By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
David Vassalli, 2016 JD Candidate
Pepperdine University School of Law
News: In 2009, a 68-year-old man suffering from arthritis in his knee checked into a hospital for a total knee replacement. Following the surgery, the man complained of confusion and disorientation and became hypoxic and anemic. The physicians on staff did not order an electrocardiogram (EKG) or a chest X-ray, and they did not treat the hypoxia or anemia. Two days after the surgery, the man died from what was diagnosed as myocardial ischemia, described as when the heart does not receive enough oxygen due to a lack of blood flow, from a heart attack he allegedly suffered during or immediately after his knee replacement. The man’s estate filed a medical malpractice action against the hospital for the conduct of its staff, as well as against his attending physician, who, the estate alleged, failed to perform necessary tests and procedures after the man presented symptoms of a heart attack, failed to refer the man to a cardiologist, and failed to properly monitor the patient after his knee replacement surgery.
The hospital was determined to be liable for the conduct of its physician and staff, but it still denied all liability for the man’s death. The jury determined that the hospital was negligent and liable to the man’s estate for his death.
After deliberating for just more than two hours, the jury awarded the man’s estate $8.25 million. The jury award included $5 million for loss of society and $3.25 million for grief and sorrow.
Background: On Dec. 8, 2009, a 68-year-old man suffering from arthritis in his left knee entered a hospital for a knee replacement. Following the surgery, according to the estate of the man’s complaint, the man’s hemoglobin dropped from 11.3 to 6.7 and serum sodium was 127, which indicated severe anemia and hyponatremia, respectively. The man also complained of confusion and disorientation.
The complaint also alleged the man’s condition should have solicited further inquiry on the part of the man’s physician and that the further inquiry would have revealed that the man suffered a heart attack during or immediately following the knee replacement. Without further testing by the physician, the man died two days later, on Dec. 10, 2009. The cause of death was myocardial ischemia, a lack of oxygen to the heart due to decreased blood flow, which allegedly was caused by the man’s undiagnosed and untreated heart attack.
The man’s estate filed a medical malpractice action against the hospital and its staff for the man’s wrongful death. Particularly, the man’s estate alleged that the hospital was liable for the conduct of its staff and that the attending physician failed to perform necessary tests and procedures, including oxygen saturation, an EKG, or a chest X-ray after the man presented symptoms of a heart attack; failed to refer to the man to a cardiologist; and failed to properly monitor and otherwise treat the man’s anemia, hypoxia, or heart attack. The hospital denied it was negligent in the man’s treatment and denied all liability for the man’s death.
In a trial lasting 10 days, the jury determined that the hospital was negligent in failing to diagnose and treat the man’s heart attack and the ensuing complications that ultimately led to his death. The jury’s decision awarded the man’s estate $8.25 million, which the hospital is responsible for paying. The jury award included $5 million for loss of society and $3.25 million for grief and sorrow.
What this means to you: This case illustrates how failing to diagnose and treat a condition can lead to liability for hospitals and physicians. Particularly, this case highlights how a lack of diagnostic testing and referral to a specialist provides the basis for liability when a symptom goes undiagnosed. In this case, the man’s drop in hemoglobin and anemia and his complaints of confusion and disorientation were determined to have solicited discovery of, or at least testing for, his prior heart attack. As such, the administration of the relatively inexpensive tests likely would have sheltered the hospital from $8.25 million of liability and possibly saved the patient’s life.Similarly, the preventative measure of referring a patient to a specialist, a cardiologist in this case, could have the same liability-sheltering effect. The time and expense involved in administering the necessary tests or in making the relevant referrals for the hospital were greatly outweighed by the unfortunate death of a patient and costly lawsuit to the hospital. As such, hospitals and physicians being presented signs of serious or unknown conditions should consider the health of the patient and possible legal liability for medical complications that could arise when deciding whether to administer relevant tests or refer the patient to a specialist.
Another lesson illustrated by this case is the need to closely monitor a patient already in the hospital’s or physician’s care. Hospitals and physicians have a legal duty to monitor patients in their care, including the duty to regularly check the patient for an increase in distress or illness, to prevent the patient from suffering further harm, and to regularly administer the patient’s medication. Liability for failure to diagnose a patient’s condition, as described earlier, can occur when the patient is a new patient, returning patient, or a patient already in your care. However, when the patient is already in the care of the hospital or physician, as was the case here following the knee replacement the man received at the hospital, the additional act of failing to monitor the patient in your care is also alleged, presented to the jury, and can lead to additional liability. Furthermore, the notion that a patient can remain in the care of a hospital and develop, succumb to, and have a fatal condition go undiagnosed will rarely bode well with a jury. Juries understand that nurses, who are with their patients 8-12 hours each shift, take on much of the physician’s monitoring role. The physicians rely on these nurses to tell them what’s going right and what’s going wrong. What breaks down is physician oversight.
As the person ultimately responsible for the patient’s well-being, the physician must never assume that no news is good news. The physician must know who the players are, which nurses are assigned to which patients, and determine if they know how, when, and why to inform the physician of changes in condition. While the allegation of failing to monitor the patient in its care is detrimental to the hospital’s case, the time the patient was in its care also provides the best opportunity to shelter itself from liability. Bearing this in mind, a physician or hospital monitoring a patient in its care who is presenting symptoms of an unknown condition should be particularly mindful of the legal liability that can ensue by failing to take necessary steps to address that patient’s symptoms.
Circuit Court of Illinois, Cook County, Case Number 2011-L-013030 (Nov. 4, 2015).