Legal Review & Commentary: Diseased transplant heart results in $2.7M verdict
Legal Review & Commentary
Diseased transplant heart results in $2.7M verdict
News: A 58-year-old man presented at the hospital for a heart transplant. His heart was removed and discarded, and a donor heart was transplanted into the man. The man never awoke from the surgery and died three days later. The man's estate sued the hospital and the physician who harvested the heart. The jury returned a verdict in favor of the plaintiff, finding the hospital 100% negligent.
Background: After waiting 14 months, a 58-year-old husband and father of three in need of a heart transplant due to longstanding cardiac complications, including three heart attacks, arrived at the hospital after being told that a heart was available. The man's heart was removed and discarded, and the donor heart was transplanted into the man. When the transplanting surgeon removed the donor heart from its container, he immediately saw and determined by touch that it suffered from left ventricular hypertrophy and coronary artery disease. The surgeon wrote "Hypertrophic heart!" in his operative notes because the amount of hypertrophy was more than he expected based on the results of the echocardiogram. Nevertheless, the surgeon determined the heart was suitable for transplant, and transplanted it. The man never regained consciousness after the surgery and died several days later. An autopsy later confirmed significant heart disease in the donor heart.
The man's widow brought an action individually and on behalf of her husband's estate against the physician who harvested the donor heart and determined that it was suitable for medical malpractice and against the hospital for negligent supervision and training.
The plaintiff asserted that the physician should have visually inspected the heart before transporting it for transplantation. Against the hospital, the plaintiff argued that it had a duty to ensure that the surgeon understood his role in transplant surgery and the necessity of inspecting the heart after removal. While the plaintiff conceded that inspecting an organ prior to transplant is not required to meet standard of care, the hospital's own policies and procedures required a visual examination by the harvesting surgeon and therefore the physician was in violation of the hospital's protocol.
The operating surgeon testified that he received the heart, assumed the hospital protocol had been followed, and that the heart had passed the visual inspection of the harvesting surgeon. If he had been on notice that such an inspection had not occurred, he would have performed the visual inspection before removing and discarding the man's heart. There was some evidence in this case that an artificial heart could have been used.
The plaintiff's expert testified that a visual inspection would have revealed that the heart was moderately or highly diseased from hypertension and drug use. The autopsy revealed that the 46-year-old heart donor had moderate to severe atherosclerosis and hypertrophy with a history of high blood pressure, cigarette smoking, and alcohol and drug use, including both marijuana and cocaine.
Counsel for the physician and the hospital argued that the heart was deemed acceptable for transplant prior to removal. The hospital had claimed it had performed all the appropriate and necessary tests, finding only mild disease, which was not a concern for transplant. Such tests are proven to be more effective than visual inspections. The hospital's expert confirmed this theory, stating that a visual inspection would have only confirmed the pre-transplant tests that were conducted. Based on those tests, the expert would have deemed the heart acceptable for transplant. In all, seven doctors and one nurse testified that the heart was suitable for transplant.
The hospital's attorney focused on the fact that transplants are inherently dangerous and have a high mortality rate. In this case, all the necessary, recommended, and appropriate tests were conducted, despite the fact that they were unable to fully identify the amount of disease in the heart. Ultimately, the defendant argued, a visual inspection would not have altered the outcome. Additionally, the defendant claimed the man's life expectancy was limited to less than one year without a heart transplant, and less than 10 years with a heart transplant.
The jury returned a verdict in favor of the plaintiff and against the defendant hospital in the amount of $2.7 million.
The case was affirmed on appeal.
What this means to you: This case is all about trust. Any time a patient enters a hospital, that individual is placing his or her trust in the administration, physicians, nurses, and other licensed staff to do the right thing. Patients rely on the reputation of the hospital and its physician staff, nursing services, laboratories, and its operating policies to assure that their health and well-being are protected.
