After Patient Death, Physician Found Negligent for Failing to Properly Monitor Anticoagulant

Dr C was a cardiologist who worked in a mid-sized practice. He was well liked by his patients and had been seeing some of them for many years. One such patient was Ms P, aged 70. Ms P had a variety of cardiac issues, including atrial fibrillation, 2 mechanical heart valves, and a pacemaker. The patient was taking the anticoagulant medication warfarin to reduce her risk of stroke.

Ms P was on a schedule to have monthly blood work done to check her International Normalized Ratio (INR) level. In this way, her warfarin levels were being monitored regularly.    

There came a time when Dr C recommended that Ms P have elective surgery to have the battery in her pacemaker replaced. Ms P agreed, and the cardiologist stopped her warfarin 5 days before the surgery. Prior to the surgery, Ms P’s INR was normal. 

The procedure took place as planned and the battery was replaced without issue. Following the procedure, Dr C had the patient begin taking the blood thinner again, which she did. The following day, however, Ms P returned to the physician’s office with bleeding and a hematoma on the procedure site. Dr C, concerned about the possibility of an infection in the area, prescribed an antibiotic, sulfamethoxazole-trimethoprim, for 5 days. The physician also ordered an INR test for the patient for the following day.

The next day, Ms P went for her bloodwork which revealed an INR of 3.2. Dr C was satisfied with this number and advised the patient to go back for another INR in 1 month, as usual. This was the last conversation Dr C would ever have with his patient. 

Less than a month later, Ms P was brought to the emergency department with clear signs of bleeding. Hospital staff worked feverishly to save her. Her INR was 22.8 and she was grossly anemic. Ms P was given blood transfusions in an attempt to replace the blood loss but it was too late. She coded numerous times and died the following day.

After her funeral, her family sought the counsel of a plaintiff’s attorney. They did not understand why Ms P had not been monitored more closely following her procedure. The plaintiff’s attorney had a medical expert look over the records and the expert was critical of Dr C’s treatment of the patient, specifically of his failure to monitor the blood thinner more closely after restarting the medication following Ms P’s pacemaker battery replacement procedure. The attorney agreed to take the case and he filed the papers and served Dr C with notice of the lawsuit. 

Dr C was saddened and upset over the death of his patient, but he did not feel responsible for it, which is what he said after being notified about the lawsuit. Prior to going to the emergency department, her INR had been acceptable, if slightly high, he told his defense attorney. And if she had been in such bad shape before calling an ambulance, why had she not contacted him? 

The case moved forward through the discovery phase and although his attorney had told Dr C that cases are often dismissed or settled early on in the process, the case against him was still proceeding.