Patient is Killed by Pulmonary Embolism After Surgery

In this case, a female patient from Pennsylvania presented to the emergency room with a broken collar bone. She was taken to the operating room, where doctors used multiple plates and screws to stabilize the fracture. Following a brief period of recovery in the hospital, the patient was discharged home without any issues. A few days after returning home, the patient noted that she had trouble breathing after a prolonged period of standing, at which point she returned to the hospital for evaluation. Imaging taken of her chest revealed the presence of multiple pulmonary emboli, and she was admitted to the ICU for treatment and observation. Following a period in the ICU the patient’s condition improved, however the treating physician failed to note findings from multiple tests in the patient’s records. Furthermore, the patient and her family were not advised of these test findings.

Some time after her discharge from the hospital, the patient returned for a procedure to remove the hardware placed on her collarbone in order to stabilize her initial fracture. The patient and her records were evaluated by the surgeon, who determined that she would be able to undergo the surgery without performing any additional diagnostic testing. The patient was discharged home after undergoing this second procedure. Several days later the patient was discovered dead from new pulmonary emboli.

Question(s) For Expert Witness

1. In this case should anti coagulation have been suggested pre and post surgery?

2. What steps and review need to be conducted after a patient suffered a pulmonary embolism- before clearing him for any other surgery's?

Expert Witness Response E-006846

This is a very unfortunate case. Given that this patient was known to be at increased risk for thromboembolic disease due to her test findings, and had a previous history of pulmonary embolus, there should have been vigilant management of her anticoagulation. Any surgery carries an inherent risk of clotting, even in patients with no history of venothromboembolic events. This patient should have undergone rigorous pre-op evaluation prior to the removal of the hardware. I would happy to review the medical records and opine on the standard of care.