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Location: Richmond, VA
Injuries: Wrongful Death
The plaintiff’s decedent, a 48-year-old man, visited his family physician with complaints of shortness of breath, dizziness, chest pain, and a dry mouth.
His vitals were obtained, and the results revealed that he was experiencing mild tachycardia, or an increased heart rate, at over 100 beats per minute. He had an oxygen saturation of 94% and blood pressure readings of 92/50 and 130/80.
This doctor’s visit took place approximately three and a half months post-op from the decedent’s thoracic decompression surgery. Following this surgery, he experienced significant mobility limitations, relying on a wheelchair and a walker for mobility. Following a physical examination, the defendant attributed the decedent’s shortness of breath to deconditioning, his chest pain to GERD (gastroesophageal reflux disease), and his dizziness to possible orthostatic hypotension.
Prior to discharging the decedent, the defendant ordered several lab studies, including a D-Dimer test. This is used almost exclusively to evaluate for acute pulmonary embolism. The D-Dimer test was ordered on a non-stat (non-urgent) basis and was scheduled to be reported the following day.
Our plaintiff’s decedent was discharged from the defendant’s office. Later that evening, he collapsed suddenly. Despite resuscitation efforts initiated by EMS, he died – approximately 6 hours after his arrival at the defendant’s clinic. The following day the D-Dimer result was reported and was severely elevated – about 30 times higher than normal. There was no autopsy.
At trial, experts on the plaintiff’s side testified that the defendant violated the standard of care. They noted that the defendant failed to develop an appropriate level of suspicion for acute pulmonary embolism based on the patient’s risk factors, presenting signs, and symptoms. The plaintiff’s experts also testified that the standard of care required the immediate transfer of the plaintiff’s decedent to the nearest emergency room so that the D-Dimer could be completed on a stat (urgent) basis, along with a chest CT-A scan.
The plaintiff’s causation experts testified that had the decedent been timely transferred to the emergency department, he would have received telemetry and other monitoring. Anticoagulants would also have been administered, to keep the existing clot from propagating. The experts also testified that the clinic’s support measures were insufficient to maintain the plaintiff’s hemodynamic stability. Thrombolytic medication could have been initiated, and it would have saved the decedent’s life. Finally, they testified that while a D-Dimer is a non-specific test and an elevated D-Dimer does not necessarily confirm a pulmonary embolism, a D-Dimer elevated to such a high degree is more likely due to pulmonary embolism.
The defendant’s standard of care experts testified that the plaintiff’s decedent did not meet the profile of a patient experiencing an acute pulmonary embolism. They explained that they came to this decision primarily because the decedent’s chest pain was non-pleuritic (sharp and painful) in nature, and his vitals were historically consistent with those gathered at other medical visits.
The defendant’s causation experts testified that the plaintiff’s decedent’s death was more likely the result of a sudden cardiac death. They claimed that this death was unrelated to his earlier presentation and not a pulmonary embolism. Those experts also testified that the plaintiff’s decedent had been evaluated for pulmonary embolism a few months prior to his death after a sudden onset of chest pain. They testified that although that evaluation included an elevated D-Dimer, a chest CT-A ruled out the presence of emboli in the lungs.
After four days of evidence, the jury deliberated for just over an hour before returning a verdict in favor of the plaintiff. Prior to closing arguments, the parties entered into a high-low agreement.
Shareholder Derrick Walker was first chair on the case, and said of his colleague Kari La Fratta, ”
Kari is obviously very comfortable in the courtroom. She demonstrates excellent preparation, trial technique, and instincts well beyond her years. I look forward to trying many more cases with Kari in the years to come.”
Special Damages: Funeral Expenses – $9,206.87
Plaintiff’s decedent was survived by a single statutory beneficiary, his wife of 15 years.