9455 Case Study: Death Following Pacemaker Insertion | Harry S. Cohen & Associates

Death Following Pacemaker Insertion

Filed under Surgical Errors, Wrongful Death

The Stoffer Case

This case involves a 70-year old woman who bled to death while at a hospital following the insertion of a pacemaker, a typically routine operation. During the operation, the Defendant surgeon punctured the woman’s left subclavian artery causing her to hemorrhage. While inserting a chest tube to drain the blood, the surgeon punctured the left upper lobe of the woman’s lung causing additional internal bleeding.

Immediately after the surgery, the surgeon left the hospital, leaving the woman with no doctor at bedside. This was followed by hours and hours of either no communication or miscommunication between the surgeon, nurses, and a pulmonologist, all while their patient was bleeding to death. Tragically, approximately ten hours after the surgery, the patient, a married mother of 2 and grandmother of 3, died during life-flight transport to a hospital in Pittsburgh.

One day prior to surgery, Sarah Stoffer, a 70-year old wife, mother, and grandmother, presented to the Defendant hospital for complaints of symptomatic bradycardia and to rule out unstable angina. Mrs. Stoffer was admitted and scheduled for a pacemaker operation.

The following day, the Defendant surgeon attempted to perform an insertion of a pacemaker in Mrs. Stoffer’s left subclavian vein. During the procedure, the surgeon punctured the left subclavian artery, causing Mrs. Stoffer to hemorrhage. The surgeon then attempted to insert a left chest tube, and in doing so, punctured the left upper lobe of Mrs. Stoffer’s lung, causing additional internal bleeding. The surgeon then proceeded to insert the pacemaker into the right subclavian vein.

The surgery ended at 2:45 pm; Mrs. Stoffer was taken to the recovery room at 3:03 pm. The surgeon testified that around 3:20 pm, he consulted the Defendant pulmonary lung specialist/intensivist, over the telephone and advised the pulmonologist of Mrs. Stoffer’s condition (the pulmonologist was at a different hospital). Although the surgeon testified that he understood that if Mrs. Stoffer’s bleeding wasn’t stopped it could cause her death and that he still considered himself to the physician in charge of her care, the surgeon proceeded to leave the hospital – leaving Mrs. Stoffer with no doctor at bedside.

Between 3:05 and 4:57 pm, Mrs. Stoffer continued to drain bloody fluid and had periods of severe low blood pressure or hypotension (86/46, 88/41, 75/45, 60/51, 73/42, 78/56, 85/67, etc). She was given two units of blood hung wide open. Sometime between 4:30 and 5:00 pm, a recovery room nurse telephoned the surgeon to update him on Mrs. Stoffer’s condition because her blood pressure was still low, her heart rate was elevated, and to also inform the surgeon how much bleeding was in the chest tube. The surgeon denies receiving this phone call despite it being charted in the medical records.

At approximately 5:00 p.m., Mrs. Stoffer was transferred from the recovery room to the ICU. The recovery room nurse stayed with Mrs. Stoffer for 45 minutes to an hour in the ICU because she believed that Mrs. Stoffer required a more experienced ICU nurse than the newer nurse in the ICU.
Because of Mrs. Stoffer’s deteriorating blood pressure and the bloody fluid draining into her chest tube, the first ICU nurse testified that she had an understanding that Mrs. Stoffer was bleeding internally, and contacted the pulmonologist via telephone.

According to the pulmonologist’s testimony, and contrary to the surgeon’s testimony, the pulmonologist first became involved with Mrs. Stoots when he received that call from the first ICU nurse at 5:45 pm. The pulmonologist testified that he was informed that Frick had a patient that had a pacemaker inserted, “a complication did occur which was bleeding supposedly from the subclavian artery, and that required insertion of a chest tube”, the patient was intubated and placed on a respirator, and sent to the ICU. The pulmonologist claims he was only called to handle the respirator. However, the first ICU nurse testified that she gave the pulmonologist a “head-to-toe assessment of Mrs. Stoffer” including vitals and the amount of blood in the chest tube, but she never told the pulmonologist that the surgeon was not in the hospital. The pulmonologist testified that he didn’t consider going to Frick at that time since it wasn’t urgent for him to be there based on what he was told over the phone. The pulmonologist believed that the surgeon was still in the hospital.

Around 6:30 p.m., a second ICU nurse arrived in the ICU to begin her shift. The second ICU nurse testified that upon receiving her report, she understood that Mrs. Stoffer was bleeding internally.

