Legal Review & Commentary

Widow awarded more than $6.7 million due to hospital’s failure to prevent fatal heart attack

By Jonathan D. Rubin, Esq.
Partner
Kaufman Borgeest & Ryan
New York, NY

Elizabeth V. Janovic, Esq.
Associate
Kaufman Borgeest & Ryan
New York, NY

Carol Gulinello, RN, MS, CPHRM
Vice President, Risk Management & Professional Practice
Evaluations
Lutheran Medical Center
Brooklyn, NY

News: In 2005, a 43-year-old man was crushed by an all-terrain vehicle when it crashed and flipped over while he was riding it. He was promptly airlifted to the nearest hospital. Tests revealed indications of internal bleeding, but they were ignored by the hospital. The patient died 36 hours later when pressure from internal bleeding caused one of his lungs to collapse and resulted in a massive, fatal heart attack. The jury awarded plaintiff $6.7 million.

Background: The injury occurred on May 6, 2005. A 43-year-old man was riding in an all-terrain vehicle that crashed and rolled over on top of him. He was crushed by the all-terrain vehicle and suffered several broken ribs, among other injuries. The patient was airlifted to the closest hospital equipped to handle his numerous injuries. A CT scan taken in the emergency department revealed indications of internal bleeding. The patient died 36 hours after arriving at the hospital when the pressure from internal bleeding caused one of his lungs to collapse. This lack of oxygen led to a massive, fatal heart attack. His untimely death occurred on his 44th birthday, which also was Mother’s Day. Tragically, his wife, children, and parents witnessed his death as they were visiting the patient at the hospital to celebrate both occasions.

Plaintiff argued that the treating physicians failed to follow up on the initial CT scan taken in the emergency department and they should have ordered further CT scans in order to monitor the initial indications of internal bleeding. Plaintiff also argued that the patient’s death could have been avoided if doctors would have used a chest tube to drain the fluid that gradually was accumulating in his chest.

The defense representatives for the hospital maintained that the doctors and nurses provided the patient with excellent care. They argued that the medical evidence proved the patient died of an unexpected and unpredictable rupture of an intercostal artery. The hospital representatives did not think that any battery of tests would have predicted or prevented the unfortunate outcome.

The trial only lasted for six days. Despite the findings of a pre-litigation screening panel that unanimously held the actions alleged by plaintiff did not cause the patient’s death, the jury ultimately held in favor of plaintiff. Plaintiff was awarded $11,000 for funeral and burial expenses, $1 million for the patient’s conscious suffering before his death, $1.2 million for loss of economic support, and $4.5 million for loss of companionship and emotional distress, for a total of more than $6.7 million. The award is the largest medical malpractice award ever handed down by a jury in the state of Maine.

According to the verdict survey form, eight of the nine jurors agreed with the verdict. Plaintiff’s attorney said the award most likely will be reduced to a figure closer to $6 million. Damages for conscious suffering and loss of companionship and emotional distress have been capped by the state legislature in Maine.

What this means to you: Based on the summary, the patient had evidence of several broken ribs and other nonspecific injuries. Therefore, based on this fact pattern, several assumptions must be made.

This male, who sustained a crush injury to his chest, was airlifted to a hospital that was equipped to handle such injuries, such as a Level I Trauma Center. Once there, a full physical assessment should have been done to include any evidence of visible trauma, level of consciousness, vital signs, neurological assessment, type and screening for blood type, and an arterial blood gas with placement of a pulse oximetry device to measure the level of oxygen circulating in the bloodstream. Additionally, all routine diagnostic imaging tests for such an injury, such as a CT with contrast of the chest, abdomen, and pelvis and a full body X-ray, should have been done. Assuming that the initial CT scan revealed a minimal amount of bleeding into the chest cavity, a repeat study to monitor any slow bleeding is a prudent plan.

Because there was evidence of internal bleeding noted on the initial CT scan, with enough pressure to cause one of the patient’s lungs to collapse, we are assuming that the bleeding was noted in the chest cavity. According to the Committee on Trauma of the American College of Surgeons, the standard of care for hemo/pneumo thorax is chest tube insertion. This procedure provides a release of pressure within the lung cavity and allows the patient’s lung to properly re-expand. It allows for accurate monitoring of any drainage of fluid from the lung to relieve pressure. Failure to drain the fluid from the chest will result in increased pressure within the cavity, causing a shift in the mediastinum. Once a chest tube is in place, the patient’s chest pressure is released, his condition can be better evaluated, drainage from the lung cavity can be properly measured, and his blood oxygen levels can be effectively monitored.

According to the hospital, the patient died of an unexpected and unpredictable rupture of the intercostal artery. However, if this rupture was the case, placement of the chest tube for drainage would have significantly helped manage that situation. The bloody drainage from the chest cavity into the drainage system would have significantly increased. This increase would have triggered an alert to the practitioners of an emergent situation. This rupture of the intercostal artery might have been unpredictable, but had a chest tube been placed, the effects of the rupture would not have been unpreventable.

Corrective actions for this case could include the formulation of critical pathways when managing patients who have sustained traumatic crush injuries to the chest. These critical pathways could include routine placement of a pulse oximetry device on the patient’s finger to continuously monitor the blood oxygen levels and serial CT scans to capture any changes of blood accumulation and enable the practitioner to react to even subtle changes in condition. However, chest tube insertion, in patients with any evidence of hemo/pneumo thorax or internal bleeding into the chest is the standard of care and should be followed.

Reference

CV-2008-115, Superior Court of Penobscot County, Maine (2011).