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Medical Malpractice: Wrongful death
Kaiser: Wrongful death, rhabdomyolysis, renal failure, dehydration, hyperkalemia, arrhythmia and death
| Disposition:
(Settlement/Arbitration/Trial) |
Arbitration |
Date: |
3/7/2003 |
Type of Case: |
Medical Malpractice |
Allegation(s): |
Wrongful death, failure to diagnose, dehydration |
Result: |
$913,852 + $25,338 (costs) + $27,091 (interest) |
Case Name: |
Paul Adkins and Katie Adkins v. Kaiser Foundation Hospitals |
Facts: |
Claimants' decedent, Susan Adkins, died at the age of 49, on January 17, 2001, survived by her husband of 22 years, Paul Adkins, as well as her daughter, Katie. She was an active woman, employed as a social worker with children from domestic violence situations. She was in an intern program with a goal of becoming a certified marriage counselor. She had been in excellent overall health the majority of her life.
On January 10, 2001, Mrs. Adkins called Kaiser's triage center, complaining of fever and chills. She was advised to drink plenty of fluids, rest and take analgesics.
On January 13, 2001, Physician's Assistant Burns was working back-to-back shifts at the Kaiser Urgent Care Clinic. Of significance during the second shift is the fact that the staff, including Ms. Burns and the other physicians, could "go home" as soon as the last patient had been released.
After continuing to feel ill, Mrs. Adkins came to the Urgent Care Clinic on Saturday, January 13th, with her husband. After taking the history, an initial set of postural vital signs were taken with Mrs. Adkins laying down, sitting down and standing up. These were grossly abnormal. According to Mr. Adkins, they had significant difficulty taking her blood pressure and actually had to get a computerized device to take it. These postural blood pressures were "positive" in that they showed significant changes depending on Mrs. Adkins' position. After taking this history and doing her physical examination, P.A. Burns' diagnosis was dehydration and gastroenteritis.
P.A. Burns ordered that Mrs. Adkins receive IV fluids. Even in the middle of flu season, it is extremely rare that someone is ill enough and dehydrated enough to require IV fluids in the Urgent Care setting. After the IV fluids, P.A. Burns indicates that it would have been her standard practice to re-check Mrs. Adkins' vital signs looking for evidence of improvement. However, the records demonstrate unequivocally that this was not done. A second set of orthostatic vital signs was ordered by P.A. Burns and was completed at 2055, 35 minutes before the IV fluids were administered. These vital signs were again abnormal.
P.A. Burns did not re-assess Mrs. Adkins before making a determination that any other treatment needed to be undertaken. According to Mr. Adkins, his wife was the last patient in the facility and they were "hurried out." This, despite the fact that Mrs. Adkins was so ill she had to be transported from the facility to their car in a wheelchair.
Mr. and Mrs. Adkins went to bed the following evening on the 14th at approximately 9 p.m. At approximately midnight, he had to help her out of bed to use the bathroom. She had a syncopal episode, passed out and he grabbed her to keep her from falling. At that time, she complained that she was having difficulty moving her feet and legs. He called 911, and the paramedics arrived. She was taken to the Kaiser Emergency Room where she arrived just before 2 a.m. on January 15th. She was hypothermic, i.e., she had a temperature of 91.8. Initial lab works drawn were grossly abnormal.
The decedent was assessed has having dehydration, hyponatremia, hyperkalemia, acidosis and hypothermia with a potential cause being rhabdomyolysis (a condition that causes muscle tissue to break down at a cellular level, causing the release of potentially toxic substances into the bloodstream including myoglobin). It has a variety of etiologies, including a viral infection caused by the flu. It is also a "time-sensitive" illness, where the patient's prognosis is dependent upon the timing of diagnosis and the rapid institution of appropriate therapy. A delay of 24 hours can make a significant difference in the patient's prognosis.
Rhabdomyolysis and myoglobinuria (the release of myoglobin into the bloodstream) can lead to metabolic instability and acute renal failure. Of patients who are diagnosed with rhabdomyolysis, the statistical incidence of survival is 95%+. The key to treatment, and therefore, prognosis, of rhabdomyolysis is rapid and substantial hydration/volume replacement which is used to "flush" the toxic substances such as myoglobin out of the kidneys allowing them to continue their normal function.
Mrs. Adkins was admitted directly to the ICU through the ER. Hydration was administered and she had four hours of dialysis the afternoon of the 16th which improved many of her lab findings. Unfortunately, by that time, Mrs. Adkins' renal failure was irreversible. Her condition continued to worsen and by January 17th she was too unstable to even consider additional dialysis. She died at approximately 8:30 p.m. on January 17, 2001. The listed cause of death was rhabdomyolysis, leading to acute renal failure, leading to hyperkalemia (excessive potassium), leading to arrhythmia and death.
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| Injury/Injuries: |
Wrongful death of wife and mother. Claimants made a claim for general damages in the amount of $250,000. With respect to special damages, claimants' economist estimated a present value for the loss of earnings, and loss of household services less personal consumption, at $711,785.00
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| Contentions: |
Claimants contended that Kaiser's failure to properly examine and test Mrs. Adkins on January 13, 2001, as well as a series of violations of Kaiser's own protocols, resulted in her condition exacerbating and deteriorating to the point that she experienced renal and cardiac failure, causing her death. Not having received the necessary treatment to clear the toxins from her system on January 13th, they continued to build, adversely affecting her kidney function, and causing her overall condition to deteriorate to the point that she would not tolerate the aggressive treatment which would have been required to save her life upon admission to the ICU.
Kaiser contended that regardless of what was done on January 13, 2001, decedent's underlying viral infection caused her death.
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| Special Notes: |
Claimants' initial settlement demand was for $895,000. Prior to the arbitration hearing, Claimants served a Statutory Offer to Compromise in the amount of $500,000.00, which was rejected.
On the Friday before the Monday arbitration hearing, Kaiser advised claimants that it had decided to admit to liability. The remaining issues of causation and damages were arbitrated on March 3, 4 and 5, 2003.
On March 7, 2003, Judge Midlam issued his award in favor of claimants for $913,852.00. Pursuant to the provisions of C.C.P. sections 998 and 1033.5, claimants served their Memorandum of Costs, in the amount of $26,150.49. Kaiser filed a Motion to Tax Costs which was heard on May 8, 2003, and resulted in an award of costs to claimants of $25,337.99. In addition, claimants were awarded interest on the total judgment at 10% per annum from February 18, 2003 to the date of payment, June 20, 2003, for an additional award of $27,090.58, bringing the total amount recovered by claimants to $966,280.57.
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