Case Studies

$1.3M Verdict Animating Negligence: Failure To Diagnose And Treat Heart Infection

When diagnosing a patient, it’s the doctor’s job to rule out the most urgent, life-threatening scenario first. But what happens when a doctor chooses not to follow basic patient safety rules when making a diagnosis, and instead chooses to assume what a condition might be?

In this case, a doctor chose to ignore the possibility of a deadly endocarditis - despite the patient testing positive for Viridans Streptococcus - until it was too late.

Michael Yonke, Esq., needed to show a jury why the doctor's negligence caused his client's death. He tasked High Impact with building visuals to simplify complex aspects of his case so he could focus on conveying the most egregious chapters of his client's story.

$1.3M Verdict Animating Negligence: Failure To Diagnose And Treat Heart Infection

This is what infective endocarditis looks like.

A doctor is never allowed to needlessly delay treatment of a potentially life-threatening illness. When doctors are told the way to treat a deadly condition, they must do so - they cannot guess that another treatment will work. If they guess and the patient is injured or killed by the guess, then that doctor is responsible for all the harm caused.

- Opening Statement by Michael Yonke, Esq., Yonke Law

Choosing to Ignore Symptoms of Infection

It all started when a patient entered a hospital with symptoms of chills, fatigue, night sweats, and headaches. The defendant doctor noted that the patient was "positive for infection" after ordering a blood test. But after ruling out a brain tumor, the defendant sent the patient home without prescribing an antibiotic - despite her testing positive for a bacterial infection. The patient was told to check back in two weeks.

One week later, the patient called her doctor concerned that she may have an infection and asked whether she should be prescribed an antibiotic. She was told to come in for her scheduled appointment a week later. At the appointment, the patient complained of having a fever for two months, night sweats, and leg pain - all symptoms of an infection. The defendant ordered a series of blood tests to rule out a blood clot in the leg.

Despite increasing evidence of a dangerous infection, the defendant chose not to consider antibiotics. Instead, she prescribed steroids and pain pills. Steroids can treat autoimmune diseases and pain pills can treat pain, but neither of these medications treats bacterial infections.

This Differential Diagnosis Chart helped Mr. Yonke emphasize the fact that doctors should always "Rule out the worst first."

Notes that are supportive of the Standard of Care breach are during the first visit when the defendant doctor notes 'positive for infection' and continues the same meds. I thought it was interesting because the patient wasn't on any antibiotics on that date.

M.D. Medical Expert's Deposition

Choosing Assumption Over Assessment

After being sent home, the patient called repeatedly over the next few days asking about the blood tests because she was worried she may have Lyme Disease. The defendant ordered a Lyme Disease test.

When the patient's blood culture results came back, the lab informed the defendant that she tested preliminarily positive for Viridans Streptococcus, a potentially life-threatening infection. The lab also provided the doctor with a list of medications that would fight it.

The defendant chose to ignore the list of recommendations from the lab and instead prescribed a different antibiotic called Doxycycline, based on the patient’s assumption that she had Lyme Disease. 

$1.3M Verdict Animating Negligence: Failure To Diagnose And Treat Heart Infection

This animation demonstrates why Doxycycline does not treat Strep V, and how negligence resulted in a ruptured heart valve.

She guessed about how to treat a potentially deadly disease when she chose to treat her patient with an antibiotic that was untested on treating the life-threatening Strep V bacteria.

- Michael Yonke, Esq., Yonke Law

Choosing the Wrong Antibiotic

The Defense would try to confuse the fact that because Doxycycline is an antibiotic, the nurse was treating her patient's bacterial infection. But the reason Doxycycline was not on the list of recommended antibiotics is because it is ineffective at killing Strep V.

Doxycycline is a "static" antibiotic, meaning that it can treat bacterial infections but it primarily relies on the immune system to finish the job. Strep V requires a "cidal" antibiotic because it kills bacterial infections without reliance on the immune system for help.

Pharmacists are trained to understand this, which is why the lab did not recommend Doxycycline. The defendant chose not to follow the recommendation of pharmaceutically trained experts. When the patient asked if the antibiotic would treat the Strep V, the defendant responded that it "should take care of it."

