Anoxic Brain Injury After Patient Denied Admission: $4.8 Million Settlement

Medical Malpractice Settlement Report, 2021
By William J. Thompson, Medical Malpractice Attorney

Middlesex Superior Court

Anoxic brain injury after patient denied admission by nurse practitioner and sent home with cardiac tamponade

The plaintiff, age 44, suffered cardiogenic shock, cardiac arrest, and a resulting anoxic brain injury on 10/31/15 from post-operative cardiac tamponade following a cardiac ablation procedure.

Seven days after the ablation, the plaintiff presented to the defendant Nurse Practitioner complaining of increased cough which started two days ago, low-grade fever, pain to his abdominal incisions, and concerns of having returned to his atrial fibrillation. His vital signs were normal, and a chest x-ray was normal. 

The NP discharged him and advised him to call the office/clinic if his symptoms worsened. The plaintiff returned to the clinic the following day with worsened symptoms requesting hospital admission. His symptoms included ongoing cough, difficulty breathing, generalized malaise, weakness, and nausea. He was again seen by the defendant NP who documented that he had increased cough and "sweats" with a heart rate "in and out of afib" overnight ( 40s to 11 Os). His vital signs were normal. An EKG was normal. A repeat chest x-ray was normal. His WBC count was elevated at 16.32. The NP consulted with another electrophysiology nurse practitioner, and the covering physician. 

The plaintiff claimed the NP failed to order an echocardiogram to assess for pericardial effusion and/or cardiac tamponade as the cause of the plaintiffs worsening presentation. 

Also, the NP rejected the plaintiff's request for admission, and failed to have him evaluated by a physician. Instead, she sent him home with instructions to rest, increase his fluid intake, and continue taking Doxycycline. She also told him to call his primary care physician if his cough worsened or if fever developed. 

The next day the plaintiff was rushed by ambulance to a different hospital. A bedside echocardiogram showed a large pericardial effusion with cardiogenic shock secondary to cardiac tamponade. In the emergency room, the plaintiff coded twice. He was revived and underwent hypothermic cooling protocol. He suffered respiratory failure, multi-organ dysfunction syndrome, myoclonus, and renal failure with shock. 

The plaintiff requires 24-hour assistance and care. He cannot walk on his own. He cannot problem solve or make consequential decisions, nor can he feed himself, control his bladder, dress himself, or wipe himself. He has undergone physical, occupational, aqua, and speech therapy. He has not worked since his injury and relies wholly on his wife and family members. 

The defendant denied liability. 

The case settled shortly before trial for $4,800,000, which was the total available insurance coverage.

Attorneys for the plaintiff: Andrew C. Meyer Jr. and William J. Thompson.

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