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66 y/0 obese woman w/ hx of hypertension and hyperlipidemia, goes to her PCP on 4/8/21 for medical clearance for a total hip replacement on 4/14/21. He does no blood work, but relies on labs from 8/6/20, 8 months earlier. That Potassium level was 3.6 (3.5-5.3=nml). Does an ekg in office and result is "no interpretation due to signal problem." On 4/14/21 Orthopedist does total hip. When transferred to stretcher the pt. codes, v-fib is noted, and she does not respond to recitation meds. Transferred to Hospital by EMS. Cardiology consult there states "V-fib potentially related to hypokalemia, 2.1 on ED labs." My questions:
1. Is PCP iiable for failing to do timely blood work and a readable ekg?
2. Is Orthopedist liable for failing to make sure these tests were actually done before operating?
3. Is Surgi-Center liable for failing to make sure these tests were done before allowing operation to go forward?
Thank you.
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Do you believe there might have been medical error?
Whomever gave clearance cannot rely on labs from 8 months prior and certainly must perform ekg on obese patients with cardiac risk factors ..additionally the Surgical centers should have verified such tests were complete Orthopedic surgeon bears less responsibility as he was told pt was clear for surgery
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Not checking labs and ekg seems to have directly led to the cardiac arrest
What makes you a good expert for this case?
I enjoy reviewing cases and have sense of who is responsible for medical errors such as these
How often do you encounter cases similar to this one in your practice?
This is unusual—labs and ekg are always done prior to preop Clearance…how could this md give clearance—I suspect pt could not perform 4 Mets
Do you believe there might have been medical error?
Age and co-morbid conditions make lab testing and ekg standard of care Labs should be within 30 days and an EKG within 6 months The lack of tests and the acceptance of an uninterpretable EKG indicate deviation from SOC
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If the patient was hypokalemic, this could have been seen on preoperative labs If the EKG showed arrhythmia rather than signal problem, again surgery could be postponed while this was evaluated
What makes you a good expert for this case?
I am a practicing Internist with 23 years of experience. I am the Senior Medical Director and Section Chief for the Department of Medicine at my institution. Outpatient care as well as quality review and standards are part of my daily responsibilities
How often do you encounter cases similar to this one in your practice?
Pre-operative assessment is a routine part of my practice. Orthopedic surgery is one of the most common surgical procedures patients are assessed for.
Do you believe there might have been medical error?
No blood tests were done prior to surgery. More likely than not a low potassium would have been detected and treated if ordered..An ekg prior to surgery could have shown an abnormality such as an arrhymia or findings suggestive of ischemic heart disease.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Lack of testing before surgery-low potassium leading to a fatal arrhytmia and death.
What makes you a good expert for this case?
I have reviewed previous cases where medical clearances were not done appropriately resulting in the death of the patient.
How often do you encounter cases similar to this one in your practice?
In my particular practice we have not had issues with incomplete medical clearances.
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