This case involves a middle-aged female patient in Rhode Island with a history of coronary artery disease. On the date of the incident in question, the patient presented to the hospital complaining of diarrhea with bright red blood. Upon admission, the patient was noted to have high blood pressure as well as a low pulse rate. An abdominal CT revealed severe diverticulosis and thickening of the colon. The next day, the patient continued to have bloody stools, along with a significant decrease in blood pressure, however care continued to be conservative. Her red blood cell count continued to drop over this period, which indicated continued internal bleeding. Eventually, the patient was prepped and scheduled for a colonoscopy, but was found dead in her room hours before the procedure was due to take place.
Expert Witness Response E-021185
I routinely treat patients with similar presentation in my ICU. From the very brief case summary provided, there appear to be concerning breaches of the standard of care that may have contributed to the patient’s death, including a delay in colonoscopy, inadequate transfusion of red cells in an actively bleeding patient with severe CAD, and inadequate monitoring of the patient. The care this patient received is very different (and much less intensive) than she would have received if the standard of care had been followed. I have written textbook chapters on managing life threatening GI bleeds. In addition, for the last 7 years I have delivered lectures on this topic at the critical care board review course organized by the American College of Chest Physicians. I also teach the same topic to the critical care fellows at my institution.
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