Patient is Killed by Internal Bleeding While on Warfarin

    Cardiology Expert WitnessThis case involves a male patient in California who presented to the defending hospital in order to have a routine surgical procedure. During the procedure, a portion of the patient’s bowel was injured, but they were able to stem the bleeding and conclude the surgery apparently without injury. However, this issue necessitated that the plaintiff to remain in the hospital for an extended period of time. While in the hospital, the plaintiff was being administered anti-clotting medication as well as Warfarin by the treating physician, however, no cardiology consultation was ordered. During the patient’s stay in the hospital, he began to experience internal bleeding that went unnoticed for an extended period of time. Despite attempts to save the patient’s life, he died in the hospital.

    Question(s) For Expert Witness

    • 1. Do you routinely treat patients with Warfarin?
    • 2. Under what circumstances should a cardiologist be consulted when prescribing these medications?

    Expert Witness Response E-001190

    I routinely treat and manage patients on Warfarin and other, similar medications. Cardiologists should be involved in the care of patients on anticoagulants if there is underlying cardiac disease, if the patient requires adjustment of anticoagulation due to other medical conditions, if the patient has complications related to anticoagulation, or if the primary physician lacks experience in managing anticoagulation. In this case, it is concerning that there was no consult due to the earlier surgical injury. I am a board-certified cardiologist with over 20 years of clinical experience. I have been chief of a major academic cardiology program and am internationally recognized as a leader in cardiovascular medicine.

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