Washington DC Metro Medical Malpractice Lawyer Blog

A young woman presented to a District of Columbia urgent care clinic complaining of recent nausea, vomiting, weakness, and shortness of breath, and was confirmed to also have low blood pressure, high heart rate, high anion gap, high blood glucose, and both glucose and ketones in her urine. These are classic signs and symptoms of new onset Type 1 diabetes mellitus. The clinic staff gave the patient IV fluids, pain and anti-nausea medications, and a bronchodilator. Several hours later, the patient was sent home despite being critically ill and unstable. The attending physician never reached a diagnosis that explained the patient's serious symptoms. Within several hours of discharge, the young woman suffered an asystolic cardiac arrest and died. She had no underlying heart problems.

The decedent had new onset diabetes mellitus with diabetic ketoacidosis (DKA), a very basic and treatable medical condition that is a potentially life-threatening condition if not treated properly. It is rare to die from new onset diabetes in the modern world because insulin is so readily available. Cells require insulin to function, and insulin operates to allow glucose into the cells for energy. Type 1 diabetes is characterized by the absence of insulin, which is incompatible with life. The acute condition of DKA is most commonly precipitated by infection, which creates extra stress on the body and an enhanced need for insulin. DKA makes the heart vulnerable to arrhythmias due to electrolyte imbalance, lack of energy, and lack of oxygen.

The case settled on very favorable terms at mediation.

The death of a child is every parent's greatest fear, and it is made all the more tragic when that loss is at the hands of the very doctors we trust to mend our bodies and improve our lives. This was the case for one family who entrusted the care of their only son, an 8-year-old with Wolf-Parkinson-White Syndrome (WPW) to a cardiac electrophysiology team thinking they would provide a cure.

WPW is a condition where the heart has one or more accessory nerve pathways which can interfere with the heart's regular rhythm and produce what is called supraventricular tachycardia, an extremely fast heartbeat which does not allow the heart to pump blood effectively. A person with WPW may not have any symptoms at all, or have them very infrequently. Those who do, typically experience palpitations, shortness of breath, chest pain or tightness, dizziness, light-headedness or even fainting during an episode. The condition carries an excellent prognosis, often resolving spontaneously in children, though very rarely complications can result in sudden death.

This fact was pressed upon the boy's parents, leading them to believe eradication of the accessory pathway through a catheter ablation procedure was vital to his well-being. While the procedure is generally safe, being performed on thousands of adults and children world-wide, it does carry risks which were also downplayed to the boy's parents.

As WPW affects people differently, a risk assessment should be performed before deciding to undergo the ablation procedure, as it will not necessarily provide more benefit without outweighing surgery related risk. Assessment and treatment are performed in an electrophysiology laboratory where catheters are introduced into both femoral veins and the left subclavian vein through punctures in the patient's groin and neck. Electrical wires are then placed through the catheters into the heart and are connected to devices that record the electrical pulses of the heart. These wires can also be used to stimulate the heart to detect accessory pathways and to perform the actual cardiac ablation procedure to eradicate those pathways.

The two main possible complications with the procedure are perforation of a blood vessel leading to hemorrhage and systemic bleeding, or perforation of the heart or its vasculature resulting in bleeding into the lining surrounding the heart called the pericardial sac. While both of these instances are eminently life threatening, they are also easily diagnosable and can be immediately treated with the tools readily available within the electrophysiology lab.

The key to preventing catastrophic events in this procedure is to very closely monitor the patient's vital signs and to act without hesitation if any abnormalities appear. Unfortunately, the family in this case was not informed of these possible complications, and the surgical team's negligence only worsened from there. During the procedure, as they began to remove the catheters, the boy's heart rate became very elevated, along with severely low blood pressure and low blood oxygen saturation. Rather than follow the standard of care and immediately check for perforation, the team seemingly ignored these obvious signs of trouble and began to move him to recovery.

To add insult, they called his parents to say that he was in recovery and the procedure went well, and so reassured that their son was fine, they went to the hospital cafeteria. They returned an hour later to hear that there was a problem, their son was on a respirator and was being taken back into surgery to fix a hole in his heart. A puncture had caused his pericardial sac to fill with blood, putting too much pressure on his heart for it to pump effectively. Post-operatively, he was put in the pediatric ICU and was in critical condition. The next day, his parents were informed that he was brain dead and not likely to survive, and they made the difficult decision to remove his life support.

The family will never be functional again after the sudden devastating blow of losing their child, an event they never had to experience if the doctors had followed the standard of care and either never performed the unnecessary procedure, or at least acted appropriately in the operating room.

