient wasn't even able to provide any meaningful history due to her underlying dementia. This was a weak case at best, but it is concerning an "expert" would manipulate the literature and/or only look at one study in order to make the lawyer happy.
There are some points where he seems pretty reasonable: point 11 "While there are studies that show little or no interaction with warfarin...." seems intellectually honest. I'm guessing he wrote a pretty opinion at first and then slowly let himself get twisted by the attorney.
Not sure if the patient's faith came up at the first visit... sounds like she may have been too demented to communicate that, but family was definitely there and could have helped.
The dementia adds an interesting element to this. I dont want to speculate too much from "too demented to give history," but if the patient was for all intents and purposes globally lacking in capacity, it would follow that family was responsible for her critical decision-making. If that's the case, they willfully declined a lifesaving treatment on the patient's behalf, and then turned around and sued when the patient died.
Honestly I think your second point is spot on. It's just really disappointing to see all the contortions that patients/families/lawyers can make to get a lawsuit out of a sad outcome.
I feel like that was harsh but at least somewhat fair as a point. Cookbook medicine is easy and (could be) cheap, but you go to a physician to have someone who can look down the road a little bit and recognize when the general practice has to be modified for the specific situation. That applies both to the person who put the patient on coumadin and the defending physician who chose not the address the elevated INR. I don't think it's lawsuit-worthy but this wasn't great care.
Old frail lady who’s anti-blood religious, on anticoagulants , passed away because of bleeding internally due to anticoagulants, why did any lawyer decided to take up this case???
How does a claim like this occur? A frail sick elderly woman on anticoagulation who wont have a transfusion dying from a GI bleed is completely unremarkable. Who thought to attribute this to an obscure (and probably insignificant) drug interaction?
Its pretty easy, just google "medical malpractice in <your town>", pick from the dozens of law firm paid ads that pop up, and call their office. You'll have a lawsuit filed in no time. I'm guessing a doctor at the hospital said something like "they never should have been put on antibiotics" to the family, which may be true, but planted the idea in their head that a mistake killed their mom.
BINGO!!! That has being my point for several years. The majority of cases that I have being involved or reviewed start with a physician making off-the-cuff remarks to make them self a big deal. We (Physicians ) not the Lawyers are the main problem. Either by being overly critical on care of other physicians without having alltje facts or by being experts on cases that are clearly not malpractice.
I disagree, based on the info provided, with the decision to prescribe the Z pak. I think we over treat viral URI, and that sounds like what this is. Having said that, this lawsuit is ridiculous. The patient was EIGHTY EIGHT for crying out loud, and the doctor even told the family that the INR was elevated! I guess documentation wise it’s a good idea to have it in the chart somewhere but luckily the family was honest about that. Ridiculous case, and the plaintiffs “expert” is clearly a hack and honestly I would favor naming and shaming such people to discourage the practice.
I think the criticism about not giving Z pak is a valid point of discussion, and is a prime example of why its a bad idea to prescribe antibiotics without affirmative identification of a bacterial source. Credit to the doctor for describing their rationale and reasoning for doing it though, rather than the random shotgunning of antibiotics I often see with no explanation.
Tempting to name/shame but I don't really want to deal with the repercussions for publicly shaming a well-respected professor emeritus. If ACEP isn't going to do it, I certainly won't either.
Any thoughts or comments on the fact that the Jehovah's Witness was okay with getting KCentra which is a human blood product, but not transfusions? I find it interesting that FFP is genereally consented for as a blood products and typically refused by JWs but this one was apparently okay with KCentra?
I got some comments from former JWs stating that RBCs are a definite no-go, but that all other blood-derived products (they call them "fractions"... FFP, platelets, cryo, etc...) are on a case-by-case basis. I have heard KCentra is not harvested from blood, that is synthetically made by recombinant biology? Haven't checked to see if that is true or not, but would explain why KCentra would be accepted.
Ok I take that back about KCentra. Their website says its made from pooled human plasma. Apparently you can get recombinant factor IX for treating hemophilia, maybe there are other examples too.
Is the repeated “I assume” by the plaintiff expert for describing factual events in the patient history normal in certain sectors? I don’t think I’ve seen it before and it struck me as odd.
I’m a bit surprised that it made it to trial given the testimony that the family was counseled about the Coumadin (TV law drama in real life?) and that, at the age of 88, potential damages shouldn’t be that high?
This struck me as just poor writing rather than something any conclusions should be drawn from. Personally, I prefer the language "I understand" when an expert recites factual bases for their opinion in a report. If the report had been stellar aside from this, I'd see it as a non-issue.
I have never seen the "assume" either, I found it quite odd. I'm not sure why this made it to trial besides the fact that there's always a small chance the plaintiff wins, even if all the facts are against them, so they just keep pushing forward.
Was this case in TX? Typically the lawyers wouldn’t chase after a questionable mishap on an 88 yo with dementia. Just curious as the woman lived right across the border.
Can confirm it was not TX... I purposefully don't positively ID locations to keep it as anonymous as possible, but you can figure it out from the context clues as Colleen mentioned. This probably would have been dismissed relatively quickly in TX because they have a gross negligence standard, and I don't think this was gross negligence (or negligent at all). That being said, every now and then an attorney in a gross negligence state somehow twists things in their favor enough to get a surprise victory.
Good case. The plaintiff expert made a lot of comments that were very questionable. Not only did he not rely on reliable literature in the subject, but he made a point to say the physician should have been overly cautious because of the patient's faith. This was strange considering that this visit was completely unrelated to GIB and her use of coumadin, and ER doc is not the one who chose to put an 88 yo woman with dementia and anti blood beliefs on coumadin. I also find it unlikely that her faith came up since patient wasn't even able to provide any meaningful history due to her underlying dementia. This was a weak case at best, but it is concerning an "expert" would manipulate the literature and/or only look at one study in order to make the lawyer happy.
