Sally Lucia was suffering from a massive infection, apparently from an earlier tummy-tuck surgery twenty days earlier. (She settled with the plastic surgeon before trial.) Lucia went to the emergency room already in septic shock, with her fingers and feet turning blue. On-call surgeon Dr. George Haedicke left his children, and arrived at the hospital to find Lucia’s infection so far advanced that her organs were shutting down; he cared for her for four and a half hours, and other doctors removed a grapefruit-sized infection from Lucia’s abdomen before transferring her to another hospital in critical condition. By this time, the tissue below her calves and in her fingers had died, and she needed amputations. A jury found Haedicke 20% responsible and his hospital 40% responsible, awarding $30 million in damages. But the jury found that Haedicke did not act with reckless disregard, immunizing him under Florida law protecting emergency doctors. Lucia, subject to appeal, will have to make do with $12 million from the hospital plus her earlier settlement. (Thomas W. Krause, “Patient Wins $30 Million”, Tampa Tribune, May 25; Justin George and Colleen Jenkins, “Amputee Wins $30 Million”, St. Petersburg Times, May 26; Colleen Jenkins, “Jurors hear from both sides in amputee trial”, St. Petersburg Times, May 10).
Press coverage is scanty on the critical question, but the Tampa Tribune Haedicke ordered “medicine that focused blood flow to the inner part of her body to protect her vital organs.” As a result, Lucia lost her legs and most of her hands, but her life was saved. Lucia’s attorney, Steve Yerrid (Oct. 5-6; Jan. 27), claims that Haedicke should have administered fluids before the medicine; Haedicke says that Lucia would have died if he had administered fluids first because her kidneys would have failed.
Now, I don’t know whether Haedicke or Yerrid is correct (though I have my suspicions). I’d be curious to hear what the medical bloggers think. But I don’t see how this should be a jury question. Either it was a reasonable exercise of medical judgment to try to save Lucia’s life without administering fluids first or it wasn’t, with the question of liability being a natural result of that answer—one of the two experts in the case is lying, and the expert and attorney who propounded that testimony did so without consequence.
Haedicke has left Tampa to practice in Tallahassee.
(Update: there has been some med-blogging over the Memorial Day weekend. Clinical Cases; Kevin MD.)
10 Comments
The more med-mal cases I read about, the more I’m convinced that we need some kind of impartial panel of experts to decide these cases.
Just love the lawyer quote:
“I keep saying, the clients I represent are never about the money,” he said. “They are all about the justice.”
Heh.
I read the press reports linked in your piece on the Lucia case in Tampa. Usual Disclaimer: Without the entire chart I can form no opinion on the quality of care in any case. Best Supposition: It appears that the emergency doctor was faced with a decision on using rapid infusion of IV fluids, the use of Levophed medication, or a combination of both. He appears to have chosen Levophed. This drug will constrict arteries to the limbs and redirect blood to the central organs. Restricting blood to the limbs may result in lack of oxygen to the point of the tissue getting gangrene. For a patient in septic shock (as was Mrs. Lucia) massive fluids may help reverse that situation BUT if central organs are damaged (and it appears the surgeon felt that was the case) then the fluid treatment may put the patient into heart failure and pulmonary edema. She could have died from that. The surgeon could have opted for using the combination but this could have led to the worst situation of all, i.e. loss of limbs and pulmonary edema both. Then he could have saved her life and turned her into another Terri Schiavo.
This was one of those situations where the doc on the scene has to make gut wrenching decisions in a matter of minutes while knowing that lawyers are going to spend months going over those decisions and with 20/20 hindsight point out to him what he actually should have done.
You know, infections happen. Did someone do her original surgery in a negligent manner? We do not have much information on this. What we see from the news reports is that a woman had a horrible outcome but we still do not know if actual negligence was involved.
I also read one of the news reports where the plaintiff attorney threw out to the gullible reporter that for ALL his clients it is, “never about the money.” LOL.
Actually there is little truth in either of the statements that are provided. The patient came into the ER in vascular collaspe (shock). With sepsis, there is a disproportiate dispersal in blood throughout the body. There is often severe dehydration and renal failure as well. It sounds like the physician ordered a pressor agent to improve the blood pressure and stimulate flow of blood to the kidneys. The pressor agent would exacerbate the problem with the fact that peripheral arteries were clamping down in the limbs to try an shunt blood to the core of the body. But the physicians job is not to worry about the limbs, it is to protect the brain, heart, liver and kidneys. Now if the blood pressure was low as a consequence of dehydration, then administration of fluids would not have caused the exacerbation of the clamping effect of the peripheral vessels. The fluid would help to improve the blood pressure and act as a driving mechanism for the kidneys.
Why did’t the physician administer fluids first? He might not know any better. But he may have been scared of a law suit or being critized by his fellow physicians (QA process). He did not know the nature of the patients cardiac condition if any and some physicians wrongly feel that giving fluids to a failing heart is wrong. If he did an overt action of this nature, it would cause him to be open to suit or critizem if something were to go wrong. He felt the lessor of two evils would be the pressor agent. But he was wrong in his assessment. I could provide a better analysis of this with more space but suffice it to say that this is a common paradox that doctors face trying to balance out the needs of the patient, the possibility of professional censure, the possibility of suit and their own ignorance or lack of judgement.
“I keep saying, the clients I represent are never about the money,” he said. “They are all about the justice.”
You can keep saying that, but how many times do you have to say something before it becomes true?
“I keep saying, the clients I represent are never about the money,” he said. “They are all about the justice.”
And if it were TRUE, you wouldn’t have to keep saying it!
“Haedicke has left Tampa to practice in Tallahassee.”
Of course he did. And in a few more years, the politicians and lawyers (redudancy alert) will wonder where all the doctors went…
From the article:
“Lucia’s attorney, Steve Yerrid, said he will ask the judge and possibly an appeals court to force the doctor to pay his share of the damages even though he did not act in reckless disregard.”
I thought it wasn’t about the money, mr. plaintiff’s attorney.
The surgeon was wrong. Extra fluids are essential in the early treatment of septic shock, and the fluids would have helped to prevent kidney failure. I have never heard of a case where fluids were restricted and vasoconstrictive drugs were administered in high enough doses to result in total limb ischemia. Other commenters note the risk of congestive heart failure or pulmonary edema with fluid therapy, but that would not be a major concern in a patient with no history of heart problems.
I fully support physicians who go out of their way to save lives, but they still have to have an ounce or two of medical sense.
The comments from Dr. Bondurant and Mr. Caskey were very interesting. Thanks guys.
The patient had a bad outcome from surgery. It used to happen a lot. Athough the risks from surgery have been markedly reduced over the years, opening up the body cavity still is a non-trivial matter, and one would expect some monitoring of a patient after a surgery. So, how did her condition get so bad – “a grapefruit-sized infection “?
Sorry, just found the question. Plastic surgery of this nature is often associated with as excess of bleeding. The large mass was likely a hematoma (collection of blood). This is usually taken care of with expectant waiting as if you touch it the chance of infection goes way up. The fact that the patient did not have to seek medical attention till 21 days post surgery would go with a scenero in which the hematoma was present, being observed, became infected either from local cellulitis or random blood borne bacteria. This sets in place a series of dominos that results in her overwhelming sepsis. There is a fair chance the plastic surgeon did nothing wrong. But it is easier for them to settle than to put up with the time and expense of trial.