$1.3M Verdict Animating Negligence: Failure To Diagnose And Treat Heart Infection

This animation shows why a cidal antiobiotic is the correct choice for killing the Strep V bacteria.

The use of Doxycycline in this setting was insufficient. It's not going to treat endocarditis. The fact that Strep V was never adequately treated led to the continuation of the endocarditis and progression of endocarditis until ultimately the patient died as a compilation of endocarditis.

- M.D. Medical Expert's Deposition

Choosing to Ignore Blood Test Results

Once the lab had provided the blood culture results, the defendant had all the evidence she needed to confirm this patient was potentially facing an urgent, life-threatening condition that could kill her if left untreated. The defendant even wrote in her notes, “Blood culture grew out of Strep V. I have given the patient Doxy. How is she doing?”

At this point, the Standard of Care requires that the patient be admitted to a hospital to rule out endocarditis and treat the Strep V appropriately. 

Instead of acting on this life-threatening condition with urgency, the defendant sent the patient home with the wrong antibiotic for possible Lyme Disease. Two days later, the Lyme Disease test would come back negative, confirming that her diagnosis was wrong.

Instead of reconsidering her diagnosis or changing the prescription based on the new information, she chose to ignore the blood tests and keep her patient on the wrong antibiotic.

This pathways chart illustrates what the defendant did wrong versus what she should have done right.

The key point in the defendant's history is the positive blood culture. When you get the positive blood culture back, then it really all makes sense. It falls into place. 'Oh that's what's going on here,' and that's when you need to really convince yourself that it's a contaminate or transient bacteremia or you need to rule out endocarditis.

- M.D. Medical Expert's Deposition

Choosing Feelings Over Facts

Eleven days after the patient should have been admitted to a hospital, the defendant met with her patient for the last time. The patient said she was still experiencing night sweats, but the strep was feeling better.

The defense would later argue that the patient misled the defendant when she said she felt better. But should a doctor disregard a blood cultivation test showing deadly results because a patient says she feels better?

That would be like a doctor disregarding a positive pregnancy test because a patient says she doesn't feel pregnant.

- Michael Yonke, Esq., Yonke Law

As medical experts would later testify, the reason the patient started feeling better was because the Doxycycline antibiotic was actually slowing the growth of bacteria and making her feel better - but it could not kill the bacteria because that's not what this antibiotic was designed to do.

The examiner who performed the autopsy said the bacterial infection, which the defendant neglected, damaged the patient's otherwise healthy heart valve, and ultimately caused her death.

This timeline charts weeks of negligent decisions and missed opportunities.

The medication doesn't fight the infection, but it does make the patient feel better. Feeling better doesn't mean a patient is cured. It doesn't mean a patient is actually getting better. It's the doctor's job to know what the effects of the medications they prescribe are.

- Michael Yonke, Esq., Yonke Law

Choosing to Not Prevent a Wrongful Death

The autopsy would later conclude that the endocarditis was likely growing on the patient's heart valve for months. It wasn't until symptoms started showing themselves that it could be uncovered. The defense would argue that the patient came to the defendant too late, and she would have likely died regardless of how quickly the defendant reacted because of the severity of damage caused by this endocarditis.

Medical experts would testify that whereas 20 or 30 years ago, patients with a torn heart valve from endocarditis were at much greater risk of death; today 9-out-of-10 patients not only survive - they go on to live healthy normal lives. The proper antibiotics would have begun killing the bacteria within 24 to 48 hours. Disease specialists and cardiologists could have worked together to treat the infection while repairing heart damage at the same. 

This animation demonstrates two options for replacing the damaged heart valves. Had the defense reacted appropriately and urgently to this life-threatening condition, this is how her death could have been prevented.

$1.3M Verdict Animating Negligence: Failure To Diagnose And Treat Heart Infection

This is how the patient's death could have been prevented.

If the defendant had followed the basic rules of patient safety, she would have acted on the blood culture results immediately. If the defendant would have sent her patient to a hospital or an infectious disease specialist at any time before May 10, the defendant would have been diagnosed, treated with the right antibiotics, and she would have lived.

- Michael Yonke, Esq., Yonke Law

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