MEDICAL MALPRACTICE ATTORNEYS IN MAINE HELPING CLIENTS WITH SEPSIS INFECTIONS
When Ben’s oldest son was about nine years old, he came down with an illness. When he began to have difficulty breathing, Ben’s wife brought him to his pediatrician. His wife called Ben on her drive home.
“What did the doctors say?” Ben asked.
“They didn’t really know, but they think he might have had an allergic asthmatic reaction to something,” she replied. “His oxygen saturation levels are down to about 90 percent.”
As it turns out, Ben had recently litigated a case in which his client’s son was discharged home with an oxygen saturation of 90 percent, only to die soon thereafter from the flu.
“I think you should take him to the hospital right away,” Ben said. “That oxygen sat is quite low, and I think he needs to be monitored more closely.”
His wife swung the car around and headed south toward the Maine Medical Center Emergency Department. Ben’s son was emergently admitted to the hospital. His physicians hooked him up to machines to monitor his pulse and oxygen saturation levels. They worried that he might be suffering from a severe and potentially life-threatening infection. Ben’s son remained in the hospital under close observation for the next few days.
Why did something that looked unremarkable to the pediatrician look like a 5-alarm fire to the physicians at Maine Medical Center? And how could a highly regarded pediatrician have missed a potentially life-threatening illness?
Cases Involving Undiagnosed Infection and Sepsis
Unfortunately, however, we often hear stories from potential clients that sound a lot like what happened with Ben’s son. We routinely accept cases in which a patient presents to a primary care office, a walk-in clinic, or an emergency department with signs and symptoms concerning infection, but is then discharged home without appropriate treatment, monitoring, or follow-up. Often, these patients go on to die from an overwhelming infection that would have been treatable days, or even hours, earlier.
Sepsis, a well-known and dreaded diagnosis, is one of the leading causes of death in the United States. In the popular imagination, sepsis is often thought of as synonymous with severe infection. In actuality, sepsis is the body’s response to infection. Sometimes, sepsis cannot be prevented. However, there are often early warning signs that, if detected and properly responded to, can prevent a patient from developing life-threatening sepsis.
Progression of Infection to Multi-Organ Failure
Sepsis begins with the development of an infection somewhere in the body. For example, the patient might have a cut, wound or surgical procedure that created a portal of entry, allowing bacteria to enter the body. Once inside the body, the bacteria may seed locally (such as an ulcer on the skin), or it may travel through the bloodstream, seeding an organ (e.g., liver, kidney, heart); a joint (knee, ankle); or a foreign object in the body (e.g., a replacement heart valve or a prosthetic joint). Once seeded, the bacteria can multiply to form an abscess which continues to act like a bacteria generator, causing the bacteria to continue to circulate throughout the body.
Bacteria in the bloodstream is called “bacteremia.” It can be diagnosed using a blood culture—that is by, drawing blood and culturing it in a petri dish. The type of bacteria that grows in the blood culture provides critical information to physicians regarding what type of antibiotic will best combat the infection.
In some patients, bacteremia triggers the body’s inflammatory response. Blood vessels constrict, causing blood pressure to drop, which reduces blood supply to critical organs. To compensate, the heart beats too fast (tachycardia), and the patient experiences a heightened respiratory rate (tachypnea) and shortness of breath (dyspnea). Without adequate oxygenated blood to the tissues and cells, metabolism becomes impaired, causing an elevation in lactic acid.
The above-described inflammatory response to infection is called “sepsis.” “Septic shock” describes the situation where sepsis causes a patient’s blood pressure to drop into a dangerous range. If a patient remains in septic shock long enough, the lack of blood supply to vital organs will cause damage to vital organs, a condition referred to as “multi-organ failure.” Multi-organ failure can result in permanent and debilitating organ dysfunction or even death.
The Point of No Return
There comes a point in the progression of sepsis when the patient is beyond the point that he or she is likely to survive even with the best medical care. Typically, the demarcation line for survivability comes at the point where the sepsis has caused the blood pressure to drop so low that the patient is in septic shock. However, even after shock, there may be a short window to save the patient. But that window closes fast, meaning that, in patients with septic shock, every second counts.
Treatment of Infection and Sepsis and Survival
Before a patient progresses to shock, medical intervention is far more likely to be successful. Such medical care includes the use of powerful IV antibiotics; hydration and volume fluid replacement with electrolytes; source control of the infection (for example, draining an abscess); and measures such as pressors to stabilize blood pressure and respiratory support. Patients with advanced sepsis require additional monitoring of their organ function and often need to be admitted to intensive care units.
When it comes to infection and sepsis, the sooner treatment begins, the higher the likelihood of patient survival. If the patient is treated before he or she becomes septic, survival is all but assured. If the patient is treated after developing sepsis, but before entering septic shock, there is a high likelihood of survival. Once shock sets in, every hour and minute of delay reduces the chances of survival.
Screening for Sepsis
Fortunately, Ben’s son received treatment and did not develop sepsis. He did, however, experience rapid breathing and a low oxygen saturation level—abnormal vital signs that, in the setting of a potential infection, should have raised a high index of concern for sepsis. The cardinal signs and symptoms of sepsis are any infections, together with tachycardia (heart rate > 100 beats per minute), elevated respiratory rate (respiratory rate > 20 per minute), and fever. However, not all septic patients present with all of these signs and symptoms. Other signs associated with sepsis include low oxygen saturation levels, pneumonia on a chest x-ray, high white blood cell count, and other abnormal lab values (including elevated C-reactive protein, sedimentation rate, band rate, or lactate).
Must Be Safe and Not Sorry
If a patient with suspected infection presents with some combination of these signs and symptoms, a provider should have a high index of concern for sepsis. When a provider is concerned for sepsis, she should have a low threshold for ordering additional testing to rule out the disease. Likewise, she should have a low threshold for admitting the patient to a hospital where he can be monitored closely for any progression of the disease.
Depending on the circumstances, the failure to exercise the right level of concern to timely diagnose and treat sepsis may be medical malpractice.