Patient Dies Due to Lack of Prompt Treatment

Case Overview

This case takes place in Iowa and involves a male patient with an extensive medical history of multiple chronic conditions. The patient went to a nephrology appointment, while just prior to the appointment, he had dry heaves and was suctioned for foul smelling, loose red secretions. The patient presented to the nephrologist with complaints of severe pain in his sides, shortness of breath, and nausea. The defending nephrologist made note of his symptoms and lab work, addressing the fact that his Bun levels were elevated and his Creatinine had also risen sharply. The defendant recommended hospitalization if his nausea and vomiting persisted, or if the patients’s creatinine continued to climb. Later that night, the patient was found in a stuporous state, with bloody sputum and an elevated body temperature. The patient was transferred via ambulance to the hospital. There, it was discovered that the patient was suffering from Legionella pneumonia, septic shock, and urinary tract infection, along with several other serious medical problems. He was placed in triage where he passed away, with immediate causes of death being sepsis and pneumonia.

Questions to the Nephrology expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

I do routinely see patients similar to the one described in the case.

Have you ever had a patient develop the outcome described in this case? If so, please explain.

I have witnessed similar outcomes to this patient.

With the rise in the patient's levels noted above, should he have been hospitalized immediately?

The patient should have been admitted immediately to the hospital.

Please explain why you are qualified to review this case.

I am qualified to review this case because I am a board certified in nephrology and internal medicine and have served as chief of nephrology for an academic teaching hospital since the mid-1980s and deal with optimal management of these clinical situations. Furthermore I have served as chief clinical operating officer of the fourth largest dialysis company in America and was responsible for 130 dialysis units in over 30 states with an associated 450 nephrology practices.

About the expert

This supremely qualified and double board certified Nephrologist is both a Clinical Professor of Medicine and Chief of Nephrology at his current institution, and has formerly served in such high ranking positions as Chief Clinical Operating Officer at a private practice. He is currently Faculty at several regional healthcare centers. He is a Fellow of the highly esteemed American College of Physicians and American Society of Nephrology, an honor bestowed only upon the most highly distinguished physicians. He is a member of numerous professional societies including the International Society of Nephrology and the American Society of Nephrology. He formerly served as President of the Rhode Island Kidney Foundation and the RI-Mass National Kidney Foundation. He has won many awards throughout his illustrious career, including the Banice Feinberg Physician of the Year Award and the Distinguished Service and Leadership Award from the American Heart Association for his outstanding contributions to clinical practice. He is highly active in the research community having won millions of dollars in grants for his projects. He has published over 80 peer-reviewed journal articles and abstracts and authored two book chapters. His expertise are highly sought after and he is frequently invited to lecture as a guest speaker both in the United States and overseas.