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San Antonio lawsuit: Pulmonologist discharged post-surgical patient with unrepaired cut artery, bleed-out risk

Medical malpractice wrongful death claim filed after complication during tonsillectomy and adenoidectomy surgery

It seems that you would need a medical expert to tell you that it would be negligence to discharge a patient from the hospital has an unrepaired cut artery. That was the issue before the San Antonio Court of Appeals recently, though, in case styled Pradyumna Mummady, MD v. Zulema Cabrera, No. 04-21-00012-CV. You can read the opinion here.

The facts of this medical malpractice wrongful death case began with the patient being admitted to Laredo Medical Center to have his tonsils and adenoids removed. During surgery, the patient developed uncontrolled bleeding from his lingual artery. That’s the artery that supplies blood to the tongue and floor of the mouth.

A physician packed the artery to stop the bleeding and transferred him to the intensive care unit (ICU) for monitoring by Dr. Mummady, who’s a critical care pulmonologist. Three days after surgery, the packing was removed without any bleeding. The next day, though, the laboratory reported critical blood levels and it was documented that the patient had blood coming out of his mouth when he coughed.

According to the lawsuit, the critical care pulmonologist ordered the breathing tube removed (extubation) and transferred him from the ICU to a nursing floor, without further blood work or investigation of potential bleeding. Two days later, the patient was discharged from the hospital.

Less than two weeks after getting home, the patient started hemorrhaging from his nose and mouth. By the time an ambulance could get him to the hospital, he was already dead. The autopsy showed that artery had been cut and that he died from severe blood loss.

To comply with Texas tort reform requirements, the plaintiff timely produced an expert report by a board-certified otolaryngologist, a head and neck surgeon. The expert focused on the patient’s hematocrit and hemoglobin lab work and vital signs, all of which showed instability and changes in hemodynamics.

The expert contended that there should’ve been a workup to see if blood loss anemia was present. He was critical of Dr. Mummady for failing to recognize the critical downward trend, getting the injury to the artery repaired, stopping the bleeding, and treating the blood loss with transfusion. The expert report also contended that the critical care pulmonologist violated the standard of care by discharging a patient whose artery had not been repaired resulting in profound blood loss anemia and serious risk of continued bleeding.

The defendant physician objected to the sufficiency of the plaintiff’s expert report. One of the key issues was whether the patient’s death was foreseeable. The expert noted that Dr. Mummady had actual knowledge that there had been an arterial injury during surgery and it was his responsibility to determine whether packing had controlled the bleed. From a medical perspective, this would be determined by looking for bleeding, but also serial complete blood count, hematocrit, and hemoglobin lab work.

The appellate court upheld the trial court’s decision that the report from the plaintiff’s expert was sufficient to represent a good faith effort to comply with the statutory requirements.

If you’ve been injured because of poor hospital, surgical, or medical care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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