Disconnection from Dialysis Machine Resulting in Death - Gander
The Gander Case
In the summer of 2015, Nancy Gander needed dialysis and was referred to the Defendant Dialysis Clinic. She had her three visits, and the visit which is the focus of the lawsuit, was in July, 2015.
Nancy arrived at the Defendant Dialysis Clinic a little before 2:00 p.m. and was connected to the dialysis machine by a Patient Care Technician who provided intermittent care to Nancy for dialysis for the next several hours.
Nancy was also assessed by a Registered Nurse in charge of the dialysis floor that afternoon. There was also a Trainee who had started training only several weeks before, and was being taught by the others.
A little after 3:00 p.m., a Social Worker at the dialysis clinic, sat down next to Nancy’s dialysis chair recliner, and conducted a detailed interview, and also during this time conducted visual examinations of Nancy’s dialysis connections.
By 3:45 p.m. or so, the Social Worker completed her assessment, and returned to her office to prepare her reports. Around 3:50 p.m., the Patient Care Technician walked by Nancy’s chair and did a cursory look at how Nancy was doing, and then left the dialysis floor to make copies and/or fax medical records.
At 4:00 p.m., an alarm rang on Nancy’s dialysis machine. The Registered Nurse went to Nancy’s recliner to document vital signs and found Nancy unresponsive and immediately noticed that her dialysis line was disconnected.
The Registered Nurse immediately clamped the line and yelled to the Trainee to go get the Facility Administrator. At the time, the Trainee was sitting behind the nurse’s desk, got up and looked and saw a pool of blood underneath Nancy’s recliner chair. She screamed “oh my God”, and turned to run down the hallway to get the Facility Administrator.
When the Trainee got to the Facility Administrator’s office, she yelled “there’s blood”. They immediately turned and ran back down the hallway to the dialysis floor. Upon entering the clinic floor, the Facility Administrator saw what the Trainee had seen – a pool of blood underneath Nancy’s chair, but none of them said a word about it. More curiously, none of them mentioned this to the Registered Nurse who had stayed with Nancy. The Registered Nurse screamed at Nancy to wake up, while the Trainee and Patient Care Technician waited for instruction.
The Social Worker was in her office and heard a commotion, and walked onto the dialysis floor where she saw everyone surrounding Nancy’s chair. The Social Worker called 911 but didn’t mention any blood loss. The Registered Nurse flushed back the blood from the dialysis lines into Nancy, and began administering saline solution. She also called for the crash cart and oxygen to be given to Nancy. The medical records show that the Registered Nurse recorded that Nancy had a pulse.
Six minutes passed and a second 911 call was made:
One minute later, the EMS responders arrived and were quickly ushered onto the dialysis floor. The paramedics asked what was going on, and were only told that Nancy was unresponsive. Although the Defendant Dialysis Clinic workers knew that there was a large puddle of blood underneath Nancy’s chair, they failed to mention that to the paramedics.
The paramedics found that Nancy had no effective heartbeat or respirations, and yet noted that no CPR was being done. The ambulance crew knew that Nancy had to be rushed to the hospital, so they quickly placed her on a stretcher and took her to the ambulance. They initiated oxygen, CPR, epinephrine and electronic shock without response.
The paramedics drove to the hospital (which was coincidentally up the hill). Upon arrival at the ER, the ER doctors recorded that Nancy was in asystole and was declared dead soon thereafter.
Neither the paramedics nor 911 were told that there was any disconnection from the dialysis machine or blood loss, and unfortunately, neither did anybody at the Hospital know about these things either.
After Nancy was taken to the hospital, her boyfriend was called and told that Nancy was being taken to the hospital, and that he should go there immediately. He drove to the hospital where he was told that Nancy had died.
In shock, the boyfriend drove back down to the dialysis clinic where he planned to retrieve Nancy’s belongings. He was met by the Social Worker who helped get Nancy’s belongings. Apparently the Facility Administrator also saw the boyfriend and said to him something of the effect that she would have thought that Nancy would have felt all of the blood loss since it ran down her shirt. The boyfriend was taken aback and didn’t know about the blood loss.
Meanwhile apparently the ER doctor was confounded about Nancy’s death, and the Coroner was called. The Coroner either called or sat down with the boyfriend and asked about Nancy’s health to try to find out what happened. It was then that the boyfriend mentioned the blood loss, which was a new revelation to the Coroner, and the beginning of the investigation.
The cause of Nancy’s death was exsanguination which is the loss of a massive amount of blood. The Defendants claimed only a small amount of blood was lost – a cupful - which is not enough to cause a death by exsanguination.
The Pennsylvania State Police conducted an investigation with several rounds of interviews. With the State Police, the Defendant Dialysis Clinic personnel acknowledged that there was a pool of blood under Nancy’s chair, and acknowledged that they did not tell that to the paramedics or that there was a disconnection from the dialysis machine. The paramedics were interviewed and said that they did not know that Nancy had bled out, or that there was a disconnection and that they were not told anything about blood loss by the Defendant Dialysis Clinic nurses. The paramedics added that they may have lost a chance to save Nancy because they did not buy the loss.
A wrongful death and survival action lawsuit was filed, and a claim for punitive damages also pursued for the allegations that the Defendant Dialysis Clinic personnel hid information from the paramedics about the blood loss and the disconnection from the dialysis machine, which may have given Nancy a chance to survive. The case was vigorously defended by the Defendant Dialysis Clinic, and thousands of documents of medical records, policies and dialysis documentation were exchanged. In addition, over 20 depositions were taken of various personnel, and motions for summary judgment and partial summary judgment pursued by the Defendant Dialysis Clinic and the personnel. The motions were denied, and the case was scheduled for trial.
On the eve of trial, the Defendant Dialysis Clinic decided to settle the case for substantial sum.