Failure to Adequately Monitor Dialysis Patient - Betts
The Betts Case
Case Summary
Joan Betts, a 54-year-old mother and grandmother, died of exsanguination (a medical term meaning massive blood loss) after the tube running from her dialysis machine back to her body became disconnected without any medical personnel realizing such had occurred. The nurses responsible for Joan’s care and supervision failed to properly inform the EMS that responded to their 911 call, and they cleaned up the blood before they arrived so that the EMS had no way of knowing what happened. The nurses’ failure to monitor Joan and report her blood loss to the EMS caused a substantial delay in her treatment and removed any chance of her survival.
Case Details
Joan was a 54-year-old mother and grandmother who needed dialysis. She had several medical conditions, including diabetes, which was difficult to control and ultimately caused chronic kidney disease. Joan’s condition got to the point where she needed regular dialysis, and she sought treatment at a local dialysis center.
Dialysis is a medical treatment which is needed when a person’s kidneys do not work sufficiently to filter the blood and remove things like waste, salt and extra water and chemicals from the blood. When somebody undergoes dialysis, the doctors hook up an access port to the arteries and veins in a person’s body. Once this is done, the dialysis machine is able to pull the blood from the patient’s body into the dialysis machine, where it gets filtered and cleaned, and then it gets pumped back into the body.
A dialysis machine has several alarms on it in case there is a problem with the blood flow in relation to the patient’s blood pressure. In addition, the nurses are required to take the vital signs of the patient every 15 to 30 minutes to ensure that the patient is tolerating the dialysis process well.
In mid-July, Joan’s boyfriend dropped her off at the local dialysis center for treatment, just as he had previously done several times before. A nurse hooked up the tubing to draw Joan’s blood from her artery into the dialysis machine, and then hooked up the tubing to her vein which ran from the machine back to Joan’s body to return the blood to her. Intermittent care was provided to Joan by the nursing staff for some time after her dialysis began.
About an hour into her dialysis treatment, an alarm went off, and the nurses checked on Joan. They noticed that Joan’s arterial blood pressure was low, and the technician decided to give Joan some saline to bring her blood pressure back up. The nurse also noticed that the dialysis machine’s alarm continued to ring, however, she believed that the machine was not “interfacing” properly. Interestingly, following the events that gave rise to the lawsuit, the machine in question was sent for inspection and was found to have no functional problems at all.
About two hours into Joan’s dialysis treatment, a trainee at the center heard the alarms go off on the dialysis machine and checked on Joan. As she did, she immediately noticed that there was blood running down the chair pooling onto the floor and yelled, “There’s blood!” The technician, the nurse and the supervisors at the center all came running to Joan’s chair.
The nurse, supervisor and trainee noticed that there was blood underneath the chair and puddling on the floor. They also noticed that the tube running from the dialysis machine back to Joan’s body was disconnected, which meant the dialysis machine was pulling the blood from Joan’s body, filtering it, and instead of returning it to her body, was leaking down Joan’s arm, down to the chair and onto the floor. Joan had lost so much blood that she was unconscious and unresponsive.
An employee at the dialysis center called 911 and initially reported that they had a patient who was unresponsive, offering no mention of the line disconnection nor the blood loss. A few minutes later, a second 911 call was placed asking if the ambulance was en route. The staff informed 911 during the second call that Joan had a rapid pulse but was not breathing, again, failing to mention for a second time that Joan’s line had become disconnected causing massive blood loss.
Once the EMS arrived, in the staff’s third account of the events, they informed the EMS that Joan may have suffered “some type” of cardiac arrest or just became unresponsive, conveniently choosing to leave out the fact that Joan’s line disconnected resulting in blood loss. Since the EMS personnel were oblivious to these facts and ultimately believed that Joan had some unknown condition or cardiac arrest, they tried to perform CPR before ultimately driving her to the Hospital. Had the EMS personnel been correctly informed of exactly what happened to Joan, their emergency treatment of her would have included treatment for blood loss. What is even more remarkable is the fact that when the EMS arrived at the clinic, they did not document or notice any blood at the scene (yet the dialysis staff adamantly testified that Joan’s blood was cleaned up after the EMS left to take Joan to the hospital).
