| |||
|
Tom has Jury Duty in the Circuit Court of Wicomico County for the month of April. Jurors are numbered 100 through 999; his number is 869. Sunday through Wednesday, after 1730, we are to call a recorded message and receive instructions as to which jurors are to report the next morning. Juries are not selected on Fridays. | |||
|
Background and timeline: Friday, February 3, 2012, the plaintiff (54 w/f), complaining of feeling bad (nausea) for about 4 days, called 911 for transportation to the ER, something she had done on several previous occasions. The plaintiff was a “hard stick.” Although the ambulance EMTs were able to do an EKG, they tried, and failed, to start an IV during transport. The ER RN also failed, after three attempts, to start an IV in the left wrist. Around 2000, the ER doctor (defendant) used an ultrasound machine to assist in the placement of the IV in the left antecubital fossa (the inside crook of the elbow). (I now feel like I could start an ultrasound guided IV if I needed to, as the procedure was explained, in detail, numerous times.) All indications showed proper installation of that IV. Four tubes of blood were drawn, fluids were started and Phenergan was administered through the IV. Based on the EKG, a STEMI (ST-elevation myocardial infarction (STEMI)) was suspected and the ER doctor made the call necessary to summon the needed personnel, as this was a Friday evening and they were not in the building. The patient/plaintiff was moved to the cardiac cath lab where she was sedated (again, through the IV) and a cardiac cath was administered by a cardiologist. It was determined that she did not have a heart attack, but had a, rather rare, Takotsubo cardiomyopathy, also known as transient apical ballooning syndrome. She was moved to a room for observation. At 0110 (Saturday, February 4), she was given an additional 6.25 mg of phenergan for nausea, and again at around 0500. Vitals were checked, routinely, during this time period, using the left wrist. About 0600, the patient began complaining about pain in the left arm and morphine was added at 0645. Around 1100, the vascular surgeon was summoned. In a two-hour procedure, beginning at 1300, he found the IV was in the left brachial artery, and not the vein. Blood clots, caused by the Phenergan, had blocked that artery and necrosis was evidenced --- irreversible damage had occurred. Over the next year, a local orthopedic hand specialist monitored the condition of the left hand, and, when demarcation between living and dead tissue was clearly established, removed the tips of three fingers. The Case: The plaintiff alleged that the defendant, the ER physician, utilizing ultrasound, negligently, installed, improperly, an IV into the left brachial artery, rather than the vein and that improper installation, compounded by the subsequent introduction of meds (toxic in an artery, but not in a vein) into the artery resulted in clotting, causing a blockage, the necrosis of digital tissue and the subsequent amputation of the tips of several digits of the left hand. The plaintiff's expert witnesses testified that this procedure should reasonably be expected to be done correctly 100% of the time and that the indicators of a "bad stick" (pulsating blood flow and/or bright arterial blood) are easy to see and to correct. The defendant's expert witnesses made it clear that there is a 2% error rate, but agreed that the indicators of a "bad stick" are easy to spot. The jury, after 30 minutes deliberation, found that the installation of the IV produced no indicators suggesting a bad stick and that, although the IV was subsequently found in the brachial artery by the vascular surgeon, a "breach of the standard of care" had not occurred as the IV functioned properly for about six hours before effects of what was subsequently found to be a bad stick were evidenced. Procedure: When ultrasound is used to guide placement of an IV in the left antecubital fossa (the inside crook of the elbow), the transducer is placed over the chosen spot. On the scope, blood vessels (structures) are visible as dark while the surrounding tissue is lighter. When the transducer is pressed down on the arm, veins will partially compress, going from round to oval (they “wink” at you), arteries will not. The needle, with a catheter sheath around it, is introduced into the arm, and using the scope, into the vein. The needle is withdrawn leaving only the catheter. If, indeed, a vein has been hit, a steady flow of dark red blood will come out of the catheter. [If the structure is an artery, bright red blood will pulse from the catheter.] Blood for testing can be withdrawn through the catheter, or fluids/meds in a gravity bag can be introduced into the vein through the catheter. What went wrong? One of the defense witnesses, an ER doctor from the Baltimore/Washington area, hypothesized that the initial cath went through an artery and into a vein. This produced the fluid expected from a good stick and showed the IV running properly. Sometime around 0200, the cath pulled out a bit so the tip withdrew from the vein and was now lodged in the artery. The subsequent introduction of Phenergan was like pouring Drano into her arm. It resulted in clotting and a loss of blood flow into the hand and fingers. Conclusion: Did the defendant put the IV into the brachial artery? Clearly! Was there anyway, at the time, he could have known this and corrected the mistake? Not in the opinion of the six-member jury. Therefore, he did not “breach the standard of care.” Aftermath: The jury supervisor has excused us from any additional jury obligation for the rest of the month. | |||
| |||
| |||
| |||
| |||
| |||
| |||
| |||
| |||
| |||