Alfred Anthony Clarke's Legal Cases (3)

Medical malpractice

Patient Develops a Large Hospital-Acquired Pressure Wound That Hospital Staff and Physicians Failed to Prevent and Treat

Mar 03, 2016

OUTCOME: $575,000 Settlement

The 55 year-old male patient presented to a local teaching hospital with altered mental status, generalized weakness, and shortness of breath. His health history included end stage renal disease requi ... ring hemodialysis, diabetes, tobacco use, obesity, and hypertension, all of which are known risk factors for the development of pressure wounds, also known as bed sores. Despite these multiple risk factors, hospital staff and physicians failed to develop and implement a plan to prevent the development of pressure wounds or to regularly monitor the patient’s skin integrity. Shortly after admission, the patient suffered respiratory failure and was intubated. He remained in bed, immobile, intubated and sedated, for approximately two weeks, which further predisposed him to developing a pressure wound. When his respiratory condition stabilized, he was extubated and transferred to the floor. Immediately after his transfer, hospital staff discovered a large, Stage II (characterized by broken or open skin) pressure wound measuring 12cm x 8cm on the patient’s sacrum (lower back just above the tailbone). The size of the wound, measuring approximately the size of a baseball, indicated that it had been present and progressively worsening for some time before it was ever discovered. But even after finding the wound, hospital staff and physicians nonetheless failed to implement a plan to treat the wound or to prevent it from worsening. Indeed, it took weeks for staff and physicians document a plan to regularly turn and reposition the patient, to provide the patient with an air mattress, and to obtain a plastic surgery consult. Following the development and identification of the pressure wound, the patient developed sepsis and was transferred to the MICU. A consulting hospital physician documented in the patient’s chart that that “the sacral ulcer [was] likely contributory to sepsis.” Eventually, the patient was stabilized and discharged to a rehabilitation facility. By the time of his discharge, the patient’s pressure wound had progressed to Stage IV (characterized as a very deep wound extending to the bone) and measured 12cm x 10cm x 5cm. Ultimately, the patient would have to be hospitalized numerous times and undergo a number of painful procedures to treat the wound and to prevent further infection, including multiple surgical debridements, a flap closure procedure and a diverting colostomy. The development of a hospital-acquired pressure wound is classified as a “never event” because it constitutes a preventable and identifiable medical error that should never occur. In this case, the plaintiff argued that the hospital’s negligence went far beyond the mere failure to prevent the development of the patient’s pressure wound and extended to the hospital’s failure to regularly monitor the patient’s skin integrity and to appropriately manage and treat the wound once it was finally identified. The plaintiff retained a nursing expert who authored a report in which she stated that this was one of the most egregious cases of negligence and patient neglect that she had ever seen. The case was resolved for $575,000. The plaintiff died shortly after the settlement from a cause unrelated to the pressure wound.

Medical malpractice

Army Nurse Sues Her Own Hospital for Letting Her Baby Die in Botched Labor and Delivery

