Urologist and internist sued after patient’s death from slow bleed

Acacia Brush Perko, Esq

On October 18, at approximately 1 PM, a 67-year-old male patient was admitted to the hospital through the emergency department. He had complaints of nausea, pain, and vomiting. The admitting assessment was acute dehydration secondary to a lithotripsy he had a day earlier to treat bladder stones. The complete blood count on admission was remarkable for low hemoglobin and hematocrit and elevated white blood cells. The patient was given fluids and pain medication throughout October 18. He also received 2 doses of a powerful anticoagulant pursuant to the orders of his urologist.

At 11 PM, a telephone order from the urologist was transcribed. It advised bed rest for the patient, said the IV rate should be increased to 150 cc’s per hour, and asked that the physician on call be contacted for further orders. The internist on call was contacted pursuant to the urologist’s order. The patient’s chart indicated that the internist gave telephone orders for an increase in the IV rate to 150 mL per hour, strict bed rest for the patient, and application of a posey vest as needed. The internist later countersigned these orders.

At 6:25 AM the following morning, the patient’s condition deteriorated significantly. The internist was again called. He left orders advising the hospital nurses to administer a diuretic and to have his partner, another internist, examine the patient as soon as possible. The patient coded at 7 AM and was pronounced dead at 7:20 AM.

An autopsy revealed 2500 mL of blood in the patient’s lower abdomen caused by an extensive hemorrhage into the bladder wall. The lithotripsy had caused a bladder stone to become embedded deep in the bladder wall, commencing a slow bleed.

The patient’s widow was appointed his administrator. She sued the urologist, the urologist’s health care group, the hospital, and the internist, alleging medical malpractice. The widow argued that despite her husband’s deterioration, all defendants failed to institute proper care, causing him to slowly bleed to death.

The plaintiff further contended that the orders attributed to the internist in the hospital chart, supposedly having been given at 11 PM October 18, were inadequate and below the standard of care. She argued that at the time the internist was called, it would have been possible to reverse the effects of the anticoagulant medication, perform surgery to repair the bleed, and save her husband’s life.

The internist testified during deposition that he never gave orders to the hospital nurses when called. He said he was not on call for the urologist, and that if the urologist wanted a consultation from him then the urologist needed to call him. The internist admitted countersigning the orders. The urologist testified during deposition that he wanted an urgent consultation from the internist, but agreed that his order, as taken down by the nurse, did not reflect the fact that he was requesting an urgent consultation.

The patient’s widow claimed between $85,000 and $200,000 in economic damages. After a 6-day jury trial, 5 men and 7 women returned a 10-to-2 defense verdict. Prior to trial, the hospital was dismissed as a defendant for a waiver of costs. Additionally, the urologist was dismissed as a defendant with prejudice under confidential terms.

LEGAL PERSPECTIVE: When a plaintiff dismisses a defendant prior to trial and that dismissal is “with prejudice,” the plaintiff is barred from ever again bringing that claim in any court. Contrast this with a dismissal “without prejudice,” where the plaintiff may subsequently bring their claim in another court. Generally, when a settlement is reached, a settling defendant will require that as part of the agreement all claims against him be dismissed with prejudice to bring an end to the controversy. Here, the urologist secured, under confidential terms, a dismissal with prejudice, meaning the widow could never bring her claims against him in any other court. Because the hospital had also been dismissed, the case proceeded only against the internist and the internist’s medical group at trial.