Woman stopped treatment for blood disease – Defense Verdict

Plaintiff, 55, suffered from amyloidosis with renal involvement, a rare blood dis­ease for which no cure exists. She under­went chemotherapy and a successful stem cell transplant in April 2012. On June 17, 2012, the patient was re-admitted with fe­ver of unknown origin and other non-spe­cific symptoms. During her readmission, the patient was seen by multiple physi­cians in various specialties. These physi­cians extensively worked her up during her month-long stay by placing her on broad spectrum of antibiotics, as well as other medications, to fight off an infection. They further ordered numerous tests, includ­ing blood chemistries, hematology studies, x-rays, CTs, blood cultures, and other spe­cialized tests and procedures.

On June 18, 2012, a CT of the sinuses supported a clinical diagnosis of acute si­nusitis and medications were adjusted. On June 21, 2012, a tagged white blood cell body scan was performed and showed persistent uptake in the chest indicative of either an inflammatory process or an in­fectious process in the lungs, and she was treated for possible lung infection. During each day of her admission, the physicians performed a neurological exam on the pa­tient and the exams were negative for de­finitive signs and symptoms of a CNS infec­tion. Throughout the course of the patient’s stay, antimicrobial therapies were adjusted and additional specialized tests were or­dered. On June 25, 2012, a bronchoscopy was performed and demonstrated gram positive cocci and antibiotics were adjusted. The patient’s fever improved along with her white blood cell count. When the patient de­veloped gastrointesti­nal symptoms around June 26, 2012, it was considered that the abdomen could be the source of her fever but the patient ini­tially refused a flex­ible sigmoidoscopy. On June 30, 2012, due to abnormal lab findings, specialized tests were ordered to look for thrombotic throm­bocytopenic purpura, or TTP, a rare disor­der of the blood-coagulation system.

When there was deterioration in the patient’s condition on July 2, 2012, with a new change to mentation, the patient was moved to the MRICU and was administered fresh frozen plasma for possible TTP, along with medication for low blood pressure and was intubated. The patient’s specialized test for TTP returned, the AdamsTS13, and was consistent with a diagnosis of TTP. The patient was therefore also started on plas­mapheresis and hemodialysis. With such treatment, her condition improved, includ­ing improvement in her sodium level, BUN, creatinine, and platelets. On July 9, 2012, the patient decided to stop all treatment, including plasmapheresis and hemodial­ysis. Thereafter, she experienced seizures and a brain hemorrhage, and she became comatose, and died on July 16, 2012.

After her death, the patient’s husband filed suit against 15 of his wife’s physi­cians and he attempted to sue the hospi­tal. Throughout the workup of the case, a dismissal of the hospital-entities and oth­er physicians were obtained, with the ex­ception of five physicians, including three bone marrow transplant physicians and two infectious disease physicians. Plain­tiff contended that the decedent’s death was caused by the failure to diagnose and treat a CNS infection and that the patient should have undergone additional test­ing for a CNS infection. Plaintiff further claimed that there was a failure of commu­nication between her attending physicians and a failure to develop a unified and effec­tive treatment plan.

At trial, plaintiff called his hematology/ oncology expert, who opined that the pa­tient did not have TTP; rather, she had a CNS infection likely from reactivated toxo­plasmosis. Plaintiff’s expert focused on the fact that one of the Defendant infectious disease physicians had recommended a toxoplasmosis PCR study that was never ordered by the attending physicians though numerous other tests had been ordered.

Well-credentialed experts in hematology/ oncology, infectious disease, and neurora­diology testified that the defendant physi­cians complied with the standard of care and that the care that was provided did not cause or contribute to the decedent’s death. In particular, the defendant physicians ap­propriately worked the patient up for fever and correctly diagnosed the patient with TTP. They testified that it was the patient who ultimately decided to stop life sus­taining treatment for TTP that caused her death.

Just before the case went to the jury, the judge granted in part the defense’s re­newed motion to strike and dismissed one of the defendants because plaintiff failed to prove that his care of the patient caused her death. During his closing statement, plaintiff’s counsel asked the jury for an award of over $2 million. After deliberating for about an hour, on Sept. 15, 2016, a jury in the Circuit Court of the City of Richmond returned a unanimous verdict in favor of the remaining four defendant physicians.

[16-T-174]

Type of action: Wrongful Death/Medical Malpractice

Court: Richmond Circuit Court

Tried before: Jury

Name of judge or mediator: Hon. William R. Marchant

Date resolved: Sept. 15, 2016

Verdict or settlement: Defense Verdict

Attorneys for defendant: Linda B. Georgiadis, Shyrell A. Reed, and Rodney K. Adams, Richmond

Attorneys for plaintiff: Robert Brown, Jr., Newport News