Do I have a medical malpractice case?

[thebaum1972]

What is the name of your state (only U.S. law)? Iowa

I believe that I have a legitimate concern with a doctor who treated me recently. Based on everything that I have read online with how difficult it is to prove medical malpractice cases...I thought I would post my story on here and get the opinion of the experts here before contacting a local lawyer.

After suffering from fatigue, joint inflammation and a stiff neck for a month, two blood tests (from two different doctors- one a general practioner, one an infectious disease specialist) confirmed that I had Lyme Disease. After the first positive test I was sent to the ID specialist who confirmed the diagnosis with a second test. This is not disputed.

The ID doctor's course of treatment was to insert a PICC line in my left arm, so that I may receive IV antibiotics, dosed by myself with aid of visiting nurses. The PICC line was put in by staff at the ID doctors hospital (not the doctor) and I began receiving IV antibiotics that day. This is not disputed.

Here's where we get to the problem. After 3-4 days after the PICC line was put in, my arm began to swell, and was extremely painful. I called the doc's office on the 6th day and they had me come into the office. The ID doctor was not there, and the nurses in the office that day had to keep calling him on the phone in order to get directions on how to treat me. He ordered for the nurses to remove the PICC line in the office, and to schedule me for an appt the following day to get a new PICC line put in the opposite arm in the hosptial's infusion center the next day.

The next day, the arm is still swollen, and the inflammation has now traveled up the arm, into the armpit area, and shoulder. I called the ID doc's office and he was there and had me come in. He examined the arm, measured it, said it was just fine, and sent me to the infusion center to get my 2nd PICC line. I kept telling him that something was wrong....but to no avail.

The 2nd line was installed, and the exact thing happened. Day 6 I went to my general practioner's office, who said "There is definitely something wrong here, I am sending you in for an ultrasound of your arms." I was diagnosed with blood clots in both arms. Deep Veinous Thrombosis, 4 in the right arm (2nd line) 2 in right arm (1st PICC line), and one in my Jugular vein in my neck. This led to 5 days in the hospital on blood thinner IV's, pain medication, antibiotics), and a huge hospital bill. The docs and nurses that I dealt with told me that I was lucky to be alive. The ID doctor was in my room before I was ever admitted apologizing that "this happened to me".

My question is that if the ID doctor had actually ordered an ultrasound when the first arm swelled up, I could have avoided a life threatening situation, a hosptial stay, and continual pain and suffering. I would have just been put on blood thinners to dissolve the clots in my left arm...without all the additional tests, problems and BILLS!

Now, I am not contesting the treatment...I am contesting that the doc was negligent in not ordering tests on my 1st Picc line arm, and putting my life in danger by putting in the 2nd line.

Also, I am not looking for a large monetary settlement, but I also don't think I should have to pay for any services involved that resulted from his negligence.

Do I have a case?

[lya]

From what you posted, it appears that you are one of the unfortuante to whom this happens but there are areas in which care rendered may have been less than standard and usual. If I were consulting on this initial claim, I would encourage the attorney to at least take a closer look without committing too many funds.

You need to be able to determine whether or not proper procedure was used during the insertion. There are two types of PICC lines. One is done with visualization of the veins (brachial to subclavian, which usually shows jugular also). The other type is a shorter version of the line and is done 'at the bedside' without visualization. Which type did you have?

The next aspect that is of concern is maintenance of the lumens. Did the nurses use positive pressure clamping after flushing and did you learn to flush and clamp the lumen(s) with positive pressure? If not, there is your source of blood clots or at least the most likely cause of the blood clots.

I would expect more to have been done to evaluate the first PICC line site. If the site was hardened (endurated), swelled above the expected post-procedure reaction, and with pain above the level of post-procedure pain, I would expect a venous ultrasound to have been performed or a doppler study done. To simply measure and do nothing does not seem appropriate.

Now for the kicker--even if there are damages due to negligence, an award for damages will probably not even begin to pay for a medmal lawsuit. You may be able to recoup the additional expenses related to the treatment of the second and third blood clots. In doing so, you will most likely lose the option of continuing with the ID physician. It greatly hinders convincing others of a physician's wrong-doing while continuing to receive treatment from the physician--not to mention how the ID physician is going to feel about having you as a patient.

[thebaum1972]

Thank you for your thoughtful post and reply to my questions. I hope to clear up the questions that you asked about in your reply.

Both of my PICC lines were in inserted in the hospital, using ultrasound machines during the procedure to make sure placement was accurrate. Following both procedures an xray technician came in and did a chest xray, which was read to check proper insertion before I was allowed to leave the infusion center.

The VNA came to my house, and worked me through the IV procedure step by step. We covered clamping, and positive pressure. I flushed the Picc line with individually wrapped, sterlie saline solution shots both before and after the antibiotics were administered. Before each new item (solution or antibiotic) was put into the line, the insertion spot was cleaned with a sterlie alcohol wipe.

No "duty of care" was given by either the nurses, nor the Infectious Disease doctor to test the 1st Picc line arm. No ultrasound or doppler machine before I was sent to the infusion center for the 2nd line. Even though I was sobbing from the pain. Less than a week later, not trusting the ID doctor with my care anymore, I went to my General Practioner who was the one who diagnosed the blood clots. I have told the ID's office that I was no longer going to be a patient of their, and have received full copies of my medical records. Some of the information included in the records is false concerning my visits (my husband was present with me at my first consultation with the doctor), but not where the blood clots were concerned. They are accurrate in their notes about their lack of ordering the test that would have diagnosed the blood clot. Funny thing is that the day the nurses removed the first PICC line was "inadvertedly left out" of the first records I received. I went through them immediately, discovered the crucial missing day and contacted the office. Since I was still in the hospital, I was able to retain that record shortly thereafter.

