$1 Million Settlement for Woman’s Death Due to Abdominal Bleed

2010 Medical Malpractice Trial Report

Failure to treat abdominal bleed leads to death of 31-year-old woman

On 11/7/02, the decedent presented to Holy Family Hospital for an elective back surgery. The surgeon performing the procedure noted that the surgery was uneventful until the last piece of disc was removed, at which time bright red blood appeared within the disc space. The neurosurgeon called for a vascular surgeon to come and evaluate the bleeding. The vascular surgeon found no active bleeding but suggested an ultrasound and CAT scan to rule out a retroperitoneal bleed. An ultrasound found no obvious collection of blood and appropriate flow in the distal aorta and iliac arteries. The CAT scan, however, did find more than one liter of fluid surrounding the aorta and inferior vena cava. The vascular surgeon decided to perform surgery to see if he could determine the source of the bleeding. Upon entering the abdomen, blood was found but the surgeon again could not determine the source. After approximately ½ hour of looking for a bleeding site, the surgeon closed the incision and sent the decedent to the PACU for close monitoring.

A few hours after the operation was completed, the decedent’s blood was drawn and her hematocrit came back very low at 28.4. Packed red blood cells were transfused and a repeat hematocrit showed an increase to 31 after the transfusion. Later that evening, the decedent was transferred to the Intensive Care Unit in guarded condition. It was ordered that the hematocrit values be drawn every 4 hours for a 24-hour period, and a doctor was to be notified if the hematocrit level fell below 29. An hour after arriving in the ICU, her hematocrit had dropped to 27.3. The defendant on-call surgeon was contacted about her falling hematocrit but he did not evaluate the decedent. In fact, the defendant surgeon did nothing to address the fact that the decedent was continuing to bleed internally.

At 1:20 A.M. on 11/8/02, the defendant was called and informed that the decedent’s hematocrit level had dropped again – this time to 23.3. She also had decreased urine output, there were essentially no bowel sounds, her blood pressure had decreased and her heart rate had become very elevated. The defendant did not come in to the hospital to evaluate the decedent but rather ordered 2 units of packed red blood cells to be transfused and indicated that he would be at the hospital in the morning to evaluate the decedent.

Upon arrival at the hospital in the morning, the defendant surgeon found the decedent to be agitated, with a very distended abdomen. He also noted that her hematocrit level continued to decrease. The decedent was transferred for a CT scan which showed an extremely large left sided abdominal bleed, much more extensive than seen previously on CT scan. Plans were then made to transfer the decedent to the Beth Israel Hospital via MedFlight. During preparation for transfer, the decedent went into pulseless electrical activity (PEA). Efforts to resuscitate the decedent were unsuccessful and she was pronounced dead. An autopsy was performed at and showed that the abdominal cavity contained a large quantity of bloody fluid, at least several liters and the pelvis contained a large amount of clotted blood. Perfusion of the aorta with water revealed a tear of the left common iliac artery.

The plaintiff was expected to present expert medical testimony that the defendant surgeon was negligent in his failure to properly respond to an obvious bleed in the decedent’s abdomen. Specifically, the plaintiff’s expected to evidence to demonstrate that the distention of the abdomen and falling blood levels required the defendant surgeon to come to the hospital, evaluate the decedent in person, and take her to surgery to determine why she was bleeding. The plaintiff further expected the evidence to show that the decedent had an injury which would not have caused her death had the defendant acted appropriately.

The defendant was expected to present testimony that his care was appropriate at all times and that there was no need for him to come to the hospital overnight as she was being cared for by the nurses and that his treatment, even if he had come to the hospital, would have been the same. The defendant was further expected to present testimony that the decedent’s tear of her artery which caused her bleeding and death was in a location which would have been very difficult to locate and repair even had emergency surgery been undertaken.

The case settled for $1,000,000 one month prior to the scheduled trial date. The defendant paid the extent of his available insurance coverage.

Lubin & Meyer attorneys represented the plaintiff in this abdominal bleed medical malpractice lawsuit.

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