Father in law slipped on ice and died

[baylor3217]

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

My father in law skipped on the ice in Monday severely injuring his ribs.

He went to the emergency room and they said he had cracked ribs and sent him home.

Last night his stomach was very distended and he started throwing up blood and drowned.

Is there any legal reason we should have an autopsy done? Seems he likely lost natured a king that was missed in the ER visit or otherwise hemorrhaged

Thoughts very much appreciated as we have to decide very soon.

 

[Zigner]

I'm sorry to hear about your family's loss.

Did your father-in-law follow up with his own physician, as (most likely) directed by the ER.

 

[quincy]

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

My father in law skipped on the ice in Monday severely injuring his ribs.

He went to the emergency room and they said he had cracked ribs and sent him home.

Last night his stomach was very distended and he started throwing up blood and drowned.

Is there any legal reason we should have an autopsy done? Seems he likely lost natured a king that was missed in the ER visit or otherwise hemorrhaged

Thoughts very much appreciated as we have to decide very soon.

If there is reason to doubt the cause of death listed, you would want to have an autopsy.

The ER might have determined your dad-in-law had cracked ribs but it was up to your dad-in-law to then seek treatment for the ribs.

Where was it that your dad-in-law slipped on ice?

You could be smart to consult with an attorney in your area for a personal review, this if only to resolve any questions you might have over his death.

Like Zigner, I am sorry to hear of your loss.



edit to add: Following is a link to an article from Medscape with an overview of the "Autopsy Request Process." You might find it helpful. Click on the NEXT links at the bottom to read all of the information provided. http://emedicine.medscape.com/article/1730552-overview

 

[baylor3217]

If there is reason to doubt the cause of death listed, you would want to have an autopsy.

The ER might have determined your dad-in-law had cracked ribs but it was up to your dad-in-law to then seek treatment for the ribs.

Where was it that your dad-in-law slipped on ice?

You could be smart to consult with an attorney in your area for a personal review, this if only to resolve any questions you might have over his death.

Like Zigner, I am sorry to hear of your loss.



edit to add: Following is a link to an article from Medscape with an overview of the "Autopsy Request Process." You might find it helpful. Click on the NEXT links at the bottom to read all of the information provided. http://emedicine.medscape.com/article/1730552-overview

Thanks for the thoughts. He was at home in the driveway.

 

[quincy]

Thanks for the thoughts. He was at home in the driveway.

Thank you for answering my earlier question, baylor3217. I wanted to make sure that there was no other negligence lawsuit that potentially could be considered, for failure to treat ice on a public walkway. Apparently not, though.

Whether an ER did enough to prevent a death is always a question that is asked when circumstances are as yours. Although the answer is usually "yes," it is sometimes reassuring for the survivors to have a personal review.

Again, I am sorry to hear of your dad-in-law's fall and subsequent death.

 

[baylor3217]

Thank you for answering my earlier question, baylor3217. I wanted to make sure that there was no other negligence lawsuit that potentially could be considered, for failure to treat ice on a public walkway. Apparently not, though.

Whether an ER did enough to prevent a death is always a question that is asked when circumstances are as yours. Although the answer is usually "yes," it is sometimes reassuring for the survivors to have a personal review.

Again, I am sorry to hear of your dad-in-law's fall and subsequent death.

Cause of death confirmed by autopsy - punctured spleen caused by the fall / broken ribs.

Why wouldn't the ER have looked for this and not sent him home??? Never even mentioned as a risk or anything remotely like a life or death situation.

His death seems totally preventable and yet they didn't even check for internal bleeding or suggest this would be an issue to his 65 year old wife.

 

[cbg]

My sympathies on your loss.

The ER's function is not to do a complete diagnosis and workup. The ER's function is to make sure you don't stop breathing.

Once the patient is stabilized, follow up care needs to be done by the regular physician. Did he do any follow up with his doctor?

 

[baylor3217]

My sympathies on your loss.

