Was this malpractice?

Factual Questions
1

Just a few days ago I went into the ER because I was had a chest cold and was having trouble breathing. Although I was probably fine, since I have a muscular disorder similar to muscular dystrophy which affects my lung strength, it’s always good to be careful when I feel I’m starting to be overwhelmed. At the ER they took a chest x-ray and took a blood test. X-ray showed a possible pneumonia developing, and the blood test was fine. They suggested I stay for 24 hours of observation, and I agreed. This is when things went downhill.

I was moved up to a hospital bed and they started an IV with antibiotics. After about four hours of no observation, a nurse took my blood pressure and noticed it was dropping pretty low, probably due to exhaustion and dehydration from sweating from a fever. The RN ordered a “bolus” of fluids to raise my blood pressure, and it worked. A few hours later, they took another blood test, and my electrolytes were very out of whack and I had some metabolic acidosis (sp?). A doctor we spoke to came to the conclusion that the bolus was too much for my small body size and unusually low muscle mass, and it sent my electrolytes out of balance. The RN denies this, saying that I must have come in with a bad stomach virus. If that’s the case, why was my blood test OK when taken in the ER before the fluids were given to me just a few hours ago? This is issue number one.

I was then moved to ICU where some actual competent doctors took care of me balanced out my electrolytes. About 24 hours later, they did a blood test and saw that everything looked normal, and the acidosis was gone. I was then moved back out of the ICU to my original bed for one more night of observation. During the night, a nurse gave me an IV of more sodium chloride while I was asleep. The problem is, there was no order. I should have been off the IV completely. For 12 hours I received fluids that weren’t ordered. In the morning they did another test and saw that my electrolytes were again beginning to tip over. Fortunately I (not the people taking care of me) caught the mistake before more damage could be done. It didn’t kill me, but a mistake like that could have been fatal. This is issue two.

Do you think I have a case of malpractice?

2

Don’t think so, afaik with malpractice cases, no harm no foul. You’re not dead, you’re not maimed. If you think that there were serious medical errors though, you could report them to the hospital’s patient relations department or I think there are other agencies that could take your complaint and look into it.

3

No. Electrolytes can change for many reasons. They can change in a matter of minutes.
The RN didn’t “order a bolus,” she either had standing orders or the doctor gave her orders over the phone. They shouldn’t have been talking over your bed, since its obvious you weren’t getting the entire story. In that, they were unprofessional, but it doesn’t constitute malpractice.
The most likely reason to see a developing acidemia, in light of your underlying disease, is hypo-ventilation combined with dilution. It can appear to be metabolic. Hypovolemic shock is life threatening. Giving you fluids for your falling blood pressure was the standard treatment.
The decision to move you to the ICU was correct and routine for the situation.
(And yes, you spelled acidosis correctly, but the more current and descriptive term is acidemia) :slight_smile:
As far as the extra 12 hours of fluids , unless you have significant renal disease, that you didn’t mention, it wasn’t life threatening. Yes, extra Normal Saline*might * cause potassium levels to slip a bit, but life threatening? Unless she was changing liter bags of fluid every couple hours, giving you liters of extra fluid, you were in no particular danger. You just had to pee a little more than usual. It was a mistake, but you weren’t injured by it. I’m pretty sure you have to be able to show injury to claim malpractice.
Were they doing arterial blood gases to determine these electrolyte and acidemia issues? That would be a painful stick with the needle perpendicular to your wrist, with the blood filling the syringe with bright red blood without anyone pulling on the plunger. Normal blood draws the needle is at a 25ûto 45ûangle, and the blood is dark red. I wonder only since, they are different tests.
It sounds like they didn’t communicate with you very well, and it made you angry.

4

This answer only pertains to NY, as that is where I practice.

While you may technically have a malpractice case, you’d be hard-pressed to find an attorney who would take it. That’s because in NY, the doctor’s lobby has severely restricted the value of malpractice cases to attorneys. Normally, NY attorneys are entitled to 33% of the recovery as legal fees. (Some states, like CA and FL, have 40%!) Due to the doctor’s lobby, in a malpractice case, that percentage gets smaller and smaller as the value of the case gets larger, until it comes to 10% for anything over $1 million or so (I haven’t checked the chart in awhile).

Additionally, it is also expensive to bring a malpractice case, as you would have to pay for two expert witnesses to testify on your behalf - the doctor who corrected the negligent treatment, and another doctor to state that the treatment was malpractice. This is expensive.

It is also expensive because the insurance companies take a particularly hard line in malpractice cases and do not settle them. So, if a lawyer takes a malpractice case, he has to be prepared to lay out at least $25,000 in fees until the case gets to trial.

On top of this is the fact that juries do not like to hold doctors liable for their malpractice. Here in NY, to bring a malpractice lawsuit, there is a gatekeeping function. You can’t just sue because you think there was malpractice - you must run the scenario by a doctor who will state that malpractice occurred (this doesn’t have to be the same doctor you use at trial). Even with that review, showing that malpractice cases that end up being brought and tried do have merit, almost two-thirds of malpractice cases where an infant is not involved result in a verdict in favor of the doctor. (Cases involving babies go 50/50.) So, almost 2 out of 3 times, the $25,000 spent is all for naught.

As one of the other posters said, “no harm, no foul.” Since you recovered, there isn’t much value to your case, and in reality, no malpractice case to be brought.

5

If your blood pressure was dropping in the ER, you likely did require a bolus of fluid. Unfortunately, there is no magic formula to say exactly how much you should get. While it is mildly frustrating that you received more fluid than ordered, I really don’t think you have a malpractice case here. No harm done, and getting the fluid right with your pre-existing acidosis can be complicated. When you left the hospital, you were breathing okay and presumably had reasonable electrolytes. Get over it.

6

Paralegal-to-be (with some ambulance chasing experience already) checking in.

No.

7

No matter how badly a hospital, physician, or other medical provider diagnoses , treats or manages a patient, unless damage is caused by such acts, there is no malpractice.

I appreciate the concern of the OP but this is the very thing that forces us to practice defensive medicine.

The situation must run smoothly from beginning to end or the question appears from Monday am quarterbacking: Did they commit malpractice? Who do you suggest I see? and How much money do you think I can wind up with?