Virginia Lawyers Weekly VA Lawyers Weekly
Type of action: Medical malpractice
Injuries alleged: Partial foot amputation, permanent deformity and pain limiting activities of daily living
Court: Fairfax Circuit Court
Tried before: Jury
Name of judge or mediator: Judge John M. Tran
Date resolved: 3/24/2022
Special damages: Approximately $670,000
Demand: $5,000,000
Verdict or settlement: Verdict
Amount: $0 (defense)
Attorneys for defendant (and city): Robert F. Donnelly and Alexandra Dare Essig, Glen Allen
Description of case: In November 2016, the plaintiff underwent an ascending aortic aneurysm repair for which the patient received Heparin. The patient was discharged only to return to the emergency room with a superficial saphenous vein clot, at which time her platelet count was 149. Four days later, the plaintiff again returned to the emergency department with worsened bilateral leg pain, and she was admitted for a DVT and had a platelet count of 195 at admission. The patient had a pre-existing condition of polycythemia vera for which the on-call defendant hematologist was asked to consult on the day after the patient’s admission, at which time the patient’s platelet count was 141. When the defendant next rounded on the patient the following day, the patient’s platelet count fell to 89, and the defendant ordered a platelet count redraw and lab tests for heparin induced thrombocytopenia (HIT) with an order for a switchover to Argatroban and cessation of heparin. The plaintiff alleged that the defendant should have diagnosed the patient with HIT and switched over to Argatroban when the platelet count fell from 195 to 141. The defendant’s hematology expert focused on the lab’s reference range at the time for platelet counts, which was 140 (low) to 400 (high). The defendant’s expert opined that the defendant timely diagnosed HIT when the platelet count fell to 89, and the defendant properly ordered a switch to Argatroban. The defendant’s expert also opined that the patient’s clinical presentation was unusual for a HIT case particularly in regards to the patient’s platelet count that rose from 149 to 195, which is inconsistent with a typical HIT case whereby the platelet count is expected to be in a continual decline. The defendant’s vascular surgeon expert opined that switching over to Argatroban one day earlier would not have had any bearing on the outcome in terms of alleviating the clot or preventing the amputation because Argatroban only prevents the development of new clots.
Alexandra Dare Essig, counsel for the defendant, submitted case information.
[022-T-069]