The pulmonologist was paged at 6:50 p.m. He called the hospital, and again spoke with the first ICU nurse. At this point, Mrs. Stoffer’s blood pressure was ominously low at 74/49. The pulmonologist was given the arterial blood gases and blood count. The blood count dropped considerably, and the arterial blood gases indicated acidosis, which was a concern. The pulmonologist thought that Mrs. Stoffer may have been hypovolemic. Since her blood pressure was low, he changed the vasopressors, and at this point, perceived Mrs. Stoffer’s condition to be critical and serious. The pulmonologist then ordered two units of PRBC, each one to run wide open and had two units kept on hold - although he testified that he did not perceive Mrs. Stoffer to be bleeding heavily – he testified she was hypovolemic, which could be from earlier bleeding during surgery. His plan of care at 6:50 pm was volume replacement, including PRBCs, fresh frozen plasma, and other IV’s.

At approximately 7:00 p.m., the pulmonologist decided to go to the hospital and informed the nurse that he was coming in. The first ICU nurse again testified that there was still no doctor bedside at this time. The first ICU nurse’s shift ended at 7:00 pm (she was relieved by the second ICU nurse).

Interestingly enough, the pulmonologist claims that during his ride to the hospital, his “check engine” light came on about a quarter of the way there (20 miles from his home to the hospital on the PA Turnpike). Although he wasn’t having any engine problems whatsoever, the pulmonologist believed that the best solution was to go back home and get another car – despite knowing he had a critically ill patient in the hospital. He claims that this may have delayed him 45 minutes to an hour – although the pulmonologist did not arrive at the hospital until around 9:00 p.m. The pulmonologist testified that the surgeon was the primary physician in charge of Mrs. Stoffer’s care at this point, and claims that he was never told by a nurse, during either phone call, 5:45 or 6:50, that the surgeon was not present in the hospital.

At 8:45 pm, before the pulmonologist’s arrival at the hospital, the second ICU nurse telephoned the pulmonologist to provide him with an update and the results of Mrs. Stoffer’s blood gas. The pulmonologist gave orders to get consents to put in a central line and an arterial line. The second ICU nurse testified that Mrs. Stoffer’s blood pressure was continuing to fall at this point, she had the sense that they could not control it, and that the cause was from internal bleeding.

The pulmonologist testified that his evaluation of Mrs. Stoffer revealed to him that she was critically ill and that she needed surgery to control the bleeding. The pulmonologist then talked to the family and had a nurse call the surgeon at home. The pulmonologist believes that the surgeon arrived at the hospital between 10:30–11:00 pm; the second ICU nurse noted that the surgeon arrived at 11:00 pm; however, oddly enough, the surgeon testified that he arrived at the hospital around 9:30 pm.

In any event, after the surgeon arrived, he spoke with the family and advised them that he could do a thoracodomy there or they can opt to transfer Mrs. Stoffer via helicopter to a hospital in Pittsburgh, 30 miles away. The family chose to transfer Mrs. Stoffer, and according to the second ICU nurse, arrangements for transfer began around 11:30 pm.

Oddly, Mrs. Stoffer was not transferred until 1:00 a.m. When questioned in his deposition why it took so long to transfer Mrs. Stoffer, the surgeon testified that he began calling a hospital in Pittsburgh around 9:30 p.m. and that it took him hours to get someone to accept the transfer; however, we obtained an audio CD of the phone calls between the surgeon and a hospital in Pittsburgh which revealed that the first call was made at 11:38 p.m., and the transfer was accepted at 11:59 p.m.

Unfortunately, Mrs. Stoffer immediately went into cardiac arrest during the life-flight and was pronounced dead at a hospital in Pittsburgh at 1:44 am. An autopsy revealed the immediate cause of death to be hemorrhagic shock, and the intermediate causes to be massive intra-thoracic hemorrhage, subclavian vein perforation, pacemaker placement, and sick sinus syndrome (abnormal heart rhythms).

On behalf of Mrs. Stoffer’s family and Estate, we brought a wrongful death and survival action lawsuit against the surgeon, the pulmonologist, and the hospital (for the negligence of its nursing staff). After years of protracted litigation, the case settled during the second day of jury selection for a substantial amount. Each Defendant contributed to the settlement.

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Publisher: Harry S. Cohen and Associates, P.C.