Medical Malpractice Lawsuit Brings
2008 Trial Lawyers
Death of 82-year-old woman from sepsis due to
improper placement of feeding tube
The plaintiff’s decedent was an 82-year-old woman who died on 1/20/02 as the result of gram-negative sepsis secondary to an abdominal wall abscess and a myocardial infarction in the setting of severe vascular disease. Her abscess and sepsis were the result of tube feeding and x-ray contrast material that accumulated in her abdominal cavity and/ or interstitial space due to a malpositioned feeding tube.
The plaintiff’s decedent was admitted to a rehabilitation hospital on 12/6/01 following bilateral femoral popliteal bypass surgeries, and subsequent treatment for a right groin wound infection. She had a tracheotomy tube in place, as well as a feeding tube.
On 12/28/01, there was a question of leaking around the gastrostomy tube. A nurse practitioner requested a gastroenterology consult, and ordered a KUB (abdominal x-ray), with gastrograffin (contrast material). The KUB showed that the feeding tube did not overlie the stomach directly.
On 12/29/01, a nasogastric (NG) tube was inserted. A chest x-ray was done to check tube placement. This film showed contrast in the left upper quadrant, however the results were not immediately available. The next time a doctor was present after the films were read was on 12/31/01. The tube feedings were stopped. The patient was then fed through her NG tube.
On 1/2/02, a gastroenterologist examined the patient. He tightened the bumper to improve the seal of the feeding tube and suggested restarting tube feedings.
On 1/3/02, the gastroenterologist replaced the existing feeding tube. His plan was to check a gastrogaffin study, and “if ok,” restart the tube feeding. This study was performed on the same day. The tube feeding was restarted during the evening of 1/3/02.
On 1/4/02, the gastrogaffin study was noted to be “okay by verbal report of team. (prelim reading).” On this same date, a chest x-ray was ordered which showed dense consolidation at the left lung base consistent with pneumonia and probably a small amount of left pleural fluid. It was further reported that this could be secondary to malpositioning of the feeding tube with a questionable development of a left subtract abscess.
On 1/6/02, another KUB with gastrograffin was performed to verify feeding tube placement. The interpreting radiologist reported that contrast material was seen to lie outside the stomach in the left upper quadrant. The covering gastroenterologist was notified of these results, and ordered the feeding tube removed.
On 1/7/02 and 1/8/02, the patient’s condition deteriorated. Her white blood count was elevated, she had a low-grade fever, she was anemic requiring blood transfusion, and she developed an ecchymotic area in the left upper quadrant of her abdomen. Subsequently she became hypotensive and developed renal failure. On 1/8/02, she was transferred to a tertiary care hospital for further management.
On 1/9/02, she underwent extensive surgical debridement from the left axilla to the umbilicus, including the abdominal wall. Necrotic tissue, approximately 500cc of pus, contrast material, and tube feeding were removed. Despite continued treatment efforts, including another surgical debridement, her condition continued to deteriorate. Ultimately, she died on 1/20/02.
The autopsy determined that the patient died as the result of gram-negative sepsis secondary to an abdominal wall abscess and a myocardial infarction in the setting of severe vascular disease.
The plaintiff alleged that the death was the direct result of substandard care rendered to the patient by the treaters caring for her at the rehabilitation hospital. The plaintiff claimed the caregivers should have determined sooner that the feeding tube was out of position and that tube feedings were not going where intended.
The defendants contended that the care and treatment provided to the patient was at all times appropriate and in compliance with the standard of care and that nothing they did or failed to do caused or contributed to cause her death. The defendants further contended that there was no evidence of peritonitis or abdominal abscess at any point prior to transfer from the rehabilitation hospital, and that all abdominal examinations performed daily were normal without any evidence of pain or distension, and not consistent with an abdominal process.
The case settled a week before trial for $750,000.
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