Lawsuit Against ExpressCare Urgent Care

Knoerlein v. Express Primary Care, LLC

pulmonary embolism malpracticeThis survival and wrongful death lawsuit was filed on behalf of a man in Baltimore County after ExpressCare Urgent Care doctors failed to diagnose his pulmonary embolism. Filed on February 2, 2017, in Health Claims Arbitration; it is the 59th medical malpractice case filed in Maryland in 2017.

Summary of Plaintiff's Allegations

Plaintiff goes to the ExpressCare Urgent Care in Dundalk, where he comes under the care of defendant doctors. When he arrives, his heart rate is high, he is short of breath, and he has low oxygen levels.

No question, these are the ingredients you need for a pulmonary embolism and the development of a DVT. Could it have been asthma? Absolutely. But these symptoms are consistent with a pulmonary embolism seemingly to the point where you would want to rule it out. Even a small risk of pulmonary embolism is a significant risk because not providing immediate treatment a pulmonary embolism can have very grave consequences. Conversely, if you have a pulmonary embolism or a DVT and you catch it early, outcomes are usually quite good. In patients who are anticoagulated, pulmonary emboli are largely or fully cleared within six months.

Back to the facts of this lawsuit. He is diagnosed with having an acute asthma attack. He is given two nebulizer treatments and a spirometry test even though his symptoms are not consistent with an asthma exacerbation. The man is discharged home before any imaging or confirmation or proof of a lack of pulmonary embolism.

Later the same day he suffers cardiac arrest. He goes to Bayview Medical Center via ambulance, in critical condition. He is pronounced deadly shortly after he arrives at the hospital. An autopsy reveals that he died of bilateral pulmonary emboli due to lower extremity deep vein thrombosis.

Additional Comments
  • The defense to this case will be that a pulmonary embolism and asthma have many overlapping symptoms, so it was reasonable to diagnose asthma. True. But plaintiff's expert is going to testify that when a patient has shortness of breath and low oxygen levels as this guy did, the standard of care requires a differential diagnosis of a pulmonary embolism. This guy should have been sent immediately to the emergency room based on these facts.
  • We have been saying it is either asthma or symptoms of a cardiac event, but it would also be both.
  • You might interpret the comments above that the patient clearly had a pulmonary embolism. That is not the case but let's put it in context. A patient with all the classic symptoms of a pulmonary embolism still probably does not have a PE. But the risk is so great and the benefits of treatment are so high that even a low likelihood of a PE is cause for alarm and testing to rule out this condition.
Jurisdiction
  • Baltimore County
Defendants
  • Express Primary Care, LLC
  • A Chief Medical Officer at ExpressCare who was a former ER doctor
  • A physician's assistant at Express Care
  • MNR Industries, LLC
  • Lifebridge Health, LLC
Hospitals Where Patient was Treated
  • Bayview Medical Center
Negligence
  • Failure to appreciate the likelihood of pulmonary embolism
  • Failure to properly diagnose plaintiff with having a pulmonary embolism
  • Failure to issue appropriate orders/recommendations to rule out a pulmonary embolism
Specific Counts Pled
  • Survival Action
  • Wrongful Death
Plaintiff's Experts and Areas of Specialty
  • Peter S. Marshall, M.D., MPH - board certified in Pulmonary Medicine and Critical Care Medicine; currently doing research at Yale School of Medicine in pulmonary embolism, therapeutic hypothermia, and critical care outcomes; three patient care locations in New Haven, Connecticut
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