Jan 08, 2016

OUTCOME: $1,175,000 Settlement

The plaintiff was a 26-year-old, active-duty enlisted soldier in the U.S. Army who worked as a nurse at Fort Belvoir Hospital in Alexandria, Virginia. In June 2013, she was admitted to the same hospita ... l for induction of labor and delivery of her full-term baby boy. Shortly after her arrival, the expectant mother was connected to an electronic fetal monitor, and Fort Belvoir physicians and nurses began administering Pitocin, a uterotonic hormone that is given to promote contractions and induce labor. One of the risks associated with Pitocin is that it can cause fetal distress. Various abnormal fetal heart rate patterns may be signs of fetal distress. When faced with these abnormal fetal heart rate patterns, the standard of care mandates that intrauterine resuscitative measures be performed. These measures include stopping the Pitocin, changing the mother’s position, and administering oxygen and fluids. By 9:30 a.m., the primary labor and delivery nurse assigned to the plaintiff identified variable decelerations of the baby’s heart rate. The nurse testified that variable decelerations are abnormal and concerning heart rate patterns that are caused by compression of the umbilical cord. By 10:30 a.m., the nurse identified late decelerations, which she admitted was a concerning finding. In response, she notified the resident obstetrician and began intrauterine resuscitation measures including oxygen by mask, boluses of intravenous fluids, and shifting the mother’s position, all of which continued uninterrupted for the remainder of the labor. However, neither the nurse nor the resident physician discontinued Pitocin. As the hours went by, the baby showed increasing signs of fetal distress. By 3:00 p.m., the baby was experiencing recurrent variable and recurrent late decelerations with almost every contraction. These decelerations, which are caused by a decrease in blood and oxygen flow to the baby, were becoming more frequent and severe. By 5:30 p.m., there was an additional concerning finding – tachycardia – which is an abnormally high baseline fetal heart rate. Again, no one stopped the Pitocin or took any further resuscitative measures to improve the fetal heart rate pattern. At 5:50 p.m., the nurse and the resident physician finally called the on-call supervising obstetrician to evaluate the patient. Upon arrival, supervising physician reviewed the electronic fetal monitoring strips and identified an abnormal, non-reassuring pattern of recurrent variable and late decelerations with tachycardia. Nevertheless, she failed to stop the Pitocin and failed to immediately deliver the baby via C-section. Rather, she instructed the mother to continue pushing. It was not until 6:30 p.m. that the supervising physician decided to proceed with an expedited, vacuum-assisted vaginal delivery. The baby boy was born at 6:42 p.m. Upon delivery, he was pale and limp, and his heart rate was 50 beats per minute (normal fetal heart rate is 110-160 beats per minute). A Code Blue was called and resuscitation efforts were immediately initiated. Despite exhaustive resuscitation efforts, the baby was pronounced dead at 7:36 p.m. Umbilical cord gases were dramatically abnormal and consistent with significant and progressive hypoxia and acidosis. The plaintiff’s baby died because he was deprived of oxygen over a prolonged period of time. The plaintiff alleged that the Army’s employees at Fort Belvoir Hospital violated the standard of care and were negligent by failing to appreciate the signs of progressive fetal distress as demonstrated by the abnormal and non-reassuring fetal heart rate patterns that persisted and progressively worsened for hours before delivery, by failing to stop the Pitocin in the face of progressive fetal distress, and by failing to deliver the baby earlier via C-section. The Plaintiff filed an administrative claim and subsequently a lawsuit against the United States of America under the Federal Torts Claims Act (FTCA). The case was settled after a mediation with a U.S. magistrate judge for $1.175 million.

Medical malpractice

Negligently Performed Laparoscopic Surgery Results in Perforated Artery and Massive Blood Loss

Sep 22, 2014

OUTCOME: $1,650,000 Settlement

Plaintiff, a 32-year-old mother of two, presented to a hospital emergency department with complaints of severe right-sided pelvic pain. The defendant gynecologist suspected a ruptured ovarian cyst and ... performed an exploratory laparoscopy. During the surgery, the defendant perforated the plaintiff’s right common iliac artery while attempting to insert a secondary trocar under direct visualization. There was evidence that the defendant negligently handled the trocar, failed to maintain proper control of the trocar, and inserted the trocar too deep into the plaintiff’s pelvis. The through-and-through arterial perforation resulted in massive bleeding and hypovolemic shock. The medical records and witness testimony suggest that the defendant waited approximately 20 minutes after discovery of the trocar injury and resultant bleeding before converting the procedure to an open laparotomy, which was necessary to identify the source of and stop the bleeding. A general surgeon was called in, and the arterial injury was ultimately repaired. The plaintiff lost more than half of her body’s total blood volume during the surgery. The plaintiff was immediately airlifted to a trauma center where she was diagnosed with critical limb ischemia. A clot had formed at the site of the iliac artery perforation and cut off the blood flow to the plaintiff’s right leg. In an effort to save her leg, a femoral-to-femoral bypass surgery was performed in which a graft was placed to deliver blood from plaintiff’s left femoral artery to her right femoral artery, thereby restoring blood flow to the entire right lower extremity. As a result of the defendant’s negligence, the plaintiff suffered significant and permanent neurologic and vascular injuries. The plaintiff currently suffers from neuropathy of her right leg and complex regional pain syndrome caused by the lack of blood flow to her right lower extremity following the injury to her iliac artery. She also suffers from claudication (pain caused by insufficient blood flow during exercise), which has resulted in functional impairment and physical limitations. In addition, plaintiff will require regular and life-long monitoring of her bypass graft, which, according to plaintiff’s experts, will need to be revised/replaced approximately once every 10 years. The case was resolved for $1,650,000.

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