The ER's function is not to do a complete diagnosis and workup. The ER's function is to make sure you don't stop breathing.

Once the patient is stabilized, follow up care needs to be done by the regular physician. Did he do any follow up with his doctor?

That's fascinating. Just got more info from the autopsy. They only xray'd his left side at the ER and said he fractured 7-10. The autopsy concluded definitely that he fractured LEFT 3,4 and 5 AND RIGHT 3,4,5 AND 6.

They sent him home and suggested he take aspirin.

He had a "splenic rupture" 6.2cm long

He had a "splenic hematoma" 11x9x4.5cm

He had hemoperitoneum (blood in the thoracic cavity) in volume measured at 1050mL (almost 4.5 cups of blood where it shouldn't be)

He also had a blood clot in his spleen as a result of the trauma.

The formal discharge instructions given read, and I quote:

"DISCHARGE INSTRUCTION GIVEN:

Rib fracture"

And now he's dead.

None of this will bring him back but suffice it to say we will be talking to our lawyer stat about options, if any.

 

[quincy]

Your mother-in-law is probably smart to talk to a lawyer.

Rib fractures do not always show up on X-rays and most rib fractures are treated at home with rest, so I am not sure that the ER doctors missed something that they should have seen on their examination of your dad-in-law. Your dad-in-law may not have experienced any signs of internal bleeding and problems might not have developed until he got home. With the extent of the injuries suffered by your dad-in-law in his fall, however, it is possible the ER failed in their care and treatment of him.

And, it the discharge instructions ONLY said "rib fracture," and there were no warnings (symptoms to watch for) or a statement about the need for follow-up care with your dad-in-law's physician, that seems to have been a failure on the part of the hospital. Patients are generally not discharged without an explanation of their injuries and what they should look for that could indicate a more serious condition has developed.

Because falls often lead to serious complications for older adults, I am actually surprised the ER released your dad-in-law instead of admitting him to the hospital for at least an overnight observation.

But the lawyer your mom-in-law sees will be able to let her know better if the ER was negligent in their care and treatment.

 

[justalayman]

unless there was a displaced fractured rib, the spleen issue was not caused by the rib issue. It was presumably caused by the same fall though. Whether symptoms for a ruptured spleen were overlooked or the symptoms had not yet presented themselves is something that needs to be researched in the medical notes.

Internal injuries can be very difficult to diagnose. Internal bleeding may have no immediate or especially discernible symptoms or it may have been determined there were no injuries to the internal organs. Given you stated his fall was in Monday and he passed Thursday or so it is possible there were no particular symptoms of internal bleeding. It's possible the spleen wasn't injured at the time.

If the ribs displaced later due to activities during the week, that could be the cause of the spleen injury. If so, while possibly an issue with the treatment at the er, it may be there was nothing wrong
With their treatment but a lack of response at home to a new injury.

It appears the er misssed severely fractured ribs. Hopefully the X-rays will either confirm or
Deny that as it is possible he sustained additional injury after leaving the er.


While this may be an er error, there are other plausible explanations where the er would have no blame as well. a thorough examination of the medical records involved is neeeded to begin to evaluate the case.

The problem is that review may cost you a bit of money. Lawyers are not doctors so before they even consider taking on most cases of medical malpractice they must hire a medically trained person to read and review the medical records. That may be passed on to you.

 

[Insane Jane]

Sorry for your loss.
It's impossible to do more than guess over the internet from the info given. My guess is that he took a fall after leaving the ER, or at some point CPR was attempted on him.
Of course it is possible that the ER, doctors, and/or nurses hold some liability, but there isn't anyway to diagnose that from here.
My advice would be to take care of everything possible to help his wife to get through this tough time.
If cremation is chosen, then I would seek a lawyer at your soonest.
Again, sorry for your loss.

