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Delay in Treating Infection in ER Resulting in Death - Poostrand

Filed under Misdiagnosis, Emergency Room, Wrongful Death

The Poostrand Case

In this case, we represented the Estate of deceased 26-year old woman named Alicia Poostrand.

Alicia had a history of thalassemia (an inherited blood disorder characterized by abnormal hemoglobin production), bipolar disorder, hypertension, and asthma. Because of her thalassemia, she was depending on blood transfusions every four to six week, and for that reason, had undergone placement of a chest port to facilitate access for transfusions.

On August 15th, Alicia went to a local hospital Emergency Room (“ER”) with a fever. She waited to be seen for two hours then left.

Two days later, on the 17th, while on a trip to visit New York City with her family, she became ill ad was taken to an ER at a hospital in New Jersey with abdominal pain, cramping, diarrhea, vomiting, watery stools, and a fever of 103.2. She was kept overnight and blood cultures were taken. The next morning, on the 18th, she left the hospital so she could return to Pittsburgh where she could be treated by her regular physicians. Upon her discharge, the hospital advised that it would call Alicia if the culture came back with any concerning findings. Later that day, the culture came back showing the presence of gram negative rods in the patient’s blood, i.e. infection; however, the hospital never called Alicia to let her know of this concerning finding. The culture itself later revealed an infection (Enterobacter cloacae) which was also not reported to Alicia.

The next day, on the 19th, Alicia returned to the local ER in Pittsburgh with diarrhea and nausea. Her fever was noted to be gone. Alicia was told to drink Gatorade and Pedialyte and to follow-up with her PCP in 3-5 days. The entire ER encounter lasted barely an hour.

The next day after that, the 20th, Alicia’s family brought her back to the local ER with difficulty breathing. This was now the 3rd visit to the local ER in the past 5 days and the 4th visit to an ER overall. A nurse documented that the patient has asthma and had run out of her inhaler. The nurse also documented tachypnea (abnormally rapid breathing), a “normal respiratory” pattern, and that Alicia’s lungs were clear to auscultation. It was also noted that Alicia had a port in her upper chest. It was further noted that Alicia had abnormal vital signs yet had an oxygen saturation rate of 100% on room air. Alicia was then seen by the ER doctor who ordered breathing treatments. Before the breathing treatments occurred, the doctor wrote that he reviewed “old records”, that no x-rays or tests were required, that he diagnosed Alicia with “acute asthma exacerbation”, and wrote his discharge order. A breathing treatment was then done, Alicia was given prescriptions for albuterol and Flovent inhalers, and was sent home.

Two days later, on the 22nd, Alicia had trouble breathing. An ambulance was called who noted that Alicia was pale and in respiratory distress. After arrival at the local ER, Alicia was found to be in profound shock with respiratory failure and severe acidosis. Pus was found at the site of chest port. She was admitted to the ICU in grave condition.

Two dater after that, on the 24th, tragically, Alicia died. The causes of death listed on her Death Certificate were hyperkalemia, renal failure, and bacteremia. Cultures from her chest port grew the same organism (Enterobacter cloacae) that had shown up in the culture taken in the ER in New Jersey.

We had the case reviewed by an ER expert from Harvard who opined that the ER doctor on the 20th was negligent for jumping to a conclusion of “asthma exacerbation” without ever developing a differential diagnosis for a patient with abnormal vital signs, a complicated medical history, and who had been to the ER several times with varying infection related complaints in a matter of days. The patient had presented with Systemic Inflammatory Response Syndrome (”SIRS”) yet the ER doctor never even considered SIRS or an infection (SIRS is the body’s response to an infection characterized by an abnormal temperature, a heart rate over 90, tachypnea, and an abnormal white blood cell count – when two of these criteria are met a physician must be diagnosed with SIRS and infection must be ruled out).

We brought suit against the local hospital and the ER doctor in Allegheny County, Pennsylvania. We also brought suit against the hospital in New Jersey (for not calling with the results of the culture) in the state of New Jersey.

By taking depositions of the caregivers involved, we learned that the ER doctor was unaware of many of Alicia’s recent symptoms that he would have learned with a more complete history and/or by reviewing the prior records (as his note suggested that he had done). Interestingly enough, in his deposition, the ER doctor claimed to have remembered several details that were not documented that coincidentally would have helped him defend the case, despite the ER encounter being 18-months prior, him testifying that the patient and her father were African-American when there were not, and despite seeing over 6,500 patients since.

We had the case reviewed also by an infectious disease expert who opined that Alicia’s infection was treatable and curable had timely, proper medical been given.

We also had the case reviewed by a hematologist at Harvard who specialized in thalassemia. He opined that Alicia’s death had nothing to do with thalassemia (as the defense claimed) and that Alicia died from an untreated infection in the patient’s port.

Prior to trial, we settled the case against the local hospital for a substantial amount. With regard to the case in New Jersey against the New Jersey Hospital, we referred the case to a top medical malpractice lawyer in New Jersey to handle that case. Days before trial, the case in New Jersey also settled for a substantial amount.