3442 Case Study: Delayed Diagnosis of Pulmonary Embolism | Harry S. Cohen & Associates

Delayed Diagnosis of Pulmonary Embolism

Filed under Misdiagnosis, Wrongful Death

The Bazzy Case

Pulmonary Embolism is the leading cause of death in American Hospitals. The standard of care requires that any emergency room patient or in-patient with acute shortness of breath, chest tightness and leg pain in the presence of risk factors such as a personal history of DVT (Deep Venous Thrombosis, blood clots in the lower legs) or PE (Pulmonary Embolism, blood clots to the lungs), and a family history of PE or DVT, be evaluated for possible DVT and PE and prescribed an anticoagulation regimen. Mr. Bazzy was a 63 yr. old male, married to a nurse that had worked at Defendant Hospital for 36 yrs. He was retired and had non-insulin dependent diabetes and hypertension, but no other chronic health problems. In 1993, he had a DVT after back surgery. His mother had a PE and his father also had a PE, and his aunt died of a PE.

Mr. Bazzy went to the local Care Center owned by Defendant Hospital with complaints of recent worsening shortness of breath and tightness in his chest. He appeared acutely ill upon exam.

He was seen by the CRNP who ordered an EKG that showed changes from an EKG he had earlier that year for clearance for orthopedic surgery, which was normal. Since this care center was owned by the Defendant Hospital where he had that test performed, the CRNP was able to pull that test for comparison to the EKG he was given that day. Because there was a change in the EKGs, the CRNP presumed that Mr. Bazzy was suffering a heart attack, administered aspirin and nitro paste, and had him emergently transported to the Defendant Hospital’s emergency room. Although the CRNP was specifically told of Mr. Bazzy’s personal history of DVT and his family history of DVT and PE, she failed to document or appreciate Mr. Bazzy’s personal history of DVT and his family history of DVT and PE. She referred him to the Defendant Hospital Emerfency Department to rule out a heart attack. On arrival at the Defendant Hospital, Mr. Bazzy’s wife, a nurse for 36 years, informed the emergency department’s physician, the cardiologist, the emergency department nurse, and the CRNP in the emergency room about Mr. B’s history of PE.

He was admitted to the cardiac floor where he arrested. He was scheduled for the cath lab the next morning and was tachycardic so a STAT EKG was performed. He developed chest pain prior to his arrest. No D-dimer test was done, no VQ scan or arteriogram (tests to rule out a PE), only a CXR in the emergency department

Mr. Bazzy died at Defendant Hospital. An autopsy was performed and it was determined that Mr. B died from bilateral massive pulmonary thrombo-emboli originating in the right lower extremity (RLE). His major diagnoses were listed as massive bilateral pulmonary thrombo-emboli, left ventricular hypertrophy, and moderate coronary atherosclerosis. The secondary diagnoses were listed as bilateral arterionephrosclerosis bilateral renal cysts, moderate aortic atherosclerosis, moderate to severe cerebral atherosclerosis. Death certificate stated PE.

We represented Mr Bazzy’s family for the wrongful death of Mr. Bazzy in carelessly overlooking, not even considering an imminent PE, despite the classic signs, personal and family history and a wife who was telling the caregivers that she suspected a PE. None of the defendants included a PE on their differential diagnosis.

This case settled out of court two weeks prior to the scheduled jury trial for a substantial amount.

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