 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
Clark v. HCA8/25/2005
linical suspicion is of paramount importance in evaluating the hand or wrist for an evolving compartment syndrome. A detailed history coupled with a thorough physical examination form the basis for the diagnosis. The use of techniques to measure compartment pressures forms the objective foundation to assist in formulating the correct treatment plan... great fault can be assigned to the clinician who chooses to ignore an evolving compartment syndrome that unnecessarily places the patient at risk of permanent disability. Here, the cosmetic benefit of avoiding the fasciotomy is overwhelmed by the often-devastating dysfunction created by ischemic damage to the contents of the affected compartments...'
Ortiz JA, Berger RA. Compartment syndrome of the hand and wrist. Hand Clin 1998;14(3):405-18
The creatinine clearance (on 5/8/03) in this case can be calculated in several ways (patient age 79, serum creatinine 1.5 mg/dL, weight 55.3 kg, height 172 cm, and BSA 1.65m2
1. Using the Cockcroft and Gault equation (Nephron 1976;16(1):31-41): 26.4 ml/min
2. Sanaka
CAUSAL RELATIONSHIP BETWEEN FAILURE TO MEET STANDARD OF CARE AND INJURY, HARM, OR DAMAGES CLAIMED
As of the date of this report, and my review of the above described records, it is my opinion that Del Sol Rehabilitation Hospital, Robert Moreno, M.D. and Mariano Palacios, M.D. failed to meet the above described standards of care by failing to properly assess, monitor and timely treat the complications which developed as a result of the improper use of Lovenox. By failing to meet the standard of care, based on a reasonable medical probability, the development of the acute, compartment syndrome created the 'devastating dysfunction created by ischemic damage' causing the complete loss of use of Lela Clark's right arm.
Standard of Care
"Identifying the standard of care is critical: Whether a defendant breached his or her duty to a patient cannot be determined absent specific information about what the defendant should have done differently." Palacios, 46 S.W.3d at 880. Dr. Pacheco's report quoted several sources that all inpatients should be screened and considered for venous thromboembolism prophylaxis based on a risk factor assessment. If pharmacologic prophylaxis is indicated, Lovenox (enoxaparin) should be given unless other exclusion criteria apply. He then referenced five articles in which compartment syndrome was discussed. At no point did he indicate that he was personally familiar with the standard of care or that the authors of the various articles had sufficient expertise.
Breach of the Standard of Care
Dr. Pacheco opined that the standard of care was breached by Dr. Moreno, Dr. Palacios, and Del Sol since they failed to properly assess, monitor, and timely treat the complications which developed as a result of the improper use of Lovenox. A physician verbally ordered administration of 66 mg of Lovenox twice daily, and Clark's home medications for hypertension were also continued. Dr. Pacheco did not specify which physician ordered the administration of the Lovenox. He did note that Dr. Porras continued the Lovenox even after Clark was transferred from Appellees' care. Clark arguably met the exclusion criteria for use of Lovenox since she was 79 and suffered from congestive heart failure, hypertension, and renal disease. But Dr. Pacheco did not state that the defendants failed to properly recognize the risk factors for venous thromboembolism or the exclusion criteria for use of Lovenox. He did not address whether Lovenox was administered due to an indication of pharmacologic prophylaxis for venous thromboembolism. He didn't even sa
Page 1 2 3 4 5 6 7 Texas Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|