Death due to Pulmonary Embolism,DVT,Broken Ankle

[MattJH]

What is the name of your state?What is the name of your state? I live in Florida, Death occurred in California.
My brother passed away suddenly a few weeks ago at the age of 57 just over 2 months after breaking his ankle. The ankle was set with pins and a cast during an outpatient surgery. Post op instructions were to elevate and medicate with Vicodin for pain.
While I am still looking into the details, there appears to be no preventative measures taken to prevent the formation of blood clots during the recovery period. No physical therapy or blood thinners even though he was obese and was not mobile during this period. A walking cast was put on and still no therapy prescribed. He felt ill enough to go to the doctor and was discovered to have a clot in each lung and in the leg and received treatment with blood thinners in the ER while waiting for an ICU bed. (none became available) He died in the ER. Causes listed on the death certificate were those in the title to this thread. My concern is that this could have been prevented since there is a high risk of developing clots from this type of injury/operation. Considering associated risk factors (age,obesity etc.), proper monitoring and treatment could have averted his death. Is there a justifiable malpractice case in this? Or is this considered an unforseeable natural complication of the injury?

 

[reviewphysician]

What is the name of your state?What is the name of your state? I live in Florida, Death occurred in California.
My brother passed away suddenly a few weeks ago at the age of 57 just over 2 months after breaking his ankle. The ankle was set with pins and a cast during an outpatient surgery. Post op instructions were to elevate and medicate with Vicodin for pain.
While I am still looking into the details, there appears to be no preventative measures taken to prevent the formation of blood clots during the recovery period. No physical therapy or blood thinners even though he was obese and was not mobile during this period. A walking cast was put on and still no therapy prescribed. He felt ill enough to go to the doctor and was discovered to have a clot in each lung and in the leg and received treatment with blood thinners in the ER while waiting for an ICU bed. (none became available) He died in the ER. Causes listed on the death certificate were those in the title to this thread. My concern is that this could have been prevented since there is a high risk of developing clots from this type of injury/operation. Considering associated risk factors (age,obesity etc.), proper monitoring and treatment could have averted his death. Is there a justifiable malpractice case in this? Or is this considered an unforseeable natural complication of the injury?

You just might have a good case if everything you said here is the gospel truth. Your first step is to contact a medical reviewer to have the medical file reviewed. because patients and their relations often miss a lot of the medical details that will determine the merit of their case

....Be relentlessly positive ,focusing whenever possible on successes not failures, that’s how you get somewhere in life

 

[ellencee]

Oh for Pete's sake! It is not routine, usual, or standard care to treat an ambulatory patient (note the walking cast in the original description of events) with anticoagluant therapy after a fracture of an ankle or of just about any other bone (hip excluded).

The poster is certainly entitled to speak with a medical malpractice attorney in California but it is a very weak claim at best.

The patient had the option of getting up and walking on the ankle. Certainly no one instructed the patient to sit around for a month with a walking cast, elevated or not.

I don't know what kind of physical therapy the poster believes is indicated for a casted ankle. Range of motion certainly can not be improved and that would be the goal of any physical therapy.

When the patient became ill, he sought and received proper medical treatment. The death is unfortunate but the claim is not meritorious.

EC

 

[MattJH]

Thank you both for your replies. It seems you each answered both sides of the issue: "possible claim if facts support lack of proper treatment" or "tough luck, you take your chances with the common accepted practice"
There are many references to this type of problem for example take a look at this link:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12776981&dopt=Abstract
The patient was only in the walking cast for less than two weeks.
"The patient had the option of getting up and walking on the ankle. Certainly no one instructed the patient to sit around for a month with a walking cast, elevated or not"
That's the point, there were no instructions. I'm a rocket scientist not a doctor, and in our business when you have knowledge of the risks, you mitigate those risks with preventive measures as best as possible. My brother certainly was not made aware of the risks and preventive measures that might be taken. The physical therapy I was alluding to, referred to post cast removal to improve circulatory function. If the "standard care" does not include anticoagulants or instructions to "get up and walk to prevent clots" and there is an "X%" death rate associated with this type of injury/surgery and that is deemed "unfortunate" but acceptable by the medical community,then it's time to reassess the treatment process.