We were able to obtain a high six figure settlement for this family in a very conservative county.

The practice of medicine has always been a fast-paced and complex environment; with modern life growing ever busier, the risks from mistakes in the doctor's office grow as well. The best precaution against becoming a victim of malpractice is being an active participant in your healthcare. Being your own advocate by staying informed, speaking up, and getting second opinions can prevent minor errors from growing into life-threatening issues. This is especially important when planning and undergoing surgery.

Recently, we represented the husband of a 66-year-old woman who died after suffering preventable complications from elective foot surgery intended to treat the pain of Charcot Collapse. There were several breaches of the standard of care by the surgeon who operated on her, as well as the doctors and staff who were involved in her subsequent emergency care.

Many common elective surgeries performed today do have non-surgical alternatives. These options should be discussed and evaluated by your doctor to determine which will provide the greatest benefit with the least risk. If surgery is decided upon, it is usually required that you be cleared through a preoperative exam to ensure that you are healthy enough for surgery. At the very least, your surgeon should be familiar with your medical history.

In this case, the woman's doctor recommended elective surgery over a non-invasive shoe-orthotic combination. He did not take into account her preexisting conditions, including age-related softening of the bones known as osteopenia, which put her at a much higher risk of developing osteomyelitis (bone infection) and made her a poor candidate for the surgery he suggested. He then failed to have her sent for medical clearance, which given her poor general health, she would not have received. Her infection risk was further exacerbated by her history of hypertension, high cholesterol, obesity, pre-diabetes and metabolic syndrome. Combined with her medical history, this should have caused her to be followed carefully and at the slightest sign of infection be cultured and treated with antibiotics with the assistance of an infectious disease consult. Instead, when she returned for her postoperative appointment complaining of wound pain and oozing, her doctor dismissed it. He provided no instructions on signs of infection to look for, and told her to return in nine weeks, both of which provided false reassurance which would further contribute to the delay of her treatment.

The bacteria seeded around the metallic devices in her foot causing a wound infection and osteomyelitis. Allowed to intensify without the administration of antibiotics, her condition deteriorated. Her husband, fearing for her safety, returned her to the medical center where she suffered still more negligence. Despite obvious indications that she needed urgent attention, she had to wait 16 hours for a bed to become available before she was given any antibiotics. During this time, the amount of bacteria attacking her was allowed to double five times, spreading to all of her body's systems at an alarming rate. The result was sepsis, or blood poisoning, which quickly led to multiple organ failure. Over three weeks of intense conscious pain and suffering followed, as she relied on a ventilator, feeding tube, dialysis, and other live-preserving instruments. We were successfully able to achieve a seven figure settlement for her family in a fairly short amount of time.

Stein, Mitchell & Muse recently brought to successful conclusion a complicated medical negligence case involving a 61-year-old man who underwent routine knee surgery and died at the hospital two months later from a persistent post-operative infection. We represented the deceased's wife and children in claims under Maryland's Wrongful Death Act (Md. Code Ann. Cts. and Jud. Proc. §3-904), alleging that the orthopedic surgeon failed to:

● disclose the heightened risk of infection when performing knee surgery shortly after the patient had blood clots in his lungs;
● examine the patient after he made repeated phone calls from home to report symptoms of wound infection;
● monitor the infection after the patient was re-hospitalized but failed to improve;
● recognize the signs of infection tracking up the thigh and into the abdomen;
● detect and treat internal bleeding caused by advanced infection before multiple organ failure led to death.

The deceased's family members sought damages for his medical bills, funeral expenses, lost future earnings, lost household services, and conscious pain and suffering, as well as for their own profound grief resulting from his unexpected death. The case was settled for a confidential amount on the second day of a two-week jury trial.

Wrongful death cases like this present complex issues on all fronts. Beyond establishing that the patient died as a result of the surgeon's negligence while several other physicians were involved in his treatment, a successful outcome requires navigating the various rules on what damages can be claimed and proven by surviving family members. For example, in this Maryland case involving adult children not residing with their father, only the deceased's widow (who was also the personal representative of his estate) could recover economic damages for his lost financial support and the value of his household services. The family's noneconomic damages - i.e., their past and future grief, often the most personal element of loss - were capped by statute (Md. Code Ann. Cts. and Jud. Proc. §3-2A-09), and the jury would not be told about that limit. If this had been a District of Columbia case, no compensation for the survivors' grief would have been available because DC's Wrongful Death Act does not recognize that element of damages.