Shortly after the EMS left to transport Joan to the hospital, the staff at the dialysis clinic contacted Joan’s boyfriend to inform him that there was an incident and he needed to get to the hospital. Incredibly, the staff again failed to reveal (even to her family) that Joan had become disconnected from the dialysis machine, resulting in massive blood loss. Joan’s boyfriend immediately went to the hospital.
Upon Joan’s arrival in the emergency room, the doctors attempted to revive her, but quickly realized that she was unresponsive and that the medications and treatment were not working. 15 minutes after her arrival in the emergency room, Joan was pronounced dead. It was determined that Joan had died of exsanguination (massive blood loss). It became apparent that neither the ambulance personnel nor the ER personnel were ever aware during their treatment of Joan that the reason she became unresponsive in the first place was due to line disconnection resulting in blood loss.
The hospital contacted the coroner to perform an autopsy. The coroner testified that he became aware of Joan’s disconnection and blood loss after speaking with Joan’s boyfriend at the hospital. In turn, the coroner contacted the Pennsylvania State Police who investigated the incident. A PA State trooper interviewed the nurses and supervisors at the dialysis center on two separate occasions, the first of which occurred a few days following Joan’s death. During the first round of interviews, the dialysis center staff were questioned about the line disconnection and the events that transpired prior to Joan’s death. The second round of interviews occurred approximately two weeks after the initial interviews because the state police became aware (from their interviews with the EMS personnel) that none of the staff had informed 911, the EMS or the ER of the fact that Joan had become disconnected and lost an enormous amount of blood. During these second interviews, the state trooper confronted each of the dialysis employees as to why the EMS were not informed of the line disconnection and the blood loss. Not one of the employees could give a straight answer.
Lawsuit
We filed a lawsuit on behalf of Joan’s estate against the dialysis center as well as the nurses and technicians responsible for monitoring and caring for Joan. We alleged that the dialysis center was negligent in failing to properly connect the tubing to Joan during dialysis, allowing it to become dislodged, and allowing the blood to pour out unchecked. Additionally, the dialysis center failed to properly watch the dialysis and monitor the alarms.
We also added a claim in the lawsuit for punitive damages because the facts show that the nurses cleaned up the blood before the EMS arrived, and that although the nurses knew that Joan had lost massive amounts of blood, they failed to tell the EMS crew or 911 about the blood loss, and instead, made up a story about Joan suffering a cardiac condition which led the doctors and EMS to try to treat a condition that did not exist.
We deposed all of the medical personnel who maintained their innocence, claiming that there was not that much blood, it was not cleaned up, and they did not withhold any information that was available to them. The trial would have taken place in a rural county and the Defendants seemed to exploit the county’s track record of defense verdicts, which Defendants in rural venues often do. The Defendants made a small offer during the pendency of the case in reliance on Joan’s comorbidities. We countered with experts in Nursing, Nephrology, and Forensic Pathology stating, amongst other things, that most people on dialysis have comorbidities, but they go to dialysis to get better and the Defendants’ actions removed that chance.
We intended to play the witness statements recorded by the PA State Police at trial because they were so powerful and reflected the facts of the case as well as the contradictions in the testimony elicited from the staff. Defendants also tried to defend the case on the basis that everyone did their job properly and the nurses and technicians were not in a position to see that Joan was disconnected and leaking blood under her chair. To counter this defense, we produced a schematic of the dialysis center showing that people in the facility had a clear view of Joan and could clearly see blood pooling underneath her chair if they were paying attention.
Result
We resolved the case for a 7-figure settlement made the day before trial.