Thrombocytopenia Misdiagnosis Lawsuit Against Hopkins

Raine v. The Johns Hopkins Hospital

Blood testThis is a medical malpractice and survival action and wrongful death suit brought by the widow the deceased. The defendants are Johns Hopkins Hospital, the patient's cardiothoracic surgeon and his treating nurse practitioner.

Misdiagnosis is all too common in medical malpractice claims. In this suit, a patient receiving heparin developed a known complication of the drug. We all understand the drugs come with risks and when a known side effect occurs with a patient, it is not the fault of the doctor. But doctors do have an obligation to be on the lookout for these known risks of a therapy and properly diagnose and treat the patient to best manage these risks. In this case, the plaintiff alleges that treatable complications were ignored by two of the patient's health care providers. As a result of a hospital's carelessness, the patient died unnecessarily.

Medical malpractice cases in Maryland must first be filed in Health Claims Arbitration. This claim was filed in the Health Care Alternative Dispute Resolution Office on January 11th, 2018. This is the 16th medical malpractice suit filed in the state of Maryland in 2018. This is the first malpractice lawsuit against Johns Hopkins in 2018.

Summary of Plaintiff's Allegations

In February 2015, a man is admitted to GBMC with complaints of chest pain. He is transferred to Johns Hopkins Hospital the next day for management of this condition. While hospitalized, the plaintiff undergoes cardiac catheterization and has a quadruple coronary artery bypass graft (surgery that improves blood flow to the heart).

After the procedure but while still hospitalized, the plaintiff is given heparin (a drug that treats blood clots). Patients who receive heparin may develop heparin induced thrombocytopenia (HIT). This is an immune system reaction that can be treated by monitoring blood platelet levels.

The plaintiff is discharged despite demonstrating a blood platelet count that has lowered from 247 to 118 over a period of less than 48 hours. Prior to his discharge, one of the plaintiff's treating doctors suspected that he may have HIT. This doctor orders two additional tests and an earlier test comes back indicating that patient was positive for HIT.

The morning after his release, a home care nurse finds the plaintiff in respiratory distress. He is diagnosed with HIT and extensive blood clots. After 8 days in the hospital, the man dies.

Case Analysis
  • The negligence alleged in this lawsuit is two-fold. The patient's widow argues that the nurse practitioner was negligent in releasing her husband despite obvious medical evidence suggesting HIT. This negligence was enabled by the patient's cardiothoracic surgeon, who failed to intervene or otherwise prevent the premature discharge.

  • Thrombocytopenia is, in layman's terms, a condition that causes a low blood platelet count. Blood platelets are essential for routine coagulation that occurs naturally in the human body. When the platelet count falls too low, the body is unable to prevent excessive bleeding. In some rare cases, Thrombocytopenia can cause internal bleeding. Although heparin is used to prevent dangerous blood clots, it can overcorrect and harm the body's natural blood clotting function.

  • It's believe that between 1% and 5% of patients receiving heparin develop thrombocytopenia. Of that number, women on heparin after cardiac surgery are believed to be at greater risk of developing HIT.

Plaintiff's Expert Witnesses

The plaintiffs have two certifying experts. The first is Teresa Stimpson, a licensed nurse practitioner specializing in the treatment of cardiac patients. Stimpson's expert report emphasizes that she has experience treating patients who have had coronary artery bypass graft surgery. She states that the patient's treating nurse practitioner departed from the standard of care in allowing his discharge from the hospital. Stimpson expressed that further testing should have been arranged. She posits that, if the NP was aware of the positive test results, the standard of care indicates that the patient be re-hospitalized.

The plaintiff's second expert is D. Tyler Greenfield, M.D., a cardiothoracic surgeon. Dr. Greenfield begins his report by emphasizing that he has performed coronary artery bypass graft surgeries. He states that the plaintiff's attending physician was responsible for the patient's care following surgery. This includes overriding or correcting the decisions made by a nurse practitioner. Dr. Greenfield argues that both the physician and nurse practitioner departed from the standard of care by discharging the patient given the suspected HIT. He also states that both defendants were negligent in not re-hospitalizing the plaintiff when new information came to light.

Alleged Negligence
  • The defendants were aware that HIT is a known side effect of heparin use.

  • The plaintiff exhibited a platelet loss of over 50% in the days after his surgery, a strong indication that he was suffering from HIT.

  • The defendants negligently discharged the plaintiff despite the fact that one of the defendant doctors suspected the plaintiff had HIT.

  • The defendants failed to re-hospitalize the plaintiff when a platelet test indicated that he had HIT after his discharge.

  • The defendants departed from the standard of care by treating the plaintiff for HIT, including obtaining appropriate consultations or switching him to a different anti-coagulant medication.

  • Due to the negligence of the defendants, the plaintiff's HIT persisted and he died from the condition.

Defendants

The Johns Hopkins Hospital, The Johns Hopkins Health System Corporation, Johns Hopkins Medicine, Johns Hopkins University, a cardiac surgeon, and a nurse practitioner based in Howard County.

Jurisdiction

Baltimore City

Similar Cases See Also Getting a Lawyer for Your Medical Malpractice Claim

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