Case details

No sign of deep vein thrombosis until out of doctors’ care: defense

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
arterial, deep vein thrombosis, embolism, pulmonary, respiratory, swelling, vascular
FACTS
On Feb. 1, 2011, plaintiff William Ross, 54, a manager for a tree trimming service, presented to a medical practice to established and saw Dr. Andrew Corr, an internist. Ross had a pulmonary embolism in 2003, causing him to be placed Coumadin for eight years, but during the visit on Feb. 1, 2011, Corr obtained Ross’ informed consent to take him off of the blood thinner. Ross then returned to the medical group on Feb. 21, 2011, and saw Dr. Louise Huang, a family practitioner. Ross presented with shortness of breath and a productive cough. As a result, a CT scan and an X-ray of the chest were performed. Based on the chest X-ray, Huang diagnosed Ross with bilateral pneumonia and placed Ross back on Coumadin. However, Ross returned to the group seven days later and was still suffering from bilateral pneumonia. As a result, he stayed on Coumadin. On March 10, 2011, Ross was examined by Corr and it was determined that Ross’ pneumonia was improving. However, due to risks, Corr took Ross off Coumadin again. Ross then saw Huang on March 25, 2011, and requested to be placed back on Coumadin, but Huang denied the request. When Ross returned to on March 28, 2011, Ross saw Huang again and placed him on antibiotics. However, three days later, Ross suffered leg pain and swelling, and presented to Riverside Community Hospital, in Riverside. He subsequently underwent an ultrasound, which showed deep vein thrombosis of the left leg. As a result, Ross had to be hospitalized. Ross sued Corr, Huang and Riverside Community Hospital. Ross alleged that the defendants failed to properly treat him and failed to diagnose his deep vein thrombosis. He also alleged that these failures constituted medical malpractice. Riverside Community Hospital was ultimately dismissed from the case. Thus, the matter continued against Corr and Huang. Plaintiff’s counsel contended that Ross should never have been taken off Coumadin and that by doing this, Corr and Huang both fell below the standard of care. Counsel also contended that Corr and Huang both failed to diagnose Ross’ deep vein thrombosis or pulmonary embolism, but acknowledged that Huang did properly diagnose the pneumonia. The plaintiff’s infectious disease expert opined that it was below the standard of care for Ross to be taken off of Coumadin and to not diagnose the pulmonary embolism. Defense counsel noted that the plaintiff’s infectious disease expert assumed that no pneumonia was ever present. Counsel also noted that the CT scan of Ross’ chest, which was performed on Feb. 21, 2011, showed no evidence of a pulmonary embolism and confirmed Huang’s diagnosis of bilateral pneumonia. Defense counsel argued that it was appropriate to take Ross off Coumadin and that there was no failure to diagnose the deep vein thrombosis or pulmonary embolism, as Corr and Huang properly worked on and treated Ross for pneumonia and other complications that were noted during his care with them. Counsel contended that it was only later, in March 2011, did Ross develop outward signs of deep vein thrombosis and that Ross did not have deep vein thrombosis when he was treating with Corr and Huang. Defense counsel argued it was within the standard of care to discuss the risks and benefits of going on and being taken off of Coumadin, all of which Corr went through with Ross, and that Ross ultimately decided to be taken off Coumadin based on his discussion with Corr. Counsel also argued that the consent was appropriate and that the medical decision to take Ross off Coumadin was within the standard of care. Defense counsel further argued that when Ross returned to the medical group on Feb. 21, 2011, it was appropriate at the time to treat him for pneumonia, as the X-ray showed bilateral pneumonia and the CT scan showed no pulmonary embolism. In addition, counsel argued that it was also appropriate, at that time, for Huang to prescribe Coumadin as a preventative measure when Ross showed signs of pneumonia and that when Ross was improving and the CT scan showed no pulmonary embolism, it was appropriate for Corr, on March 10, 2011, to take Ross off of Coumadin, based on the same consent and risk of bleeding. Defense counsel noted that Huang recommended a repeat CT scan at the meeting with Ross on March 25, 2011, but that Ross refused and that the first time Ross complained of leg pain and swelling was three days after Ross last saw Corr and Huang. Thus, defense counsel argued that Ross was noncompliant in taking Coumadin before or after treatment., Ross presented to Riverside Community Hospital with complaints of leg pain and swelling. He subsequently underwent an ultrasound, which showed deep vein thrombosis, and was put on Lovenox injections, a quick-acting blood thinner. He was also put back on Coumadin. When his deep vein thrombosis resolved, he was discharged from the hospital. Ross claimed that veins in his legs were damaged from the deep vein thrombosis. He alleged that as a result, he continues to suffer from postphlebitic syndrome, also called postthrombotic syndrome, which causes swelling and pain and which manifested as a result of the deep vein thrombosis. Ross, who worked as a manager for a tree trimming service that prevented trees from interfering with power lines, never stopped working and worked up until trial. However, he claimed he would have to stop working from Jan. 1, 2016 onwards. Defense counsel contended that, most recently, Ross manifested another condition, superficial venous insufficiency, which, by itself, could cause the same complications that stem from deep vein thrombosis. Thus, defense counsel argued that this superficial venous insufficiency could have also caused Ross’ postphlebitic syndrome. Defense counsel noted that no medical opinions, or anyone from Ross’ company, claimed it was medically improbable for Ross not to work in the future. The defense’s expert economist testified that there was no objective evidence to suggest that Ross would need to stop working. The expert added that Ross’ employer never knew of Ross’ condition and that no negative actions were ever taken against Ross, so it was speculative to claim any future lost income.
COURT
Superior Court of Riverside County, Riverside, CA

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