 

[justalayman]

Sorry for your loss.
It's impossible to do more than guess over the internet from the info given. My guess is that he took a fall after leaving the ER, or at some point CPR was attempted on him.
Of course it is possible that the ER, doctors, and/or nurses hold some liability, but there isn't anyway to diagnose that from here.
My advice would be to take care of everything possible to help his wife to get through this tough time.
If cremation is chosen, then I would seek a lawyer at your soonest.
Again, sorry for your loss.

That is a very good point about the cpr. In my training and through discussions with emt's and paramedics it is accepted as a good probability you will injure ribs of a person, especially an elderly person, when performing cpr. Given it had been less than a week since the initial injury, it may not be possible to differentiate a new injury from the original injury as there would be little to no healing of the ribs in that time.

 

[quincy]

That is a very good point about the cpr. In my training and through discussions with emt's and paramedics it is accepted as a good probability you will injure ribs of a person, especially an elderly person, when performing cpr. Given it had been less than a week since the initial injury, it may not be possible to differentiate a new injury from the original injury as there would be little to no healing of the ribs in that time.

The autopsy should have been able to distinguish old injuries from new injuries.

There was a study* done by the Association for the Advancement of Automotive Medicine that looked at rib fractures (as sustained in car crashes) and the visibility of these fractures on x-rays (compared to the number and location of fractures detected at autopsy). Less than 40% of the rib fractures were detected with an initial X-ray. This can lead to a delayed diagnosis of internal injuries, often up to 10 days after an injury.

It was noted in the study that "simple rib fractures are generally considered to be life threatening only when they occur in the elderly or persons with pre-existing pulmonary disease," with elderly generally being defined as those over age 70.

With the dad-in-law being in his 60s, there might not have been the concern shown in the ER that might have been shown an older victim of a fall.




* "Rib Fracture Patterns and Radiologic Detection - A Restraint-Based Comparison" by Jeff Crandall, Richard Kent, James Patrie, Jay Fertile and Peter ******

 

[justalayman]

The autopsy should have been able to distinguish old injuries from new injuries.

There was a study* done by the Association for the Advancement of Automotive Medicine that looked at rib fractures (as sustained in car crashes) and the visibility of these fractures on x-rays (compared to the number and location of fractures detected at autopsy). Less than 40% of the rib fractures were detected with an initial X-ray. This can lead to a delayed diagnosis of internal injuries, often up to 10 days after an injury.

It was noted in the study that "simple rib fractures are generally considered to be life threatening only when they occur in the elderly or persons with pre-existing pulmonary disease," with elderly generally being defined as those over age 70.

With the dad-in-law being in his 60s, there might not have been the concern shown in the ER that might have been shown an older victim of a fall.




* "Rib Fracture Patterns and Radiologic Detection - A Restraint-Based Comparison" by Jeff Crandall, Richard Kent, James Patrie, Jay Fertile and Peter ******

We're talking of Less than 4 full days difference in an older patient? I'm not sure there would be discernible differences, especially given the fact any healing that started would likely be disrupted by cpr, if performed.

Anyway, it wouldn't be a bad idea to investigate the op's avenues.

 

[quincy]

We're talking of Less than 4 full days difference in an older patient? I'm not sure there would be discernible differences, especially given the fact any healing that started would likely be disrupted by cpr, if performed.

Anyway, it wouldn't be a bad idea to investigate the op's avenues.

An autopsy should be able to tell new injuries from old injuries.

There are some legitimate questions raised by baylor3217 over the care and treatment of his father-in-law but it would take a personal review of all of the facts to determine if these questions that are raised can lead to a supportable-lawsuit answer.

What we don't know is what might have occurred during the period between release from hospital and death. If the dad-in-law complained of additional pain a day or two after release from the hospital and did not seek medical treatment right away, for example, that can absolve the emergency room of any fault.

At any rate, I think it is smart for baylor3217's mother-in-law to speak to an attorney, if for no other reason than reassurance that the death was not something they could have been prevented.