Verdicts & Settlements

NJ Medical Malpractice – Failure to Perform Timely Blood Transfusion

$1,750,000

This was a medical malpractice action involving a 48 year old patient who was admitted with a one day history of bloody stools, and abdominal pain, in which the plaintiff contended that the defendant attending gastroenterologist, under whose service the patient was admitted on a Friday evening, and who was on call for the weekend, negligently failed to visit the patient and evaluate his condition despite being advised of signs and symptoms of an active G.I. bleed. The plaintiff further contended that the defendant first year resident negligently failed to order a transfusion despite instructions to do so in the event the patient’s hemoglobin levels fell below 10.0 and notwithstanding that the blood drawn at approximately 8:00 p.m. showed that the hemoglobin level had dropped to 8.8.

Finally, the plaintiff also contended that the defendant nurses negligently failed to obtain blood from the in-house blood bank, notwithstanding that an initial 4:30 a.m. fall, a hemoglobin drop to 7.8 and documented coffee grounds emesis prompted the ordering of a transfusion on a STAT basis. The patient fell a second time in the bathroom at approximately 10:30 a.m., suffered a cardiac arrest, and was pronounced dead approximately two and a half weeks later. The plaintiff maintained that the decedent was in a semi-vegetative state during this period and the plaintiff made a claim for pain and suffering.

The evidence disclosed that the decedent was admitted at approximately 4:00 p.m. on a Friday with a history of lower left quadrant abdominal pain and bloody stools over a one day’s duration. The defendant attending physician was not physically at the hospital, but was on call. At approximately 5:00 p.m., he obtained the history from the resident. A colonoscopy was negative. The defendant attending physician ordered that if the hemoglobin, which was then above 10.0, fell below that number, he should be transfused. The plaintiff contended that the defendant attending physician was advised of signs and symptoms of an active G.I. bleed and should have visited the hospital and evaluate the patient.

The defendant attending physician denied that he was advised of signs or symptoms of an active G.I. bleed. The deposition of a non-party resident, who had taken the decedent’s history, reflected that she spoke with the attending physician at the time of admission. She testified that she certainly would have told him of the history of streaks of bright red blood that morning and a positive rectal examination for bright red blood that morning and a positive rectal examination for bright red blood at the time of admission. The non-party resident indicated that as a second year resident, she recognized this as an active G.I. bleed, but that it was the attending physician’s decision not to come to the hospital that Friday evening, as evidenced by his order to place the decedent on a liquid diet. The plaintiff contended that based upon such testimony, the attending physician’s denial of being advised of an active G.I. bleed should be rejected.

The plaintiff contended that as the attending physician, this defendant clearly should have evaluated the patient. The attending physician’s group covered both this hospital and a second hospital. The plaintiff would have also produced evidence that despite the urgency of the situation, the defendant attending physician initially stopped at the other hospital to conduct rounds that Saturday morning before going to the defendant hospital.

The plaintiff further maintained that at approximately 11:00 p.m. on Friday night, the hemoglobin fell to 8.8 and the defendant first year resident was advised. The plaintiff contended that the defendant resident nonetheless determined that the transfusion could wait until the a.m. labs were drawn. The plaintiff contended that the resident’s failure to order a transfusion at that time was clearly negligent.

The plaintiff also maintained that when the transfusion was ordered on a STAT basis at 4:30 a.m., the blood should have been obtained from the in-house blood bank within 60-90 minutes. The evidence disclosed that when the blood still hadn’t been picked up by 6:30 a.m., the blood bank called the floor making inquiries. The plaintiff contended that the blood was nonetheless never obtained. The plaintiff maintained that after a new shift came on duty at 7:00 a.m., she took care of other duties without obtaining the blood. The plaintiff contended that at approximately 8:00 a.m., the nurse’s supervisor directed the nurse to attend a hospital meeting and advised her that she would take care of the nurse’s duties. The blood was not obtained and the transfusion was not performed before the second fall and the calling of a code.

The plaintiff contended that the decedent was in a semi-vegetative state between the time of the code and his death approximately two and a half weeks later and experienced conscious pain and suffering. The defendants denied that this position should be accepted, and maintained that the decedent never regained any consciousness or experienced conscious pain and suffering. The plaintiff would have countered that the decedent reacted to painful stimuli, including pin prick tests and the plaintiff would have contended that such evidence reflected some level of pain and suffering.

The case settled prior to trial for $1,750,000, including $875,000 from the attending physician and $875,000 from the hospital for the negligence of the resident and nurses.

REFERENCE
Plaintiff’s economist expert: Stan Smith from Chicago, IL. Plaintiff’s gastroenterologist expert: Maxwell Chait, M.D., from New York, NY. Plaintiff’s nurse expert: Polly Zimmermann from Chicago, IL.
E.B. v. K.H., M.D., et al. Docket No. MON-L-1546-07, 1/5/10
Attorney for Plaintiff: Charles A. Cerussi of Cerussi & Gunn, P.C. of Shrewsbury, NJ and Garden City, NY

COMMENTARY
The claimed lost income in this case, in which the decedent left a wife and no children, was significantly less than the recovery. The defendant would have also argued that the records reflected that the decedent was comatose during the tow and a half week period between the code and his death and that the positive pin prick tests relied upon by the plaintiff in its arguments that the decedent experienced conscious pain and suffering were indicative of a reflexive response only and did not support the plaintiff’s position. The plaintiff was nonetheless able to resolve the case for $1,750,000, and the evidence of a lack of communication among the defendants and that despite the orders to transfuse the patient if his hemoglobin levels fell below 10, no transfusion was performed, would have clearly created a strong jury reaction.

Additionally, it is felt that the reaction against the attending physician would have been heightened by the evidence that besides failing to visit the decedent upon admission, this defendant decided the following morning to stop by the other hospital which his group covered before visiting the decedent, would have heightened this reaction. Finally, the plaintiff would have emphasized that although the transfusion had been ordered on a STAT basis at 4:30 a.m., the blood still had not been obtained from the in-house blood bank as of the time of the approximate 10:00 a.m. code.