I seriously don't need a major settlement. I just want the lawyer's bills paid, and my hospital bills taken care of that I would not have accured if it wasn't for his negligence.

[lya]

What antibiotic were you receiving through the PICC line? What was the size of the infusion bag (50 ml, 100ml, 250ml)?

Did you aspirate blood before you flushed with saline prior to the infusion of antibiotics?

Did you clamp the tubing while continuing to push the saline flush after the completion of the infusion?

I don't understand your term, "duty of care". Please explain.

Without reviewing your records, I cannot begin to determine why you were clotting so frequently. Generally, PICC lines that clot and occlude in such a short period of time are not being properly maintained, ie. not remaining clamped, not flushed sufficiently, or the solution is too concentrated for the patient's veins to tolerate.

I don't think you have a claim that will justify attorney expenses and complete reimbursement of hospital expenses. I encourage to you to think in terms of the minimum that you are willing to accept in settlement and to think outside the physician-error box. Failure to adequately educate, train, and evaluate the patient by the home care nurse may be the negligent act(s) instead of physician error.

(on a humerous note and changing names to protect the innocent, the other day while consulting on an initial complaint, I asked, "are you saying it was physician error?" The claimant answered, "no; it was Dr. Smith!)

[bamboozled]

Malpractice cases are contingency based. If the attorney wants you to sign that you will pay costs, run and look elsewhere.
My attorney was paid off by the OBGYN's attorney to blow my case (I got a letter, unsigned, by the OBGYN's attorney letterhead 4 years later).
Every "expert witness doctor" called me telling me "your attorney got paid off" and then he tried to bill me $800.00 for my endocrinologist time in the trial. I sent him a letter saying: Malpractice cases are contingency based. I never heard from him again.
I'd love to turn him into the BAR ASSOCIATION, but lawyers policing lawyers?
No justice there. I just let it go and have moved on....I really dislike attorneys. They would sell their mother's for a dollar.....

[barry1817]

Originally Posted by bamboozled

Malpractice cases are contingency based. If the attorney wants you to sign that you will pay costs, run and look elsewhere.
My attorney was paid off by the OBGYN's attorney to blow my case (I got a letter, unsigned, by the OBGYN's attorney letterhead 4 years later).
Every "expert witness doctor" called me telling me "your attorney got paid off" and then he tried to bill me $800.00 for my endocrinologist time in the trial. I sent him a letter saying: Malpractice cases are contingency based. I never heard from him again.
I'd love to turn him into the BAR ASSOCIATION, but lawyers policing lawyers?
No justice there. I just let it go and have moved on....I really dislike attorneys. They would sell their mother's for a dollar.....

Which is why there are so many lawyer jokes around and why they resonnate so well. Which leaves me with the lawyer joke that I liked best


How can you tell when a lawyer is well hung?

There is no room between the rope and the neck.

[bamboozled]

How can you tell a lawyer is lying?
His lips are moving....
I like your joke much better though!

[ecmst12]

Um....maybe it's a little tacky to tell bad lawyer jokes in a forum full of lawyers that you may even be looking for help from...

[bamboozled]

Originally Posted by ecmst12

Um....maybe it's a little tacky to tell bad lawyer jokes in a forum full of lawyers that you may even be looking for help from...

Plus, any attorney on this free website, is not too busy in the office. I do not get upset over blonde jokes....sense of humor is essential these days~

[JustAPal00]

My favorite:

What's the difference between a lawyer and a catfish???


Ones a low life bottom feeding scum sucker; the other's a fish.

[JustAPal00]

What do lawyers use for birth control???


Their personalities.

[tranquility]

The problem with lawyer jokes is that most lawyers don't think they are funny,
and most people don't understand that they're just jokes!

Lawyers are people who can write a 10,000-word document and call it a brief.

At the funeral of a lady was her doctor, a friend and her lawyer. Each had
promised her that at her funeral they would toss $1000 into her grave. The
doctor and friend each tossed in their $1000 cash, after which the lawyer
removed the cash and placed a check for $3000.

Definition of a lawyer: a man who helps you get what's coming to him.

Lawyers are the only profession where the more there are, the more are needed.

When asked, "What is a contigent fee?" a lawyer answered, "A contingent fee to a
lawyer means, if I don't win your suit, I get nothing. If I do win it, you get
nothing."

No artist ever interpreted nature as freely as a lawyer interprets the truth.

Between grand theft and a legal fee, there only stands a law degree.

Man goes goes to lawyer for help.
Man: What is your least expensive fee?
Lawyer: $50 for three questions.
Man: That's pretty expensive, isn't it?
Lawyer: Yes. So what's your third question

Two lawyers are walking on the beach. A lovely blond woman in a skimpy bikini
walks by. Lawyer #1 says, "Boy, wouldn't you like to screw her?" Lawyer #2
asks, "Out of what?"

[Proserpina]

Originally Posted by JustAPal00

What do lawyers use for birth control???


Their personalities.

Now that was funny!