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4 Cases That Exemplify Our Work

On Behalf of | Jan 23, 2023 | Firm News

At McKeen & Associates, P.C., we take on challenging cases that require an expert level of understanding of the medicine at issue. We do this to ensure the maximum amount of compensation for our clients who have suffered from medical negligence. Below are some of our more recent successes.

A Misdiagnosis That Led To Death

McKeen & Associates lawyers Brian McKeen and Kenneth Lee recently achieved a $1 million settlement in a case involving the tragic death of a 48-year-old man. The decedent had a condition known as factor VIII (8) deficiency or classic hemophilia. This is a serious genetic disorder that is caused by missing or defective clotting proteins. This condition prevents blood from clotting normally, leaving patients with hemophilia A at risk of severe bleeding.

The recent case involved the plaintiff being rushed to the hospital after having vomited blood while eating dinner that evening. After being initially evaluated in the ER, the ER doctor placed an order for the plaintiff to receive Factor VIII. However, the hospital did not have any Factor VIII, so the plaintiff was administered 4000 units IV of an anti-inhibitor coagulant called FEIBA.

The following morning, the patient underwent a hematology consultation. The doctor negligently stated that factor VIII replacement was not required at the time, despite noting that repeat bloodwork revealed the patient’s hemoglobin decreased from 11.8 to 9.4, his blood pressure was only 77/47, and that he had multiple episodes of bright red blood in his stool. Subsequently, a gastroenterologist (GI), evaluated the patient and determined he was likely suffering from an upper GI bleed, but only recommended monitoring the hemoglobin and hematocrit without taking urgent action.

After diagnostic testing revealed that the plaintiff was continuing to bleed internally, the GI improperly decided to perform an upper GI endoscopic examination. This procedure was continued without communicating with the hematologist to ensure that the patient was optimized for a surgical procedure. That evening, when the GI began the procedure, a lesion was found which was improperly identified as a Mallory-Weiss tear and the GI opted to inject the lesion with epinephrine. After the injection, the plaintiff suffered a massive hemorrhage which led to a cardiopulmonary arrest, causing severe damage to the brain and heart. Tragically, the patient died on the operating table.

During the case, the defense argued that the plaintiff had an anatomical abnormality in his esophagus which began to bleed on its own, and that the bleed had nothing to do with the underlying condition of hemophilia. The defense further argued that due to this alleged anatomical abnormality, no amount of Factor VIII replacement would have been effective in stopping or slowing down the massive hemorrhage that ultimately led to plaintiff’s tragic death.

McKeen & Associates attorneys overcame these defense arguments by establishing that the bleed was likely caused by an esophageal varix, which is a well-known development in a patient with liver cirrhosis which the plaintiff had. Had a medication called Octreotide been administered shortly after plaintiff’s arrival at the hospital, and had the plaintiff been appropriately treated with either Factor VIII or FEIBA and optimized for the endoscopy procedure, the hemorrhage never would have occurred, and the patient would have survived.

A Severed Vein

Lawyers Brian McKeen and Kenneth Lee recently obtained a $1 million settlement on behalf of a woman who suffered an injury to a blood vessel during a surgical procedure to treat endometrial cancer. During the surgery, the defendant surgeon injured the plaintiff’s hypogastric vein when he attempted to manually remove lymph nodes during the pelvic lymph node sampling portion of the surgery. Although the surgeon recognized the injury at the time, he failed to adequately repair the injury as the patient showed signs of a bleed immediately upon being sent to the recovery room.

Eventually, the surgeon realized that the patient needed to be taken back to the OR to identify the source of the bleed and to gain control of the bleeding. However, upon taking her back to surgery, the surgeon was unable to control the bleeding, and a vascular surgery team had to be called into the OR to assist. In the operative note, the vascular surgeon noted that the internal iliac vein (sometimes referred to as the hypogastric vein) was found to be “transected,” or in other words, completely divided in two pieces. All the evidence in the case pointed to the conclusion that the vein had been transected during the initial surgery by the defendant surgeon.

After the devastating injury, the plaintiff had to be transferred to another hospital, where she was admitted for nearly a month for extensive treatment and rehabilitation. Her injuries were extensive and required numerous procedures and significant time in the hospital.

During the case, the defense argued that the injury to the hypogastric vein had been timely recognized and repaired, and that the plaintiff’s subsequent bleeding happened because of a disseminated intravascular coagulation (DIC), which is a condition whereby abnormal clumps of thickened blood (clots) form inside blood vessels. They argued that the DIC occurred due to underlying co-morbidities but denied that the post-operative bleeding had been caused by the vessel injured by the defendant during the initial surgery.