Hospital accreditation such as The Joint Commis-sion, the Medicare Conditions of Participation, and state health department surveys are all intended to be an assurance of recognizable quality and dependability. Board certification singles out physicians and nurses with added training and recognition in their field. Hospitals trade on the reputation of the facility, its staff, and the physicians who practice there.
This patient and his family placed their trust in this transplant team and it clearly failed them. In sentinel events such as this, The Joint Commission requires a comprehensive root-cause analysis (RCA).
We understand that the hospital performing the transplant used a team approach to heart transplantations consisting of a nurse coordinator, a cardiologist, a procuring surgeon, and transplanting surgeon. The team clearly had policies and protocols that it relies upon each step of the process. Each decision is contingent on the accuracy of the one preceding it. Any breakdowns in the process, including the judgment of the team to proceed, possibly will doom the entire transplant.
In this case, the transplant surgeon apparently overlooked information that would have made him question the reliability of the donor. The 46-year-old donor had a history of high blood pressure, cigarette smoking, and alcohol and drug use, including both marijuana and cocaine. This is not the history of an individual who can be expected to have a healthy heart absent of disease. The autopsy revealed moderate to severe atherosclerosis and hypertrophy of the heart. Based on this information, there is a suspicion that the transplant surgeon made a serious error in judgment to proceed.
The next step also apparently failed. Once the transplant surgeon gave the go-ahead, the procuring surgeon traveled to the donor hospital, where he opened the donor's sternum and was to visually inspect the heart and feel it for defects. While visual inspection may not be totally reliable, the hospital transplant policy did require a visual inspection, and it appears that this did not happen.
A visual inspection may have revealed that the heart was moderately or highly diseased from hypertension and drug use. Using experts, the hospital was able to defend the use of the donor heart, as all the required preliminary testing indicated only mild disease, which was not a concern for transplant. Yet the hospital's policy was breached, and this in itself is a violation of the standard of care. This speaks to why policies should be routinely reviewed. It is entirely possible that in the early days of transplant, visual organ inspection was considered essential, but with experience and more reliable diagnostic testing, such visual inspections may no longer have the relevance they once had.
Nonetheless, the protocol was never changed, and the transplant surgeon stated a reliance on that step of the process just as the procuring surgeon had relied on the transplant surgeon's initial opinion that it was prudent to proceed with harvesting the heart. Because the transplant surgeon trusted the established policy that ensured visual inspection, he assumed that the heart was healthy and that he could safely proceed. Had the hospital changed its protocols to eliminate the visual inspection at the time of procurement based on the reliability of diagnostic testing, the process would have likely dictated that a visual inspection be completed at the time of transplant prior to the removal of the patient's diseased organ.
Obviously, the transplant surgeon was aware that the heart he was using was not optimal. He never gave the patient's family the opportunity to evaluate alternatives and then decide if they wanted to risk the possibility of continued disease and/or heart failure or explore the various pros and cons of an artificial heart, at least on a temporary basis. In essence, they deprived the patient and family decision makers of their right to informed consent.
Clearly, this patient died because the trust he placed in the hospital and the surgeons was ignored when the transplant surgeon failed in his duty of care to properly assess the potential for a healthy heart and the procuring surgeon failed to adhere to policy. There is no question that a heart transplant is a risky procedure with failure likely to result in death. Modern techniques to assure accuracy in selection of the organ to avoid rejection and other predictable complications cannot compensate for due diligence on the part of the operative team to follow procedure and to make accurate assessments.
The root cause of this man's death was clearly the transplant surgeon's failure to recognize that the heart that he was to receive most likely would be inferior goods. From there, the process deteriorated further, and this patient and his family paid the ultimate price.
Reference
No. 02 L 7989 Circuit Court of Illinois, Cook County Judicial Circuit.
A 58-year-old man presented at the hospital for a heart transplant. His heart was removed and discarded, and a donor heart was transplanted into the man. The man never awoke from the surgery and died three days later. The man's estate sued the hospital and the physician who harvested the heart.Subscribe Now for Access
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