On January 14, 2020, a Baltimore City medical malpractice wrongful death jury returned its verdict in the amount of $5,870,000 against the University of Maryland Medical System (“UMMS”) that included $62,177 in economic damages, $9,972 in funeral expenses, and $5.8 million in noneconomic damages. The noneconomic damages awarded by the Baltimore medical malpractice jury will be capped at $962,500 pursuant to Maryland’s cap on noneconomic damages in Maryland medical malpractice cases.
The Underlying Facts
The woman had heart valve replacement surgery at UMMS on June 10, 2016. While recuperating from sugery in the hospital, she suffered cardiac arrest on June 13 and suffered a severe brain injury as a result. Six days later, the woman died.
The plaintiff’s Maryland medical malpractice wrongful death lawsuit alleged that the woman suffered cardiac tamponade after her surgery that the hospital negligently failed to timely diagnose and treat, delaying treatment for more than an hour when minutes count, thereby leading to her death. The defendant denied that the woman had developed cardiac tamponade, which is a known complication from the type of surgery the woman had, despite the medical records mentioning cardiac tamponade in several places.
A spokesperson for UMMS stated after the verdict that the hospital is investigating post-trial motions and an appeal, further stating that UMMS does not consider the verdict supported by the evidence submitted during the trial: “The University of Maryland Medical System recognizes that this was a very difficult case both for the Mason family and for our providers and we are extremely saddened by the loss of one of our patients. The health and well-being of our patients is, and always will be, our highest priority.”
Cardiac tamponade is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock. The diagnosis of cardiac tamponade is a clinical diagnosis that requires prompt recognition and treatment to prevent cardiovascular collapse and cardiac arrest. The treatment of cardiac tamponade can be performed at the bedside or in the operating room.
Cardiac tamponade is caused by the buildup of pericardial fluid (exudate, transudate, or blood) that can accumulate for several reasons. Hemorrhage, such as from a penetrating wound to the heart or ventricular wall rupture after an MI, can lead to a rapid increase in pericardial volume. Other risk factors, which tend to produce a slower-growing effusion, include infection (tuberculosis [TB], myocarditis), autoimmune diseases, neoplasms, uremia, and other inflammatory diseases (pericarditis). The pericardial fluid that builds up slowly is better tolerated in patients than with rapid accumulations.
The diagnosis of cardiac tamponade can be suspected on history and physical exam findings. ECG may be helpful, especially if it shows low voltages or electrical alternans, which is the classic ECG finding in cardiac tamponade due to the swinging of the heart within the pericardium that is filled with fluid. This is a rare ECG finding, and most commonly the ECG finding of cardiac tamponade is sinus tachycardia. In severe cases, one may note electrical alternans.
A chest x-ray may show an enlarged heart and may strongly suggest pericardial effusion if a prior chest radiograph with a normal cardiac silhouette is available for comparison. CT chest can also pick up pericardial effusion.
Echocardiography is the best imaging modality to use at the bedside, whether it is a point-of-care echo or a cardiology echo study. Echocardiography can not only confirm there is a pericardial effusion, but determine its size, and whether it is causing compromise of cardiac function (right ventricular diastolic collapse, right atrial systolic collapse, plethoric IVC).
The treatment of cardiac tamponade is the removal of pericardial fluid to help relieve the pressure surrounding the heart. This can be done by performing a needle pericardiocentesis at the bedside, performed either using traditional landmark technique in a sub-xiphoid window or using a point-of-care echo to guide needle placement in real-time. Often the removal of the first small amounts of fluid can make a large improvement in hemodynamics, but leaving a catheter within the pericardium can allow for further drainage.
Cardiac tamponade is a medical emergency and without treatment is invariably fatal. The key is the timing of intervention; the longer the delay, the worse the outcomes. Patients suspected of having cardiac tamponade due to medical causes should be monitored closely and acted on promptly as they can deteriorate quickly. Patients with tamponade caused by malignant disease have death rates exceeding 75% within 12 months; patients with a non-malignant cause have a mortality rate of less than 15%.
If you or a family member suffered serious injury (or worse) due to medical malpractice in Baltimore or elsewhere in Maryland, you should promptly find a Baltimore medical malpractice lawyer (Maryland medical malpractice lawyer) who may investigate your medical malpractice claim for you and represent you in a Maryland medical malpractice case, if appropriate.
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