MedMalReviewer Case #16
This week’s case is special.
Instead of the usual case summary and an expert witness opinion, we get to see the entire malpractice case records. This includes EMS reports, nurse documentation, imaging reports, lab results, and physician documentation.
And unfortunately, the final autopsy report.
Read the entire case by clicking here.
If you just want to see the quick summary and see the expert witness opinions, continue below.
A 55-year-old man was out on a group motorcycle ride in summer 2012. While navigating a bend in the road, he lost control. He struck a glancing blow off the side of an oncoming car, and came to rest in the road.
He was taken to a nearby ED and found to be hypotensive. A liter of normal saline was given, and he was started on norepinephrine. After a general surgeon saw him, CT scans were obtained.
Results showed pelvic fractures with bleeding, and a femur fracture.
The trauma center was called, and a helicopter was dispatched.
The patient continued to be hypotensive, and eventually 4 units of RBCs were ordered. The hospital was not a trauma center, and there were long delays in getting the blood and starting the transfusion of the first unit.
The helicopter staff arrived at the patient’s bedside. They spent nearly another hour getting him ready for transport, and just as they were getting ready to leave he went into cardiac arrest.
After a short attempt at resuscitation, he was declared dead.
He had been in the ED for several hours and died with 2 units of RBCs still not transfused.
You’ll want to read the entire records here before checking out the expert witness reports.
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An EM expert was hired by the plaintiffs.
A trauma surgeon was also hired by the plaintiff.
The defense hired an EM physician, who was deposed. Several highlights are shown below:
Finally, a vascular surgeon was also hired by the defense:
The case continued for several years. Eventually the surgeon and the hospital were dropped. The EM physician took the case all the way to trial.
The jury found in his favor.
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MedMalReviewer Opinion:
1) There was clearly room for improvement by the entire staff at the hospital. They were ill-prepared for this situation and it cost the patient his life. The failure to start aggressive blood transfusion and delay in transfer are the two glaring issues.
2) This case illustrates the favorable treatment that physicians receive in front of a jury. While there were clearly many mistakes, the jury did not feel that they were negligent when taking into consideration that this was not a trauma hospital and they simply did not have the resources to effectively treat him.
3) The claim that a DPL should have been done is laughable. The fact that the trauma surgeon agreed to put this in his expert report is inappropriate. In the face of so many valid criticisms, there is no need to add such an outdated suggestion. It calls into question the expert witness’ expertise and degrades the nature of his testimony when read by an informed reader.
I feel like EMS should bare some responsibility with this one too. Given the patient's mechanism of injury, ALS intercept should have been requested or even a helicopter if available. There's no reason a BLS crew should have been the sole field providers for a trauma patient with a violent mechanism of injury.