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Malpractice defense: Coronary artery disease vs. medication administration

Posted Jun 18 2009 10:08pm

In addition to my consulting work and writing the Health Business Blog, I’m chairman of the board of Advanced Practice Strategies, a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety. Here’s the Advanced Practice Strategies case of the month.

For previous examples see Fetal assessment and response and Stroke after lung surgery.

Illustrated Verdict by APS
Every month APS’s Demonstrative Evidence Group shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of healthcare providers. Please feel free to forward it to colleagues or clients.

About Us
APS is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. To learn more, e-mail us or call 877.APS.4500.

Case Request
If you have an upcoming case in any of the following areas, please send us an e-mail and we’d be happy to show you some relevant examples of our work:
Bariatric/Gastric Bypass
Birth Injury & Defects
Brain Injuries
Cancers
Cosmetic Surgery
Delayed/Mis-Diagnosis
Dental Issues
Digestive Tract Issues
Emergency Room
Female Reproduction
Film Duplication/Digitizing
Film Enlargement
Heart Attack & Cardiac
Infection
Lasik Eye Surgery
Male Reproduction
Medication Issues
Spinal Cord Injuries
Surgical Issues
General Inquiries

Judgment for the Defense
Coronary Artery Disease vs. Medication Administration

A patient presented to the hospital with an increased white blood cell count along with presumed cellulitis of his leg. He was treated with antibiotics for this infection. During medication administration, the patient suffered a cardiovascular collapse and, despite the resuscitative efforts of the care team, could not be revived.

http://www.aps-web.com/projectreview/IV/IV_0509web/2202m3.jpg

PLAINTIFF’S CLAIM:
The plaintiff claimed that the care team was negligent in administering the antibiotic medication and further that resuscitation efforts after the patient coded were ineffective due to further negligence. The plaintiff suggested that these incidents of negligence were the proximate cause of the patient’s death.

DEFENSE’S ARGUMENT:
Examination of the patient revealed severe cellulitis with a lymphatic streak up the leg. He had no palpable pulse below the groin on either side and was not receiving an adequate blood supply to his foot. To treat this condition, it was recommended he be admitted and treated with IV antibiotics. The medical history taken during the evaluation showed that the patient had a 20+ year history of diabetes, peripheral artery disease, hypertension, and coronary artery disease. He also had a history of two prior heart attacks. In fact, he had been treated for one at the same hospital and was discharged against medical advice after he refused to undergo recommended coronary bypass surgery.

An autopsy found that the decedent’s heart was twice the size of a normal heart for a man of his age, indicating that it was working extremely hard as a result of cardiac disease. There was significant blockage in every single one of the decedent’s major coronary arteries. The autopsy further stated that myocardial infarction in the setting of coronary artery disease, aortic atherosclerosis, and peripheral vascular disease was the cause of death.

VISUAL STRATEGY:
We worked with the attorneys, their clients, and the experts to develop a visual strategy that would help explain the severity of the patient’s vascular disease to the jury. It demonstrated the relationship between the patient’s vascular disease to the autopsy, which identified the cause of death as myocardial infarction in the setting of coronary artery disease, aortic atherosclerosis, and peripheral vascular disease.

RESULT:
Judgment for the defense.

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