Facts

Decedent, Susan Baratti, 52, presented to the emergency room at Presbyterian Intercommunity Hospital on July 19, 2010 at 11 a.m., with complaints of acute onset of shortness of breath and shoulder pain, radiating to the chest. She was triaged, an EKG was run immediately and Dr. Michael Martin examined her at approximately 11:08 a.m. At the time of her presentation, the patient was characterized as a morbidly obese female that had been diagnosed with deep venous thrombosis, with possible pulmonary embolus, on May 14, 2010 and had been admitted and treated for these conditions at Presbyterian Intercommunity Hospital from May 14 through May 16, 2010. She was also noted as having been treated at the Coumadin clinic at Presbyterian Inter Community Hospital (PIH) from May 19, 2010, through July 15, 2010.

Laboratory workup on July 19, 2010 indicated in pertinent part, that the patient had a presenting blood oxygenation level of 65 percent, normal cardiac enzymes and that her INR (International Normalization Ratio) was at a therapeutic level of 2:01. Further note was made of bilateral lower extremity swelling and edema.

At 12:13 p.m., a resident physician ordered a CT angiogram, an echocardiogram and a bilateral lower extremity Doppler to rule out a possible DVT/PE. Unfortunately, the patient coded some 40 minutes later and passed away, prior to these tests being performed. At autopsy, it was determined the patient died as a result of the complete occlusion or blockage of her right main pulmonary artery, due to a massive pulmonary embolus.

PLAINTIFF'S CONTENTIONS:
Plaintiff's experts contended her presenting complaints, when coupled with her recent hospitalization and treatment for DVD/PE should have led Dr. Martin to order Heparin immediately to prevent formation of new clots, even though the patient was on Coumadin therapy. Plaintiff's experts argued despite her INR of 2.05, the patient was not adequately anticoagulated. All experts agreed the patient was likely suffering pulmonary embolic activity for some time before her presentation.

Plaintiff further contended following administration of Heparin, further workup of the patient could then proceed. Plaintiff alleged that by 11:13, Dr. Martin had enough information from test results to order an echocardiogram, which Plaintiff alleged would likely have shown a right heart strain, strongly suggesting pulmonary embolic activity. Plaintiff contended had these studies and CT angiogram been ordered in a timely manner the patient would likely have survived.

Plaintiff further alleged the absence of any charting being entered by Dr. Martin, except for his post mortem history and physical report, coupled with the fact a resident entered the orders for the CTA and other tests, collectively indicated Dr. Martin had not been attentive to or actively engaged in the treatment of the decedent, during the subject emergency room treatment of July 19, 2010.

DEFENDANT'S CONTENTIONS:
Defendant contended his management and treatment of the decedent complied with the applicable standard of care. Defendant further argued the treatment administered to decedent in the emergency room was done as a team approach, under the direction of Dr. Martin.

On cross-examination, both of Plaintiff's experts conceded the fatal embolus did not migrate to the patient's right pulmonary artery until just immediately prior to the code being called on the patient and that therefore, even had the CTA and echocardiogram been done sooner, as urged by plaintiff, they would not have shown the fatal embolus.

Defendant further contended that given the patient's INR was at a therapeutic level at the time of her presentation to the ER, heparin was not indicated and would have done nothing to prevent the breaking off and migration of the fatal embolus. Defendant further argued TPA was contraindicated in this setting, especially prior to a definitive diagnosis of PE being made by a CTA.

Settlement Discussions

Plaintiff initially demanded $250,000; which was lowered to $150,000 at the time trial commenced. Defendant offered a waiver of costs. At trial, Plaintiff requested $500,000 in general damages.

Result

Defense verdict.

Other Information

FILING DATE: Sept. 16, 2011.

Deliberation

40 minutes

Poll

12-0 (defense as to liability)

Length

nine days