Case details

Defense argued procedure did not cause patient’s hematoma

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
fracture, hip, nerve, neurological, peripal neuropathy
FACTS
On May 6, 2010, plaintiff Ronald Morrow, 60, an incarcerated man, was brought to the UC San Diego Medical Center, in San Diego, with multiple medical problems, including a non-healing ulcer of the right foot, atrial fibrillation, and a history of diabetes, obesity, peripheral vascular disease and peripheral neuropathy. Since Morrow was a stroke risk, he was given 140-milligrams of the anticoagulation medication Lovenox (Enoxaparin) twice a day, on the basis of his weight, for atrial fibrillation/stroke prevention. It was ultimately determined that Morrow would require an angiogram and angioplasty procedure to assess the blood flow in his right leg due to poor blood flow and the non-healing ulcer. In anticipation of the procedure, Morrow received his last dose of Lovenox at around 9 a.m. on May 9, 2010, and was not given Lovenox in the evening of May 9 or the morning of May 10. At approximately 1 p.m. on May 10, 2010, Morrow underwent an angiogram and angioplasty via contralateral access to minimize the extent of required amputation. The procedure, which involved a puncture in the groin at the femoral artery, was performed by Dr. Anand Prasad, an interventional cardiologist; Dr. Patrick Hu, an interventional cardiology fellow; and Dr. Mitul Patel, a cardiology fellow. Morrow’s Lovenox dose then was resumed on the evening of May 10. In the early hours of May 16, 2010, Morrow complained of groin pain. An attending internal medicine physician conducted a physical exam and saw no sign of a hematoma/AV fistula or a pseudoaneurysm. That same day, Patel another conducted an exam and also found no such evidence, and an ultrasound was unremarkable. However, Morrow continued to complain of pain and, on May 17, 2010, he underwent a CT scan, which showed an enlargement of the left iliacus muscle, likely secondary to a large hematoma. As a result, Morrow was diagnosed with a femoral neuropathy/plexopathy from compression of the femoral nerve. Morrow sued Prasad; Patel; and the operator of UCSD Medical Center, the Regents of the University of California. Morrow alleged that the defendants negligently treated him both before and after the surgery and that this negligence constituted medical malpractice. The county of San Diego was originally named as a defendant, based on Morrow’s allegation that it delayed treatment while he was incarcerated. However, the county ultimately settled out earlier in the case. Prasad and Patel were also both dismissed from the case with a stipulation as to course and scope. Thus, the matter proceeded to trial against the Regents only. Morrow’s expert neuroradiologist opined that Lovenox should have been held for two days before performing the angiogram/angioplasty procedure. The expert also opined that one dose should have been held after the performance of the procedure and that the failure to do so resulted in the iliacus hematoma. The expert testified that Morrow did not exhibit symptoms until days later because the blood slowly oozed upward and collected in the iliacus area. The Regents’ interventional cardiology expert testified that the biological activity of Lovenox is such that no active amount remains after 12 hours. The expert also testified that the standard of care only required that the morning dose of Lovenox be held on May 10, 2010, and he opined that holding two doses — one on the evening of May 9 and another on the morning of May 10 — was within the standard of care. The expert further opined that the administration of Lovenox after the procedure was also conducted in an appropriate manner. The Regents’ counsel argued that the angiogram/angioplasty procedure was performed in a manner that was within the standard of care in all aspects and that the hematoma was unrelated to the puncture at the time of the procedure. Specifically, counsel argued that hematomas resulting from these procedures would typically manifest one or two days after the procedure and that Morrow did not exhibit symptoms of a hematoma until May 16. Thus, Regents’ counsel argued that Morrow experienced a spontaneous bleed due to continued use of anti-coagulants post-procedure., A CT scan showed an enlargement of Morrow’s left iliacus muscle, likely secondary to a large hematoma. As a result, Morrow was diagnosed with a femoral neuropathy/plexopathy from compression of the femoral nerve. Morrow claimed a permanent injury to his left leg, including pain and neuropathy. The plaintiff’s pain management physician testified that Morrow continues to suffer consequences of femoral neuropathy. For example, Morrow alleged his condition caused a fall, resulting in a fracture of his left hip. Thus, Morrow sought recovery of $264,000 in past medical costs and $668,000 in non-economic damages. The Regents’ expert interventional radiologist testified that the bulk of Morrow’s hematoma was a distance away and disconnected from the puncture site. Defense counsel argued that, as such, the puncture site was not the source of the hematoma and that the hematoma was unrelated to the angiogram/angioplasty procedure. The Regents’ expert neurologist opined that Morrow’s many severe pre-existing conditions contributed to his bilateral leg problems and that the neuropathy from the hematoma was not a substantial contributor to Morrow’s current complaints and condition. The Regents’ interventional cardiology expert testified that due to Morrow’s extensive and serious medical history, including IV drug use, hepatitis C, uncontrolled diabetes, obesity, a 20-year history of smoking, cocaine use, peripheral vascular disease, peripheral neuropathy, atrial fibrillation, and others, Morrow’s life expectancy was less than five years.
COURT
Superior Court of San Diego County, San Diego, CA

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