ExpressCare Lawsuit in Anne Arundel County

Schwartz v. Express Care Urgent Care Centers

Outside of a Nursing HomeThis is misdiagnosis wrongful death case filed by the family of a woman who died after treatment at ExpressCare in Harford County. It was filed in Health Claims Arbitration on January 17, 2017, and is the 26th medical malpractice case filed in 2017 in Maryland. It is the first Harford County malpractice suit of the year.

  • Another lawsuit filed against ExpressCare 16 days later in Baltimore County. This is another wrongful death lawsuit alleging the misdiagnosis of a pulmonary embolism.
Summary of Plaintiff's Allegations

The decedent, a 66-year-old overweight woman, goes to Urgent Care with lethargy, vomiting, cough, wheezing, pain in her ear and collar bone, and diarrhea. She has a slight fever and an elevated blood pressure.

Defendant physician assistant and defendant physician evaluate the decedent and find that she has mild difficulty breathing, tenderness in her left clavicle area, and coarse breath sounds with lower lobe rales. They order a chest-x-ray, which they interpret as having no focal infiltrates.

Defendant radiologist reviews the chest x-ray and finds clear lungs, no effusion, and no heart enlargement. Allegedly, he fails to note the evidenced enlarged heart. Defendants discharge decedent home with bronchitis and prescriptions for antibiotics. (Not sure why antibiotics were prescribed for bronchitis, but it is not essential to the case.)

Nine days later, decedent returns to Urgent Care, complaining of continued lack of strength and energy, in addition to difficulty breathing, high blood pressure, and a high heart rate. She has finished the antibiotics but has no improvement in her symptoms.

Defendant nurse practitioner evaluates her and finds mild exertional shortness of breath and right ear pain. Defendant diagnoses her with general discomfort and high blood pressure and sends her home.

Four days after her second trip to Urgent Care, decedent goes to the ER at Harford Memorial Hospital with shortness of breath and lower extremity swelling. The physician evaluating her finds diffuse rhonchi with bilateral edema, and he is concerned about a pulmonary embolism or acute coronary syndrome. He orders laboratory tests, a chest x-ray, and an EKG.

The physician finds that the decedent has an acute inferior wall myocardial infarction, a positive troponin level, and possible inferior and posterior wall akinesis with inferoseptal ventricular septum defect.

Due to the possible complications, the doctor at Harford Memorial decides to transfer decedent to University of Maryland Medical Center (UMMS). While waiting to be transferred, she deteriorates rapidly.

When decedent arrives at the University of Maryland, she has a ventral septal defect, and an intra-aortic balloon pump is placed. She then has a ventriculotomy done to close the ventricular septal defect. A few days later, the decedent has a stent placement of her right external iliac artery done.

Things quickly get worse. While in recovery in the ICU, decedent develops acute renal failure which progresses into chronic renal failure. While she is at UMMS, decedent becomes debilitated and immobile, develops a sacral wound, blood clots in both legs, and requires a feeding tube. She remains at UMMS for almost a month, and is then transferred to Levindale Hebrew Geriatric Center for medication and wound care.

After a few weeks at the geriatric center, the decedent is brought to Sinai Hospital due to rectal bleeding. She has blood transfusions and is diagnosed with heparin-induced blood platelet deficiency. The doctors attempt to remove the excess fluid with dialysis, but the decedent is unable to recover due to severe hypotension. After half a month, decedent dies due to hypotension and cardiomyopathy.

Her family brings this claim, arguing that the Urgent Care doctors were negligent in missing the key signs and symptoms of serious, life-threatening injuries.

Additional Comments
  • Plaintiffs are likely to claim that the standard of care first required concern at ExperssCare that her symptoms were cardiac in origin and represented unstable angina or an acute coronary syndrome (inadequate blood flow to the heart muscle). The path would be to draw serial blood samples to make sure there was no heart muscle damage based on increases in the CK, CK-MB or troponin level. These suspicions would also warrant an electrocardiogram to rule out a myocardial ischemia or infarction and arrhythmias. The question is whether those symptoms warranted that heightened level of concern in the first place. These are not classic harbingers or acute coronary syndrome.
  • Plaintiffs' lawyers use as a sword in the Complaint that the woman was a 66-year-old smoker who was overweight and had high blood pressure. All of the increases the risk of cardiac problems so the thinking it that should have been on alert. The defendants are obviously going to use this to argue the die was already cast and that this patient was at risk for a great many maladies which confounded the diagnosis.
  • We never realized until we began analyzing every Maryland malpractice lawsuit just how many lawyers wait until the very last minute to file malpractice cases. In this case, the plaintiffs' lawyer waited until three days before the statute to file suit. Have our lawyers every waited to the last minute to file a case? Sure. It happens. The client comes to you late, or treatment continues up to the time of limitations. But it should be a rare event based on compelling circumstances, not the standard operating procedure it appears to be for too many malpractice lawyers.
  • It is hard to comment on the strength of the radiology case without seeing the reports and films. That might be the best argument plaintiffs have but it is hard to tell from the complaint without seeing the medical records.
Jurisdiction
  • Harford County
Defendants
  • Express Care at the Festival/Express Care Urgent Care Centers
  • A certified nurse practitioner
  • A certified physician assistant
  • An internist
  • Net Medical Xpress Solutions, Inc.
  • A radiologist
Hospitals Where Patient Was Treated
  • Harford Memorial Hospital
  • University of Maryland Medical Center
  • Sinai Hospital
Negligence
  • Failure to take reasonably thorough history, conduct reasonable exam, and create reasonable differential diagnosis to rule out life threatening conditions
  • Failure to facilitate on an emergent basis the appropriate diagnostic studies
  • Failure to emergently direct decedent to an ER
  • Failure to appreciate that decedent's chest x-ray was significant for cardiomegaly
  • Negligently diagnose decedent with malaise and hypertension
Specific Counts Pled
  • Wrongful Death
Plaintiff's Experts and Areas of Specialty
  • None at this time
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