A hospital patient underwent an open heart surgery with a number of complications that included serratia marcescens bacteremia. The infection did not respond well to antibiotics and the family was told that it would be terminal because they could not control the source. The patient did indeed die, although the death certificate lists "multisystem organ failure" and "non-ST-elevation myocardial infarction" as the causes of death. I understand that these infections are usually associated with outbreaks and I'm looking for an expert on the standard of care and possibly causation with regard to the infection. I may need an epidemiologist but I'm not really sure.
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Do you believe there might have been medical error?
Serratia infections may sometimes occur in hospitalized patients who are severely ill for other reasons, and the presence of this infection does not necessarily suggest a medical error. More information would be required to determine causality.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Again, it is not clear from the details provided if a medical error occurred, but it seems like the infection did lead to the patient’s death.
What makes you a good expert for this case?
I am a practicing infectious diseases physician with 7 years of experience caring for critically ill hospitalized patients. I have treated Serratia infections many times.
How often do you encounter cases similar to this one in your practice?
I treat bloodstream infections in hospitalized patients almost every day.
Do you believe there might have been medical error?
Cases of nosocomial bacteremiia due to Serratia most often would be related to a line infection. Other sources could be mediastinitis after sternotomy. The source of infection was not defined in the summary. Information seems incomplete. It would be very unusual for a physician to determine that an infection is overwhelming and incurable without knowing more. Serratia, being a Gram negative rod with endotoxin, would be very likely to be the cause of multi organ failure. The role of myocardial infection in death is probably contributory but not primary.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
See above. We do not have have sufficient information about the case given the above to be able to make a judgment about medical error.
What makes you a good expert for this case?
Extensive experience in highly complex cases such as this, and an effective, clear and concise objective communicator. I also have substantial experience advising attorneys on complex cases such as this.
How often do you encounter cases similar to this one in your practice?
6-12 times per year. Such scenarios are fairly common in my experience.
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