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.)
The decision was made to open up decedent’s chest. There was absolutely no blood in the pericardium. The 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. Needless to say, Ms. Smith died unnecessarliy.
In the circumstances of this case, the applicable standard of care required the surgeons (i.e. Hall and Gamic) to stop the procedure when there were drops in blood pressure while “tugging on the lead.” It is common for defibrillator lead, 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 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.
Use of lasers to extract leads requires experience and judgment to make the determination as to how much pulling to use on a lead, how long to pull on a lead, etc. Dr. Hall had never performed this procedure and Dr. Lee had only performed it 6-7 times per his deposition. Dr. Lee, as well as Dr. Hall, per standard of care should have halted the procedure when complications arose and if necessary obtain cardiology consultation to evaluate the situation and take the proper steps. Continuing the procedure caused the major injury to the vessels which led to Ms. Smith’s death. The defendant physicians were not sufficiently experienced to perform this procedure. (See Part 3 of 3.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.