Patient Dies Due to Lack of Prompt Treatment

Joseph O'Neill

Written by
— Updated on October 27, 2017

Nephrology Expert WitnessThis 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.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients similar to the one described in the case? Please explain.
  • 2. Have you ever had a patient develop the outcome described in this case? If so, please explain.
  • 3. With the rise in the patient's levels noted above, should he have been hospitalized immediately?
  • 4. Please explain why you are qualified to review this case.

Expert Witness Response E-000014

I do routinely see patients similar to the one described in the case. I have witnessed similar outcomes to this patient. Personally, I have always aggressively managed my patients in order to either prevent the clinical syndrome of disease from occurring or to treat it promptly. The patient should have been admitted immediately to the hospital. 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.

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