McKeen & Associates countered by establishing that the finding of the “transected” vessel was a clear indication that the surgical injury caused by the defendant had not been adequately repaired, and had it been, as the standard of care required, the plaintiff never would have suffered the post-operative bleeding which led to the development of ischemia (lack of blood flow) to the nerves in her legs, which ultimately led to the plaintiff’s compartment syndrome, foot drop and other permanent injuries.

A Delayed Diagnosis Of A Spinal Hematoma

McKeen & Associates lawyers Brian McKeen and Kenneth Lee recently obtained a $1 million settlement on behalf of a 90-year-old client who was rendered paralyzed as a result of a delay in diagnosis and treatment of a spinal epidural hematoma.

Hours after having received a lumbar epidural spine injection for pain management, the Plaintiff, a retired anesthesiologist, suffered increasing lower back pain and weakness in the legs. Upon being admitted to the emergency department at the local hospital, the nursing staff noted that the patient was having difficulty walking. The pain and progressing weakness that the plaintiff complained of in the hospital are well-known red flags for a potential space-occupying lesion in the spinal canal, including a condition known as a spinal epidural hematoma. It is also well-known and established that an epidural injection, like the one the plaintiff had undergone less than 12 hours before his ER presentation, can be inciting factor for a hematoma.

Despite these warning signs, the on-call physician, who specialized in emergency medicine, failed to take the necessary steps to diagnose and ensure treatment of the condition, in violation of the applicable standard of care.  Although the doctor did order a CT scan of the spine, the CT scan failed to demonstrate the hematoma. This led to the discharge of the patient from the hospital, which allowed for the hematoma to increase in size and to eventually cause severe compression of the spinal cord.

Soon after returning home, the plaintiff lost feeling in his legs. When the patient returned to the hospital, an MRI was performed which showed the presence of a massive hematoma compressing the spinal cord. The patient underwent an evacuation and decompression surgery of six levels of his spinal cord. Despite this surgical attempt to reverse any neurologic deficits, the plaintiff was permanently paralyzed as a result of the hematoma.

In the lawsuit, the defense attempted to argue that the hematoma was not caused by the epidural injection, but rather, was caused by the plaintiff suffering a fall at home shortly after being discharged from the defendant hospital’s emergency department. This claim was countered by taking an aggressive approach to depositions of the defendants and defense experts. In further questioning, concessions were made indicating the fall was not the inciting factor for the development of the hematoma. The treating neurosurgeon also testified that the hematoma had been caused by the epidural injection, and that the hematoma was causing the plaintiff’s post-injection symptoms that were present during the initial ER visit.

Improper Use Of Opioid Medication

McKeen & Associates lawyers Brian McKeen & Kenneth Lee recently obtained a $1.5 million settlement on behalf of a 63-year-old man who suffered multiple injuries as a result of improper administration of opioid pain medication. The case arose out of two separate acts of blatant negligence by members of the staff at the defendant hospital, leading to permanent physical and cognitive injury to the plaintiff.

After the plaintiff had undergone partial knee replacement surgery, a nurse administered Dilaudid to the plaintiff in clear violation of a physician’s order. The administration of Dilaudid, as well as the nurse’s failure to appropriately monitor the plaintiff’s respiratory status (in violation of another Order by the anesthesiologist) caused the plaintiff to suffer a respiratory arrest. Although the patient was able to be revived and resuscitated with Narcan (a clear indication that the arrest was caused by the Dilaudid), a lasting acute kidney injury was suffered.

Despite knowledge of the acute kidney injury (which was revealed through a CBC which showed a creatinine of 2.97) the doctor initiated a pulmonary embolism (“PE”) Protocol and ordered that a CT scan with contrast be carried out. In doing so, and in ignoring the patient’s positive response to Narcan, the doctor failed to consider that the patient was on Metformin (a clear contraindication to the administration of IV contrast) and allowed the CT scan to be performed. Not surprisingly, the CT scan caused the patient to suffer additional (and permanent) kidney injury and necessitated a trip to the ICU where it was thought that the patient might not survive.

During the case, the defense argued that the physician’s decision to pursue the chest CT scan was reasonable as pulmonary embolism is a life-threatening condition, and it was appropriate to rule that out as the cause of the respiratory arrest. McKeen & Associates was able to establish that the plaintiff did not demonstrate any normal signs or symptoms of pulmonary embolisms, such as chest pain or shortness of breath, and his positive response to Narcan led to the clear conclusion that the respiratory arrest had been caused by the administration of Dilaudid.


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