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Delay in Treating Infection in ER Resulting in Death - Picardi

Filed under Misdiagnosis, Emergency Room

The Picardi Case

Summary:

A patient went to a hospital Emergency Room (“ER”) concerned about his swollen and painful left wrist. His symptoms and abnormal lab tests all pointed to an infection. A fluid culture confirmed an infection; however, before the culture results came back, the doctors diagnosed the patient with gout and discharged him to home. Even worse, no one called the patient with the culture results as they should have done when the results came back later that day. Tragically, when someone finally called 4-days later, the patient had already been admitted to another hospital where he died from the exact same infection he had in the ER. The attending ER doctor, the resident ER doctor, the nurses responsible for calling the patient with the test results, and the lab personnel at first tried to put up a unified defense (they all shared the same hospital insurance lawyer); however, when pressed, they eventually all began to point fingers at each other. The patient was 62-years old. He worked for the Defendant hospital for 39 years as a laborer and had recently retired. He was married, had two adult children, and two grandchildren.

Facts:

Gregory Picardi, a recently retired 62-year old, husband, father and grandfather, went to a hospital ER on January 13 at 10:45 a.m. with complaints of a swollen and painful left wrist. A resident documented that Mr. Picardi had generalized weakness, unsteadiness, felt cold all the time, and had a decreased appetite (all signs of an infection). After the resident and attending ER physician examined the patient, a wrist x-ray was performed, an arthrocentesis (a procedure using a syringe to collect synovial fluid from a joint capsule) with fluid culture was performed, and a complete blood count was performed.

The x-ray was negative. The blood work showed a white blood count of 14.9, a C-reactive protein level of 24.3, neutrophils of 11.64, and bands of 1.49 (also all potential signs of an infection). The results of the fluid culture were pending.

The attending ER doctor diagnosed Mr. Picardi with “acute gout of the left wrist” and discharged him to home at roughly 2:45 p.m. He was started on Indocin, prednisone, and oxycodone. Critically, he was not given any antibiotics. The discharge instructions focused on the left wrist and hand, advised the patient to follow-up with his PCP in one week, and stated, “If an infection is seen [in the fluid culture], we will notify you.”

Less than 3-hours after discharge, a positive Gram stain result came back revealing that the patient - who was just discharged with a gout diagnosis – did in fact have an infection (a Gram stain is a lab procedure used to detect the presence of bacteria in a sample taken from the site of a suspected infection; it gives relatively quick results as to whether bacteria is present). None of the caregivers did anything to call Mr. Picardi to let him know about the infection.

The next day, January 14th, a positive “preliminary” culture report came back showing an infection. Again, none of the caregivers did anything to call Mr. Picardi to let him know about the infection.

Two days after that, on January 16th, a positive final culture report came back confirming an infection (the culture reports revealed streptococcus pneumonia). Again, none of the caregivers did anything to call Mr. Picardi to let him know about the infection on that day.

It was not until January 17th, four days after discharge, that someone finally attempted a “wellness call” to Mr. Picardi (depositions revealed that the nurse that tried to call Mr. Picardi thought she was supposed to call him just to see how his gout was doing; she know nothing about the infection results). The records and deposition testimony also revealed that additional “wellness calls” were made on the 18th, 19th, 21st, and 22nd. Voicemails were left each time. On the 22nd, nine days after discharge, a letter was sent to Mr. Picardi requesting him to call the ED so that they could check on his status. Again, none of the calls/voicemails ever mentioned an infection.

Sadly, by the time “wellness” calls were made it was too late. Two days after discharge, on the morning of the 15th, Aaron Picardi, Mr. Picardi’s son, noticed that his father was somewhat confused and in pain. Aaron immediately took his dad to a different hospital (closer) where Mr. Picardi was diagnosed with acute sepsis, was intubated, and admitted to the ICU. Mr. Picardi’s condition deteriorated over the next several days from sepsis and multi-organ failure until he died on January 22nd. An autopsy was performed which confirmed that the underlying cause of death, which caused the sepsis and multi-organ failure, was the untreated streptococcus pneumonia infection.

Prior to contacting our firm, Mr. Picardi’s family couldn’t get any answers from the Hospital about what happened. In fact, even after we filed suit, the Hospital denied any wrongdoing and firmly took the position that the care was appropriate.

We had the case reviewed by an emergency room expert, a pathology expert, an infectious disease expert, and a coroner, all of whom agreed that the hospital was negligent and, had the infection been properly and timely treated, Mr. Picardi was would be alive today.

Ultimately, we took the depositions of seven different hospital employees: (1) the attending ER doctor; (2) the ER resident doctor; (3) the lab director; (4) the lab technician that performed the Gram stain; (5-7) and three different quality assurance nurses responsible for calling Mr. Picardi to let him know that he had an infection. Each person either pointed fingers directly at someone else or generally at other areas of the hospital. This was striking because no matter how obvious the negligence is in a malpractice case, the Hospital’s insurance lawyer never allows witnesses to point the finger. Here, this included:
To defend the case, the Hospital had an ER “expert” write an expert report simply concluding that the care was appropriate. He provided no basis for his conclusory opinion. He did not review any of the depositions that were taken in the case. When this was brought to the Court’s attention, the Court gave the Hospital’s insurance lawyer 10-days to either admit negligence or have the expert provide a basis for his opinions. Almost braggingly, the Hospital’s insurance lawyer represented to the Court that he had never admitted negligence in a case in 30+ years no matter how clear his client’s negligence had been. 10-days later, the same lawyer, on behalf of his clients, admitted negligence. The defense then pivoted and became that the infection was going to kill Mr. Picardi even if proper care was given. Additionally, even though there was no evidence that Mr. Picardi was non-compliant with his discharge instructions, the Hospital’s insurance lawyer attempted to blame the patient and his family for not calling the hospital when his condition did not improve in the hours after discharge.

  • The lab personnel agreed that they should have called the ER when they had the infection results 2-hours after discharge to notify the doctors of the infection. However, the lab’s position was that they didn’t make that call because the resident failed to properly label the specimen.
  • The attending ER doctor blamed his discharge of the patient with an “acute gout” diagnosis on the resident for not telling him enough information, i.e. the patient’s symptoms, the bloods test results, etc.
  • The resident claimed that she told the attending everything, and the attending had access to the same information she had regardless of what she communicated.
  • Quality Assurance nurses - who were responsible for following up on the infection results and calling the patient - blamed “the system”, e.g. “I don’t know why [the other Quality Assurance nurse] didn’t follow what we normally do. I don’t know if she had 180 charts that day. I have no idea why that wasn’t done.”

Days before trial, the case settled for a substantial amount.