Young Mother Dies After Missing Dialysis Treatment

Young Mother Dies After Missing Dialysis Treatment
Ann W. Latner, JD
September 01, 2009

Dr. H, 52, had been a nephrologist for more than 20 years. He shared a practice with several other physicians and had a steady flow of patients, many of whom came regularly for dialysis treatments.

One of them, Ms. W, had been Dr. H's patient for eight years. An obese 34-year-old single mother, she had diabetes and end-stage renal disease (ESRD), as well as pulmonary hypertension, sleep apnea, and oxygen dependent lung disease. Over the past few months, her condition had worsened, and she now required dialysis three times a week.

Catheter bleeding

The patient's mother usually brought her in for her dialysis treatments. One day, as Ms. W was being prepped, Dr. H noticed that she was bleeding around the catheter area. He halted treatment and sent her to the emergency department (ED) of the local hospital.

At the hospital, the ED physician put in a suture to stop the bleeding, and, after consulting Dr. H on the phone, ordered blood work to ensure that Ms. W's potassium levels were not excessive after missing dialysis. However, before the tests could be completed, Ms. W was discharged from the hospital. A few hours later, a hospital employee whose identity was never discovered cancelled the lab order since Ms. W had already been discharged.

The next morning, Ms. W's mother called Dr. H to ask if Ms. W should come in for dialysis. Dr. H, assuming that the hospital had confirmed patient's potassium levels were normal, said they could wait until the following day to resume dialysis, but Ms. W died at home that evening.

No autopsy

Although no autopsy was performed, the death certificate listed the cause of death as hyperkalemia. Dr. H was shaken by the belief that she might not have died if he had not delayed dialysis that day. He was dismayed, but not surprised, when he learned that Ms. W's mother had filed a malpractice suit against him, the ED physician, and the hospital in connection with the death.

Dr. H's insurance carrier provided a defense lawyer, and the case proceeded through depositions, motions, jury selection, and finally to trial, where the cause of Ms. W's death was hotly contested.

The plaintiffs' lawyer called two experts — a nephrologist and an expert in emergency medicine — who both testified that Ms. W died of excessive serum potassium.

Dr. H's attorney called an expert nephrologist of his own, who testified that the cause of death could not be determined without an autopsy. The ED physician's lawyer called a cardiologist, who testified that the cause of death was respiratory arrest secondary to lung disease, and another expert nephrologist, who testified that the cause of death was a pulmonary embolus secondary to superior vena cava syndrome.

Testifying on his own behalf, the ED physician said his own opinion was that the death was caused by a pulmonary embolism. Dr. H did not testify about why Ms. W died.

In her closing argument, the plaintiffs' attorney pointed an accusatory finger at Dr. H and his codefendants.

“They did not follow through,” she told the jury. “They ordered blood work, and then never bothered to make sure it was done. They sent Ms. W home without any test results.

“And then when her mother called to see if she needed to come in for dialysis, Dr. H assumed that since he hadn't heard from the hospital, the blood work was okay. Ms. W relied on her doctors, these doctors who owed her a duty of care, and they failed her. They didn't follow through, and they are responsible for her death.”

After a long deliberation, the jury returned with a verdict of $1.2 million for Ms. W's mother and 10-year-old son. Dr. H was found 40% at fault; the hospital 45% at fault; and the ED physician 15% at fault.

Legal background

The cause of death was pivotal in this case, because the plaintiff had to prove it was the direct result of the clinicians' failure to meet their duty to the patient.

Ms. W should not have been discharged from the hospital before the lab results were in. The order for the potassium analysis should not have been cancelled. And Dr. H not have assumed no news was good news before telling Ms. W's mother that dialysis was not necessary the next day. By establishing those facts, the plaintiff showed that the clinicians had a duty to Ms. W and that duty was breached.

But, if her death was caused by something unrelated — an aneurysm for example — then the fact that a duty was breached would be irrelevant, liability could not be proved, and Dr. H would be off the hook. Ultimately, the jury believed the plaintiffs' witnesses who concluded that Ms. W's death was due to an excess of potassium caused by missing her regularly scheduled dialysis.

Protecting yourself

The old adage about making assumptions holds true here. Dr. H assumed that Ms. W's blood results were normal because he hadn't heard from the hospital. But in this case, not hearing from the hospital meant that the blood work had not been done. Had Dr. H or his made a phone call, or had his nurse make a phone call, this lawsuit might have been averted.

Always wise to check on test results yourself before using those results as a basis for advice to a patient.

Ms. Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.

http://www.renalandurologynews.com/Young-Mother-Dies-After-Missing-Dialysis-Treatment/article/147839/