 

[ellencee]

Well, Matt, physicians have been treating ankle fractures for thousands of years and as yet there has been no reason to routinely treat the patient with anticoagulant therapy, which has its own risks including some really serious potential complications.

You stated the lack of physical therapy contributed to the outcome but now that you have been given information contrary to what you would like to hear, suddenly you have changed your story to therapy after the cast was removed; therefore as it concerns your claim of malpractice resulting in the death of your brother, the issue of physical therapy is moot.

Giving you credit for being the scientist you say you are, you are very familiar with incorporating relative facts into scientific reasoning. It should, therefore, be prudently clear that by receiving a walking cast your brother knew he was supposed to WALK.

I guarantee you that the medical records include documentation of discharge instructions and documentation that your brother received a copy of the instructions and was witnessed giving his verbal understanding of the instructions.

I am sure you are devastated by your brother's death, but the medical providers are not to blame.

Consult with a medical malpractice attorney and if one is interested in your claim, let the attorney investigate the records but be prepared to pay for a medical expert's opinion and be prepared to hear yet another answer that you do not like.

 

[Honey1955]

Have the records reviewed. That is the only way to receive a true opinion because there are so many little things in the records that can make a big difference in whether the case has merit or not.

 

[panzertanker]

Have the records reviewed. That is the only way to receive a true opinion because there are so many little things in the records that can make a big difference in whether the case has merit or not.

Honey, This question was asked and answered 6 days ago!!!
Ellen did a very articulate job, and stated THE EXACT SAME THING YOU DID!!!
Have the records reviewed.

Was your 2 cents worth REALLY necessary???

BTW ellen;
I had to cast a non-displaced spiral fx of the distal fibula friday... wonder if I need to start coumadin therapy???

 

[MattJH]

panzertanker,
Did you evaluate the patient's risk factors? Probably not, as ellen says "physicians have been treating ankle fractures for thousands of years..."
Well let's see, here's a fact for you: "nationwide, complications from deep-vein thrombosis (DVT) kill more people than from breast cancer, AIDS and highway fatalities combined." (about 200.000) By the way March was DVT awareness month but I doubt either of you were aware of that fact. Your trivialization of this issue is appalling for supposed "professionals". And it is a fact that there are enlightened physicians who do recommend prophylaxis anticoagulants in low doses when risk factors are considered to be significant.
And yes ellen I do have a copy of the discharge instructions, they are pretty useless to say the least, since they are not complete. I had also talked to my brother 4 days before he died and he was not instructed as to a walking regimen as you imply, though he did try to walk, being obese it was difficult and he was fearful of re-injury. Now one would think assisted therapy might be appropriate at this point for someone of his stature...........

Now, this question was answered 9 days ago as you stated, but I think Honey1955 is entitled to her 2 cents without getting stomped on, but then you would have missed your chance at 2 cents worth of a dig with that
" .... wonder if I need to start coumadin therapy???" comment.

 

[rmet4nzkx]

And the risks are even higher of adverse or interactions with anticoagulant therapy.

I know of a fit young man, a police officer, a runner, with low body fat and low risks. He presented with vague pain and was Rx PT and he died suddenly while watching TV of DVT.

 

[panzertanker]

panzertanker,
Did you evaluate the patient's risk factors? Probably not, as ellen says "physicians have been treating ankle fractures for thousands of years..."
Well let's see, here's a fact for you: "nationwide, complications from deep-vein thrombosis (DVT) kill more people than from breast cancer, AIDS and highway fatalities combined." (about 200.000) By the way March was DVT awareness month but I doubt either of you were aware of that fact. Your trivialization of this issue is appalling for supposed "professionals". And it is a fact that there are enlightened physicians who do recommend prophylaxis anticoagulants in low doses when risk factors are considered to be significant.
And yes ellen I do have a copy of the discharge instructions, they are pretty useless to say the least, since they are not complete. I had also talked to my brother 4 days before he died and he was not instructed as to a walking regimen as you imply, though he did try to walk, being obese it was difficult and he was fearful of re-injury. Now one would think assisted therapy might be appropriate at this point for someone of his stature...........

