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Facts: An adult female presents to the ED with pain, redness and swelling in her leg. O2 sats are WNL and she has no respiratory symptoms. She is appropriately evaluated and diagnosed with a DVT. The EP consults the patient’s PCP, arranges a followup appointment for the next day, and gives her a first dose of Lovenox. He prescribes Lovenox for home use and discharges her with instructions and information about DVT’s. She collapses and dies in the pharmacy while waiting for her prescription to be filled. No autopsy is done but she is presumed to have died of a massive PE. Her family consults an attorney, files a lawsuit and the case goes to trial.
Plaintiff: A DVT can lead to a pulmonary embolus. You should have admitted me to the hospital. I would have been treated sooner and more aggressively and not died – but you sent me home. That is below the standard of care.
Defense: Automatic admission of a patient with a DVT was the standard of care 20-30 years ago, but it isn’t now. Outpatient treatment of a DVT with Lovenox is within today’s standard. You were treated appropriately. Lovenox is the same drug you would have been given if you were admitted. In fact, even if we knew you had a PE and admitted you, you would have been treated with the same drug. The outcome would have been no different. We cannot predict anyone’s outcome and are sorry about your death, but being in the hospital would not have changed anything. Sometimes we can do everything right but patients still die.
Result: Defense verdict after less than 2 hours of deliberation.
Takeaways:
* The standard of care changes with the times. Her care was not negligent.
* Outpatient treatment of DVT is within the current standard of care.
* Admission to the hospital and treatment with the same drug would not have changed anything.
* Thus, the failure to admit would not have caused the patients death.
