May 2016

Medical malpractice involving overdose of medication is more common than many people realize. One recent medical malpractice/wrongful death action involving overdose was brought against an attending physician as well as the hospital where the patient died. The plaintiff alleged that the defendant doctor negligently failed to decrease the levels of the blood-thinning medication, Lovenox, as indicated by a consulting pulmonologist. As a result, the plaintiff alleged that the patient developed retroperitoneal (abdominal) bleeding suffered cardiac arrest and ultimately died.

On October 9, the decedent went to the emergency room of the defendant hospital complaining of flu-like symptoms.  Specifically, he complained of fever, chills, dyspnea, cough, and nausea.  Diagnostic studies revealed a deep vein thrombosis present in the left popliteal vein.

Later that afternoon, the decedent’s lab results came back with a slightly elevated creatinine level.  The defendant attending physician requested a hematology consult who ordered Lovenox 80 mg every 12 hours due to the high probability of the decedent of developing a pulmonary embolism. Lovenox is the brand name for enoxaparin, a blood-thinning anticoagulant drug used to prevent and treat blood clots.

A pulmonary consult was also requested.  The pulmonary consult ordered that if additional diagnostic testing came back negative, the Lovenox should be decreased to 40 mg once a day.  Later that day, a CT scan was performed which did, in fact, come back negative as there was no mention of any type of embolic event.

The following day the decedent’s creatine levels had risen to 2.0. (Creatine is a compound involved in the supply of energy for muscular contraction, and pulls water into your muscle cells.) That morning the hospital administered 40 mg of Lovenox per the pulmonology consult which the plaintiff argued should have been the only dose of Lovenox received that day.  However, the defendant attending physician indicated that she never saw this consult note and ordered the Lovenox at 80 mg twice a day.

The next day, the decedent’s creatinine levels continued to remain high.  Later that night, he lost consciousness and was transferred to ICU 90 minutes later where it was determined that he had developed a retroperitoneal bleed. The following day the decedent went into cardiac arrest and was subsequently resuscitated.  His health continued to deteriorate and his kidneys continued to fail which the plaintiff claimed was as a result of the over medication of Lovenox. Not long after, the decedent succumbed and passed away.

The case was mediated where a settlement of $1,400,000 was reached.

This tragic medical malpractice action seems to typify a classic lack of communication between doctors involved with in-patient hospital treatment. In fact, a study just released by John Hopkins University found that medical errors are now the third leading cause of death in the United States.

Evidence clearly showed that a consulting hematologist ordered the blood-thinner Lovenox at 80 mg every 12 hours to avoid pulmonary embolism. However, a consulting pulmonologist ordered that the dosage be decreased to 40 mg once a day, if the decedent’s diagnostic tests were good. Sure enough, subsequent testing showed no indication of an embolic event, yet the Lovenox dosage was never lowered.

The plaintiff’s evidence seemed to show that the mistake was blatant. The more challenging aspect of the plaintiff’s presentation was establishing the causal link between the Lovenox and the decedent’s ultimate death. In this regard, it has long been known that enoxaparin (brand name Lovenox) is associated with retroperitoneal bleeding. In this case, the plaintiff’s experts were able to make the causal leap to convincingly show that the bleed resulted in cardiac arrest and the decedent’s subsequent death.

A confidentiality agreement in the $1.4 million settlement precludes identification of the defendants involved.