Now, this question was answered 9 days ago as you stated, but I think Honey1955 is entitled to her 2 cents without getting stomped on, but then you would have missed your chance at 2 cents worth of a dig with that
" .... wonder if I need to start coumadin therapy???" comment.

You stated that he had a "walking cast" on. Don't you think it was put on for a reason? You state he was fearful of reinjury; was he told to walk and he decided to be non-compliant?
If he was obese and unable to walk well/at all, why did you/he not seek follow up care to clarify or change his current regimine of 'elevation and vicodin '?
I DO evaluate my pt's risk factors. Where did you see me write that I do not???
I in no way trivialized the situation. You had not returned to answer anymore questions or to give us more info; therefore I told honey that there was no need to revive a 'dead' thread (no pun intended).

"nationwide, complications from deep-vein thrombosis (DVT) kill more people than from breast cancer, AIDS and highway fatalities combined." (about 200.000)

And exactly where did you cite that from?
Yes, more people die from DVT than from AIDS and breast CA combined. Did you decide to throw in Highway fatalities for fun?
http://www.preventdvt.org/
There is the TRUE link to DVT info.

Who is at Risk for Deep-Vein Thrombosis?
Certain individuals may be at increased risk for developing DVT, although DVT can occur in almost anyone. Some risk factors or triggering events to discuss with your doctor include:

Cancer
Certain heart or respiratory diseases
Prior DVT
Advanced age
Acute medical illness with restricted mobility
Inherited or acquired predisposition to clotting
Obesity
Stroke
Hospitalization
Patients undergoing major surgery, such as joint replacements, who remain immobile in bed after an operation
Pregnancy
Restricted mobility caused by long-distance travel
Use of birth control pills
Postmenopausal hormone replacement therapy
Trauma

Do you see "broken ankle"?
A reasonable assessment of care post-op for an internally set fx ankle is elevation, rest, pain meds and PT when able. The walking cast was placed so he could do just that. Are you saying that they put him in it and then said "go back home and sit on the couch with the leg up and continue with Vicodin"?

It appears there is more to this than you have given us. NOW you tell us that the d/c summary was incomplete. How so?

Don't throw out accusations without firsthand knowledge. I, and others, are trying to help. If you do not like the anwers you receive then you should not be asking the questions...

 

[ellencee]

pz
Switch to recognition of the grief process...anger, seeking to blame someone. Someday this poster will realize that his brother brought about his own lifestyle and made his own choices in how to recover from the broken ankle and is ultimately responsible for the outcome--if the poster is of sound mental health, he will stop seeking to blame others.

I'm gonna pass the bull's-eye suit back to you and run for cover!


EC

 

[hopalong]

Calluses

I was reading this to learn about my own leg. I believe that I had this condition DVT as I had a cast that was on too tight. I am 53 broke ankle and had to pay for my own recasting, as the insurance wouldn't. I had the symptoms for DVT and nobody wanted to or realized what I was talking about. Just the usual go home elevate and rest, burning muscles behind the knee,,,,hmmm, don't know why.
I am sorry for your lose of your brother and I hope that the others here are able to find some remedy for their calluses! It sounds like the calluses are very deep also.

 

[Antigone*]

I was reading this to learn about my own leg. I believe that I had this condition DVT as I had a cast that was on too tight. I am 53 broke ankle and had to pay for my own recasting, as the insurance wouldn't. I had the symptoms for DVT and nobody wanted to or realized what I was talking about. Just the usual go home elevate and rest, burning muscles behind the knee,,,,hmmm, don't know why.
I am sorry for your lose of your brother and I hope that the others here are able to find some remedy for their calluses! It sounds like the calluses are very deep also.

This thread is 6 years old. Please do not necropst.