Urology malpractice consult: Patient dies following lithotripsy procedure

Urology Times JournalVol 48 No 8
Volume 48
Issue 08

Stone embedded in bladder wall, causing slow bleed

The plaintiff’s decedent, a 67-year-old man, was admitted to the hospital through the emergency department. He had complaints of nausea, pain, and vomiting.

The admitting assessment was acute dehydration, secondary to a lithotripsy procedure he had the previous day to treat bladder stones. The complete blood count on admission was remarkable for low hemoglobin and hematocrit and elevated white blood cells. The patient was given fluids and pain medication for 18 days. He also received 2 doses of a powerful anticoagulant medication pursuant to the orders of the defendant urologist.

A change in the patient’s condition prompted a telephone order from the urologist for bed rest, to increase the IV rate to 150 cc’s per hour, and to contact the hospital physician on call for further orders.

The internist on call was called pursuant to the urologist’s order. The medical chart indicated that the internist gave telephone orders for an increase in the IV rate to 150 cc’s per hour, strict bed rest, and to apply a Posey vest (method used to restrain a patient) as needed. The internist later countersigned these orders.

At 6:45 AM the following morning, the patient’s condition deteriorated significantly. The internist was again called, and he left orders with the hospital nurses advising them to administer a diuretic and to have his partner, another internist assuming duties from him, examine the patient as soon as possible. The patient coded at 7 AM and was pronounced dead at 7:20 AM.

Patient suffered extensive hemorrhage

An autopsy revealed 2500 cc’s of blood in the patient’s lower abdomen caused by an extensive hemorrhage into the bladder wall, caused by an embedded bladder stone deep in the bladder wall. Apparently, the lithotripsy caused a bladder stone to become embedded into the bladder wall, commencing a slow bleed.

The patient’s wife sued the defendant urologist, the hospital, and the 2 internists for malpractice. She alleged that despite her husband’s deteriorating condition, all defendants failed to institute proper care, which caused him to bleed to death.

The plaintiff also contended that the orders attributed to the internist, supposedly at 11 PM, were completely inadequate and below the standard of care. She contended that at the time the internist was called, it would have been possible to reverse the effects of the anticoagulant medication, perform surgery, repair the bleed, and save her husband’s life.

The internist claimed that he never gave orders to the hospital nurse when called. Instead, he argued that he was not on call for the urologist, and if the urologist wanted a consultation from him, then the urologist needed to call him. Although the internist admitted he countersigned the orders, he testified that he did so in error.

The plaintiff claimed the urologist should have never ordered the anticoagulant medication and doing so was below the standard of care.

The urologist testified that he wanted an urgent consult from the internist. However, he agreed that his order, as taken down by the nurse, did not reflect that he was requesting an urgent consultation.

The decedent was 67 at the time of death. His wife sought damages for wrongful death and claimed between $85,000 and $200,000 in economic damages.

Urologist dismissed prior to trial

Prior to trial, the urologist was dismissed under confidential terms. The case proceeded to trial against the internists. The jury trial lasted 6 days. After 6 hours of deliberation, the 12-person jury, made up of 5 men and 7 women, returned a 10 to 2 verdict in favor of the defense.

Legal Perspective

The settling defendant urologist left an empty chair at trial. Generally, defendants stick together; one does not point the finger at the others. At a jury trial, the jury will be asked to apportion fault among all those whom the jury believes are at fault for the injury. For example, if the jury finds Defendant A 30% liable and Defendant B 40% liable, there is still 30% remaining. In that hypothetical, the jury could apportion that to the empty chair. In a medical malpractice case, that apportionment requires expert testimony that the empty chair defendant was negligent.

In this case, since the urologist was no longer in the case, the internists were able to argue that the outcome was the entire fault of the urologist. That may have made the difference in the jury in this case reaching a defense verdict in favor of the defense.

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