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.
To learn more send an email or call 877-APS-4500.
|Judgment for the Defense
Lung Infection vs.
Chronic Pulmonary Embolism
She initially presented with apparent worsening of an atypical pneumonia and was treated with antibiotics. Her physicians also prescribed anticoagulation medications prophylactically to prevent clots from developing in her legs during her hospitalization. At the beginning of her admission, a series of diagnostic tests to identify a DVT and/or PE were negative, including an ultrasound of her legs and a chest CT. During her hospital stay, she spiked fevers to 103 °F and chest x-rays showed a probable new left lower lobe pneumonia. She also developed respiratory failure with an unclear etiology. Follow-up CTs were performed that showed the patient had diffuse, bilateral infiltrates consistent with pneumonia and acute respiratory distress syndrome (ARDS).
Throughout her hospital stay, the patient’s symptoms were consistent with an infectious process. However, an autopsy revealed that the patient had massive pulmonary emboli within both lungs, pulmonary arteries, inferior vena cava, and the right side of heart. The defense theory was that these findings were the result of an acute event and not chronic emboli that resulted in her cardiorespiratory arrest and death.
There were findings that supported this theory:
Proper steps to anticoagulate the patient were taken at the time of her treatment, and placement of an inferior vena cava filter was not indicated. The patient’s death was an unfortunate medical result that was not caused by negligence on the part of any of the defendant physicians.
We also illustrated pneumonia and acute respiratory distress syndrome (ARDS) in the same format with both illustrations and films. This helped to support the diagnosis of infection rather than chronic pulmonary embolisms as the etiology for her breathing distress.
We enlarged the patient’s films onto boards to demonstrate the progression of the condition and to allow the experts to explain to the jury that what was seen on the films was more consistent with the appearance of infection rather than chronic pulmonary emboli.
To support the diagnosis of an infection we illustrated blood and pus excreting from a tracheostomy tube.
We put together a series of illustrations to show how a deep vein thrombosis (DVT) can form in the leg and how emboli can break off and travel up the bloodstream.
We created a board that explained how a vena cava filter works, to educate the jury on location and function of the filter.
As a follow up to the previous board, we also created an exhibit to show one complication that could have arisen if a vena cava filter had been placed during her stay. Because she showed signs of infection throughout her stay, her doctors were concerned that a clot could become lodged in a filter and become grossly infected.
We illustrated the massive in situ acute thrombosis to show what the defense believed caused her death.
We enlarged the patient’s pathology slides of the pulmonary emboli found at autopsy.
Finally, we created timelines to illustrate the constant care that the plaintiff received by multiple physicians throughout her hospitalization.
This combination of illustrations helped the defense successfully explain that:
Attorney John Mulvey called to share his defense verdict and give thanks:
This was the most Medical Illustration Exhibits that I have ever used in a single trial and I am very happy with the outcome. I can’t thank you enough for being so available to my clients, for additional boards while the trial was in session and for doing last minute edits to make the defendant feel completely comfortable and secure in his teachings to the jury.”