Defense Verdict in a Case of an Upper Gastrointestinal Bleed
PRI obtained a defense verdict on behalf of an emergency medicine physician and an ambulatory endoscopy facility in a case of a then 64 year old decedent who died one day following discharge from the emergency department.
The patient presented with a chief complaint of vomiting. He had a known history of cirrhosis with gastric varices for which he was being followed and treated by his personal gastroenterologist. One month prior, the patient’s private gastroenterologist performed an EGD and glued a gastic varix. One week before arriving in the ED, the patient had a follow-up EGD to assess the efficacy of the gluing procedure. This EGD was performed by a different gastroenterologist because the patient elected to see a gastroenterologist that was closer to his home. At the time of the incident, the private gastroenterologist believed that this recent EGD was unremarkable.
In the ED, the patient reported discolored emesis approximately nine hours prior and was unsure if it was blood or fruit from breakfast. He denied pain and had a calm affect. Vital signs were stable. His skin was warm and dry. His bloodwork was within normal limits and there was no evidence of bleeding while in the emergency department.
Our defendant emergency medicine physician had a clear and independent recollection of the patient. He well remembered contacting the decedent’s private gastroenterologist to discuss the patient’s history and current treatment and to raise the question of esophageal lavage. The gastroenterologist felt that a lavage was not a sensitive test and carried bleeding risks in patients with known varices. Additionally, the gastroenterologist felt reassured by the recent EGD and therefore had a low threshold for concern. He informed the ED physician that given the patient’s clinical stability, absence of active emesis, and recent benign EGD, the patient did not need urgent/emergent GI evaluation. The ED physician subsequently discharged the patient from the emergency department. The following day, the patient died from a variceal bleed. The patient’s family brought suit against the parties involved, including the PRI-insured endoscopy facility where the second EGD was performed as well as the PRI-insured emergency medicine physician.
During the discovery phase of the lawsuit, it became known that the second EGD in fact, identified a red spot on a gastric varix, putting this patient at high risk for bleeding; however, the patient’s private gastroenterologist was not aware of this finding.
A confident and seasoned emergency department physician, our doctor felt he treated the decedent well and certainly did not depart from the standard of care. Our insured discussed the case at length with the patient’s private gastroenterologist, both determining that the patient was not actively bleeding. With our experienced physician and a strong and assured legal defense team, the case was brought to trial.
At trial, PRI’s defense team was able to show that, regardless of bleeding or breakfast as the reason for the discolored emesis, our physician treated the patient as if he had hematemesis. He believed that even if the patient had spit up blood earlier that morning, he was without any further episodes of bleeding from that time until he presented to the emergency department approximately nine hours later. Our insured appropriately reached out and discussed the case and plan of care with the patient’s gastroenterologist. Even after the gastroenterologist provided reassurance, our ED physician used shared-decision making and advised the patient that he could remain in the ED for observation, an offer which was declined by the patient. The patient was given careful discharge instructions which were not followed by the patient.
In defense of the endoscopy facility, PRI was able to show that the facility had indeed provided the patient’s primary gastroenterologist with a timely report of the EGD. This report described the concerning finding which indicated that the patient was at high risk for bleeding.
PRI’s defense counsel persuasively showed how the standard of care was met for both the emergency medicine physician and the endoscopy facility and the jury returned a unanimous defense verdict.