The plaintiff, a 66 year-old male, underwent a Coronary Artery Bypass Grafting procedure on July 29. While the CABG procedure proceeded seemingly without incident, plaintiff developed severe hypoxia after the procedure, was transferred to ICU, and was placed on a ventilator. He required up to 100% oxygen, almost five times the normal amount.
The pulmonary and critical care group was called in to manage the care in the ICU and to determine the cause of the hypoxia.
During the first week in the ICU, multiple members of the defendant pulmonary and critical care group saw the patient, who continued to have a significant oxygen requirement. Multiple potential causes were considered with the pulmonologists ultimately concluding that a pulmonary embolus was the most likely explanation for the hypoxia.
Having made that determination, the pulmonologists began Heparin therapy, which is the gold standard for treating pulmonary emboli. The patient, who initially improved on the Heparin, remained on the Heparin for approximately two weeks. At that time, he was found to have a retroperitoneal hematoma compressing his spinal cord. This caused temporary paresis and allegedly permanent nerve damage.
The plaintiff contended that his hypoxia was not caused by a pulmonary embolus, but rather, was the result of pulmonary edema caused by volume overload. He argued that the Heparin therapy should not have been conducted empirically and that the standard of care required “objective” testing (Doppler ultrasound, perfusion scanning or pulmonary angiography) to confirm the presence of a pulmonary embolus before a course of Heparin therapy could be continued.
Defendants argued that the referenced tests would either have failed to provide information sufficient to warrant the suspension of Heparin therapy or posed such a significant risk to the patient’s health that they were contraindicated. Specifically, as plaintiff’s expert would concede, both Doppler ultrasound and perfusion scanning would “miss” a pulmonary embolus at least 50% of the time. On the other hand, everyone agreed that pulmonary angiography would almost certainly have revealed whether or not a pulmonary embolus was present. However, the performance of the test requires contrast material which was contraindicated in the patient because he was experiencing kidney dysfunction.
The plaintiff’s standard of care expert was Dr. Peter Fedullo, a pulmonologist from the University of San Diego. He has written extensively on the diagnosis and treatment of pulmonary emboli. However, the defense was able to utilize his prior writings in cross-examination to limit his effectiveness as a witness.
The jury deliberated for approximately two hours before returning a defense verdict.