This wrongful death lawsuit was filed by the estate of a woman in Baltimore City after her liver was negligently and fatally injured during blind pericardiocentesis for pericardial effusion. This particular claim was filed in Maryland Health Claims Arbitration on May 8, 2017 and it is the 216th medical malpractice case filed in Maryland this year.Summary of Plaintiff's Allegations
A 29-year-old woman went to Johns Hopkins Hospital with complaints of a fever, sore through, cough, and muscle pain. After a CT scan, it was determined that she had a pericardial effusion - a buildup of fluid around her heart. A transthoracic echocardiogram, completed the next day, confirmed a circumferential pericardial effusion with a diastolic inversion of the right ventricle consistent with tamponade physiology. This means, and we will talk about it more in the comments, that the building pressure from the fluid surrounding her heart made it more difficult for each of the heart's chambers to fill with and pump blood.
Two physicians at JHH attempted to drain the fluid around her heart by subxiphoid pericardiocentesis. They performed the procedure twice without success, allegedly blindly without utilizing the proper diagnostics to confirm proper placement of the instrumentation. During the procedure, the physicians damaged the woman's liver and failed to recognize that they had caused an injury. The physicians finished the procedure and placed a drain to further relieve fluid from around the woman's heart. Over the next five days, the woman had two transthoracic echocardiograms and a CT scan. The effusion seemed smaller than when she was first admitted, with no evidence of tamponade. The woman was discharged, with instruction to follow up as an outpatient.
Two days later the woman arrived at another hospital by ambulance after collapsing at home. She was intubated and went into a pulseless electrical activity cardiac arrest, requiring resuscitation. An abdominal ultrasound revealed free fluid in her abdomen, and a CT angiogram revealed active arterial bleeding from her liver.
At the hospital she underwent an abdominal aortogram with left hepatic artery embolization - a radiographic study of the abdominal aorta and a procedure attempting to stop the bleeding. Due to the buildup of pressure in her abdomen, she was sent to an operating room for an exploratory laparotomy. Her doctors found blood, clots, and more than three liters of intra-abdominal fluid. The surgeon noted a contusion of the bowel and a damaged area of her liver. Her injuries were extensive, resulting in a ruptured subcapsular hematoma, an actively bleeding liver laceration, and pulmonary edema. The procedure was terminated, the woman's abdomen was packed, and she was moved to the Surgical Intensive Care unit. Two days later she returned to the operating room for an abdominal re-exploration and washout, and a subxiphoid pericardial window was made during the procedure.
The next day, eleven days after her allegedly negligent pericardiocentesis, the woman was pronounced dead. An autopsy confirmed that her death was result of the liver injuries she had sustained at the defendant hospital.Additional Comments
A pericardial effusion is excess fluid surrounding the heart. A pericardial effusion ranges from harmless to life threatening.
The fear is cardiac tamponade which is when the fluid in the heart prevents the heart ventricles properly from properly expanding. The pressure from the fluid prevents the heart from working properly. This can lead to the heart becoming unable to circulate blood to the entire body.
Symptoms include shortness of breath, fatigue, chest pain and evidence of low cardiac output. These are possible indications for invasive treatment with pericardiocentesis.
A pericardiocentesis involves inserting a needle into the pericardial space around the heart to drain the fluid and relieve pressure on the heart.Pericardiocentesis comes with the risk of putting the needle in the wrong place. So doctors performing the pericardiocentesis used appropriate techniques to guide placement of the catheter including an electrocardiogram and radiologic guidance with a fluoroscope.
A blind pericardiocentesis would be doing the procedure without being able to see the where the needle was going without an ECG or fluoroscopic guidance. This is how it was done before modern radiology and there is a 10-20% mortality from a blind pericardiocentesis. The only reason today to do this procedure blind would be if there was an emergency. But that begs the issue of whether it had to be blind and whether the procedure, blind or not, had to be performed and was performed within the standard of care.
The other issue in the case is not just the injury to the liver but the failure to recognize the harm to the liver during the procedure so that it could have been immediately treated.
Trial is set for July 16, 2018. Waranch & Brown is defending the case for Johns Hopkins.Jurisdiction
- Baltimore City
- Johns Hopkins Hospital
- Failure to perform the proper diagnostic tests and procedures to determine the severity of the woman's condition
- Failure to appropriately and conscientiously treat the woman's condition without inflicting injury
- Failure to continuously evaluate the woman's condition and the effects of treatment
- Carl W. Adams, M.D., expert in thoracic surgery, subspecializing in cardiovascular and thoracic surgery
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