Virginia Injury Law Blog
Decedent, age 49 at the time of his death, underwent an arthroscopy with synovectomy operative procedure on his left knee in 2006. Eight days post-op defendant orthopedic surgeon diagnosed decedent with an acute deep venous thrombosis involving the gastrocnemius veins of the left lower extremity. He prescribed Lovenox and Coumadin to prevent the further development of DVT and a potentially fatal pulmonary embolus. Decedent remained on anticoagulation therapy for three months with no complications.
In 2008 the same surgeon performed an arthroscopy with an anterior cruciate ligament reconstruction with hamstring autograft operative procedure on the decedent’s same knee. He was not placed on anticoagulation prophylaxis following the surgery. Six days post-op he acutely developed difficulty breathing with choking, chest pain and syncope. After initially recovering, while being transported to the hospital he stopped breathing and was noted to be with pulseless electrical activity. He was pronounced dead shortly after arrival at the hospital.
Plaintiff’s experts opined that decedent was at a higher than standard risk for a potentially fatal PE given his demonstrated history of DVT following the first surgery. They further opined that the second surgery was longer, involved more blood loss, a longer tourniquet time, decedent was two years older, heavier and less ambulatory; all further increasing the risk for clotting. Given all of the above, plaintiff contended that the defendant was negligent in failing to advise the decedent that he was at an increased risk for the development of DVT and PE and further negligent in failing to place him on prophylactic anticoagulation.
No autopsy was performed. Plaintiff contended that the decedent’s clinical course, prior history and terminal ECG’s were most consistent with a pulmonary embolus. The cardiac monitor strips performed on the day of death were consistent with a pulmonary embolus as the cause of a respiratory arrest and inconsistent with a myocardial infarction. The lack of pulmonary edema further supported a pulmonary embolism rather than a myocardial infarction.
Defendant’s expert orthopedic surgeon testified that the standard of care did not require the defendant to place the decedent on prophylactic chemical anticoagulation following the second surgery. He further opined that there were no definitive studies to demonstrate a reduced risk of fatal pulmonary embolism in outpatient orthopedic procedures with chemical prophylaxis/anticoagulation nor were there any guidelines published from the American Association of Orthopedic Surgeons recommending prophylactic anticoagulation in patients having undergone the decedent’s type of arthroscopic procedure. Defendant contended that there was simply no consensus in orthopedic practice on the use of chemical prophylaxis in outpatient orthopedic patients.
Defendant further contended that it was speculation to conclude that the decedent’s cause of death was a pulmonary embolism. Defendant’s cardiology expert testified that the decedent’s prior EKG’s demonstrated a history of a prior myocardial infarction and that his rhythm strip on the day of his death was consistent with a myocardial infarction rather than a pulmonary embolism. He further testified that he saw no clinical signs or symptoms consistent with a pulmonary embolism.
Beneficiaries were decedent’s wife and four adult children. The law firm of Pierce & Thornton retained two orthopedic surgeons, two cardiologists, two hematologists, a forensic pathologist, a pulmonary critical care specialist and a PhD economist to prove their client’s case. The case settled two weeks prior to trial and after the completion of all experts’ depositions for $1,700,000.