It is worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, U.C. Davis Medical Center, Mercy, Sutter, or any skilled nursing facility.
(Please also note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this wrongful death case and its proceedings.)
Decedent was scheduled for pacemaker and lead extraction secondary to the infection at Memorial by surgeon David Hall, M.D., on January 19, 2009. This was a percutaneous laser lead extraction.
Surgery began at 1532, with purulence encountered in the pseudocapsule. The generator was explanted, and around 1655 problems began. There is a handwritten note at 1700 stating there was easy removal of A-lead, but there were problems with the V-lead. Decedent had sudden loss of blood pressure which improved with released traction, but then dropped again. The surgeons apparently attributed the drop in blood pressure to tugging on the lead. The procedure continued producing another sudden drop in blood pressure and which point sternotomy was performed.
The decision was made to open up decedent’s chest. There was absolutely no blood in the pericardium. Right chest was filled with blood. Large bore catheters were placed including one on the atrium. Rapid blood and fluid infusion was implemented. For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.
On exploration, Dr. Hall found shearing of the right subclavian vein, innominate vein and complete shredding of the superior vena cava. The AICD lead (i.e. the V-lead) was found to have a large swath of superior vena cava and parietal pleura. The azygos vein had been sheared and retracted deep into the chest and was bleeding swiftly. Consequently, Ms. Smith died as a direct result.
In the circumstances of this case, standard of care required the surgeons (i.e., Hall and Lee) to stop the procedure when there were drops in blood pressure while tugging on the lead. It is common for defibrillator leads, which have coils attached, to become overgrown with tissue in the vessels. This is why one must proceed with caution when trying to cut or lase the leads free of the vessels. Subject defendant physicians should have halted the procedure to assess the problem and explore alternatives, e.g. use of fluoroscopy to explore the area to determine the cause and extent to the problem, use of trans-esophogeal echo to evaluate, etc. The fact the blood pressure was dropping upon “tugging” of the lead and rebounding when traction on the lead was released is evidence the lead was firmly attached to the vessel, and the blood pressure drop was either a reflex from pulling on the myocardium or from blood loss. Either one of these situations would require halting the procedure to evaluate the situation and assess proper action.
Additionally, use of trans-esophogeal echo is standard practice and would absolutely have determined if there was a hole, rupture, or bleed.
Further, if the lead was firmly attached to the vessel, it could have been approached in a different manner. It could have been cut off as far as possible and left in the body or it could have been approached through the groin. While it would be preferable not to leave a potentially infected lead in the body, the fact the epicardial lead had already been left in the body would indicate the risk from infection was not considered potentially life threatening. The infection could have been treated, or further surgery performed. (See Part 3 of 13.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.