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Suit claiming surgery too soon after medication fails – Defense Verdict

Plaintiff was scheduled to undergo percutaneous nephrostomy (PCN) by the defendant, an interventional radiologist. The purpose of the PCN was to provide plaintiff’s urologist access to the left kidney for calculus removal. Plaintiff had a significant past medical history, including coronary artery disease, cardiac catheterization with stenting and pulmonary emboli. He was taking daily Coumadin and daily 81 mg aspirin.

Per his internist, the Coumadin was discontinued and plaintiff was “bridged” with Lovenox in the days leading up to the PCN. Plaintiff took his last doses of Lovenox and aspirin the night before the PCN (approximately 15 hours before the PCN).

The attempted PCN was unsuccessful. There were no clinical indications of any intra-procedure complications. At the conclusion of the procedure, defendant consulted with the treating urologist, who decided to admit the plaintiff overnight.

Later that night, plaintiff’s vital signs deteriorated. It was determined that he was hemorrhaging, likely as a result of the attempted PCN. He suffered a myocardial infarction and hemothorax requiring chest tube. Plaintiff spent approximately five days in the ICU and five days on the regular unit. He was discharged to home.

The allegations of negligence were that defendant negligently failed to wait at least 24 hours after the last dose of Lovenox and five to seven days after the last dose of aspirin before proceeding with the PCN; and defendant failed to obtain plaintiff’s informed consent for the PCN by failing to tell plaintiff he was at increased risk of bleeding from the PCN because of the timing of the last doses of Lovenox and aspirin. The defense rebutted each of these claims, presenting expert testimony that the standard of care required defendant to wait just 12 hours after the last dose of Lovenox before proceeding and did not require defendant to hold aspirin for five to seven days. The defense experts also testified that, as of the time of the PCN, plaintiff was not at increased risk of bleeding.

The case was submitted to the jury on day four of trial. The jury returned a defense verdict in approximately one hour.


Type of action: Medical malpractice
Injuries alleged: Renal hemorrhage, myocardial infarction, hemothorax requiring chest tube, scar tissue/mass in left upper quadrant of abdomen, diminished stamina and libido, increased fatigue and depression
Name of case: Confidential
Court: Frederick County Circuit Court
Tried before: Jury
Judge: Dennis L. Hupp
Special damages: Approximately $50,000 in medical expenses
Verdict or settlement: Defense Verdict
Date: Aug. 25, 2011
Insurance carrier: The Doctors Company
Attorneys for defendant: Susan L. Mitchell and Marc A. Brown, Fairfax
Attorneys for plaintiff: Thomas E. Albro and R. Lee Livingston, Charlottesville

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