There are some points where he seems pretty reasonable: point 11 "While there are studies that show little or no interaction with warfarin...." seems intellectually honest. I'm guessing he wrote a pretty opinion at first and then slowly let himself get twisted by the attorney.
Not sure if the patient's faith came up at the first visit... sounds like she may have been too demented to communicate that, but family was definitely there and could have helped.
The dementia adds an interesting element to this. I dont want to speculate too much from "too demented to give history," but if the patient was for all intents and purposes globally lacking in capacity, it would follow that family was responsible for her critical decision-making. If that's the case, they willfully declined a lifesaving treatment on the patient's behalf, and then turned around and sued when the patient died.
Honestly I think your second point is spot on. It's just really disappointing to see all the contortions that patients/families/lawyers can make to get a lawsuit out of a sad outcome.
I feel like that was harsh but at least somewhat fair as a point. Cookbook medicine is easy and (could be) cheap, but you go to a physician to have someone who can look down the road a little bit and recognize when the general practice has to be modified for the specific situation. That applies both to the person who put the patient on coumadin and the defending physician who chose not the address the elevated INR. I don't think it's lawsuit-worthy but this wasn't great care.
My takeaway: be very careful with anticoagulation. Document discussions and risks/benefits.
I knew it was risky before, but finding all these lawsuits has made me realize the weight of that risk. Really drives home the point.
Old frail lady who’s anti-blood religious, on anticoagulants , passed away because of bleeding internally due to anticoagulants, why did any lawyer decided to take up this case???
No idea. Seems like a good way to bankrupt your law firm.
Hopefully…
How does a claim like this occur? A frail sick elderly woman on anticoagulation who wont have a transfusion dying from a GI bleed is completely unremarkable. Who thought to attribute this to an obscure (and probably insignificant) drug interaction?
Its pretty easy, just google "medical malpractice in <your town>", pick from the dozens of law firm paid ads that pop up, and call their office. You'll have a lawsuit filed in no time. I'm guessing a doctor at the hospital said something like "they never should have been put on antibiotics" to the family, which may be true, but planted the idea in their head that a mistake killed their mom.
BINGO!!! That has being my point for several years. The majority of cases that I have being involved or reviewed start with a physician making off-the-cuff remarks to make them self a big deal. We (Physicians ) not the Lawyers are the main problem. Either by being overly critical on care of other physicians without having alltje facts or by being experts on cases that are clearly not malpractice.
Couldn't agree more
I disagree, based on the info provided, with the decision to prescribe the Z pak. I think we over treat viral URI, and that sounds like what this is. Having said that, this lawsuit is ridiculous. The patient was EIGHTY EIGHT for crying out loud, and the doctor even told the family that the INR was elevated! I guess documentation wise it’s a good idea to have it in the chart somewhere but luckily the family was honest about that. Ridiculous case, and the plaintiffs “expert” is clearly a hack and honestly I would favor naming and shaming such people to discourage the practice.
I think the criticism about not giving Z pak is a valid point of discussion, and is a prime example of why its a bad idea to prescribe antibiotics without affirmative identification of a bacterial source. Credit to the doctor for describing their rationale and reasoning for doing it though, rather than the random shotgunning of antibiotics I often see with no explanation.
Tempting to name/shame but I don't really want to deal with the repercussions for publicly shaming a well-respected professor emeritus. If ACEP isn't going to do it, I certainly won't either.
Any thoughts or comments on the fact that the Jehovah's Witness was okay with getting KCentra which is a human blood product, but not transfusions? I find it interesting that FFP is genereally consented for as a blood products and typically refused by JWs but this one was apparently okay with KCentra?
I got some comments from former JWs stating that RBCs are a definite no-go, but that all other blood-derived products (they call them "fractions"... FFP, platelets, cryo, etc...) are on a case-by-case basis. I have heard KCentra is not harvested from blood, that is synthetically made by recombinant biology? Haven't checked to see if that is true or not, but would explain why KCentra would be accepted.
Ok I take that back about KCentra. Their website says its made from pooled human plasma. Apparently you can get recombinant factor IX for treating hemophilia, maybe there are other examples too.
Is the repeated “I assume” by the plaintiff expert for describing factual events in the patient history normal in certain sectors? I don’t think I’ve seen it before and it struck me as odd.
I’m a bit surprised that it made it to trial given the testimony that the family was counseled about the Coumadin (TV law drama in real life?) and that, at the age of 88, potential damages shouldn’t be that high?
This struck me as just poor writing rather than something any conclusions should be drawn from. Personally, I prefer the language "I understand" when an expert recites factual bases for their opinion in a report. If the report had been stellar aside from this, I'd see it as a non-issue.
I have never seen the "assume" either, I found it quite odd. I'm not sure why this made it to trial besides the fact that there's always a small chance the plaintiff wins, even if all the facts are against them, so they just keep pushing forward.
Was this case in TX? Typically the lawyers wouldn’t chase after a questionable mishap on an 88 yo with dementia. Just curious as the woman lived right across the border.
Can confirm it was not TX... I purposefully don't positively ID locations to keep it as anonymous as possible, but you can figure it out from the context clues as Colleen mentioned. This probably would have been dismissed relatively quickly in TX because they have a gross negligence standard, and I don't think this was gross negligence (or negligent at all). That being said, every now and then an attorney in a gross negligence state somehow twists things in their favor enough to get a surprise victory.
It appears more likely California. Rosarito was referenced which is Baja California Tijuana.