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  1. #1
    Join Date
    Sep 2010
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    Elbert, Co.
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    10

    Unhappy Should I Have Been on Blood Thinners After Hospital Discharge

    My question involves medical malpractice in the state of: Colorado

    I recently had a rollover accident where no one else was involved. I'm a large man, close to 400 lbs where my seat broke and my chest was repeatedly slammed into the steering wheel of the Jeep resulting in collapsed lungs and nine broken ribs.

    While in the first hospital for initial treatment I was given blood thinners to keep me from clotting. On release I was taken off of the blood thinners and sent home with pain medications. I also had instructions not to change altitude due to the lung injuries and that if I were to develop a fever, I should go to the hospital right away.

    Three days later I develop a fever and go to a hospital closer to where I was staying. They immediately put me on blood thinners while in the hospital and helped me deal with pneumonia that had developed due to my lung injuries.

    During my hospital stay, I did some research (I could use a laptop) and found that clotting is very real threat for a person with my weight and the trauma that I had sustained. Yet, again after leaving this hospital, I was released with not blood thinners, even though I was on them the entire time I was admitted.

    Two days later I develop a fever and I go back to the hospital. They check my xrays and find that there are no changes and that I should stay for observation. At that time, I had already made arrangements months prior to see my primary doctor at the VA. These appointments can take months to get and I didn't want to miss it, so I signed out of the hospital against their wishes.

    That night I developed excruciating pain in my leg where a blood clot had developed from my groin to my foot. A piece broke off and went through my heart and landed in the main artery to my lungs. It was so big that it was found at the VA with NO special die's while taking a cat scan.

    Ever doctor I talked to said the blood clot could have been avoided if I were on blood thinners when at home as well as while in the hospitals. So now I have deep vein thrombosis and a pulmonary embolism.

    Given that hospital one and two did not send me home on blood thinners. Can I bring charges against them and if so, what would I have to do, to proceed. This seems straight forward, yet, if I know the law, it's probably not.

    With all that said, does anyone have any thoughts or recommendations about this crazy situation I'm in? Thanks in advance for the help!

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Should I Have Been on Blood Thinners the Entire Time

    No, you cannot bring charges against them. This does not fall under criminal law.

    You are free to consult with a med-mal attorney who will review your records and determine whether a reasonable standard of care was breeched.

  3. #3
    Join Date
    Sep 2005
    Location
    Behind a Desk
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    98,846

    Default Re: Should I Have Been on Blood Thinners the Entire Time

    In terms of the first hospitalization, you suffered no injury from not being on blood thinners. Your subsequent hospitalization was completely unrelated to blood clots.

    In terms of your second, you don't actually tell us what prescriptions you were given upon discharge, but when you leave a hospital AMA (Against Medical Advice) you put yourself in a position of peril. You're bypassing the procedures by which the hospital can gauge your condition and create a plan for after discharge.

    I'm not sure if by "that night" you mean "After my doctor visit at the V.A."; if so, why didn't you address your apparent wish to be on blood thinners with your V.A. doctor? And if not, why did you check out of the hospital AMA if your appointment was on a different day?

  4. #4
    Join Date
    Jan 2006
    Posts
    38,867

    Default Re: Should I Have Been on Blood Thinners After Hospital Discharge

    This seems straight forward, yet, if I know the law, it's probably not.
    It is very straight forward. You signed yourself out of the hospital against medical advice. Once you do that, what happens is on you.

    Ever doctor I talked to said the blood clot could have been avoided if I were on blood thinners when at home as well as while in the hospitals.
    true but remember, you removed yourself from their care when you discharged yourself. They cannot force you to accept medical attention. If you check out AMA, they are not going to continue treatment in a half assed manner with you being at home when you should be in the hospital.


    On top of this, depending on how far you had to drive to get to the VA hospital, your weight and sitting in a vehicle could have caused what happened.

  5. #5
    Join Date
    Sep 2010
    Location
    Elbert, Co.
    Posts
    10

    Default Re: Should I Have Been on Blood Thinners the Entire Time

    Mr. Knowitall, I totally understand the confusion and the issues revolving around leaving a hospital AMA. Just for clarity's sake, "That Night" meant the night I signed out of the hospital AMA. As for why I chose to go to my other appointment, the appointment was for my primary care doctor at the VA. I'm not sure if you've ever had to deal with the VA and getting an appointment with anyone, including your primary. I can't even call my primary directly, just to give you a clue of how much of a PITA it is dealing with the VA. However, my primary doctor is one of the best they have out here. As it turns out it was the best move I could have made as I received the best care out of all the hospitals I've been to. I went in with a 103.9 fever and my doc sent me directly to the emergency room where they diagnosed the blood clot in my left leg that went from my groin to my foot and the pulmonary embolism that was actually seen when not using the special dies normally used to see an embolism... IE the clot was HUGE!

    The reason I left the other hospital AMA is that I was just released the night before and I was still having problems. All they did was take me back for x-ray's and not a cat scan. It they had given me a cat scan, I would have stayed!

    To be honest, I never had the intent in going after anyone for money... as in to make a profit. It just seems to me that if I'm on something while in the hospital that there was a reason and that reason never went away just because of discharge. So if anything I was just looking to reduce my bill anywhere I can... hospitals are NOT cheap if you know what I mean!

    Thanks so much for your input!!! This site is GREAT for just asking questions and getting a clue of how things work.

    jk, like I was saying to Mr. knowitall.... thanks for your input! I really do apreciate it. This whole accident has been a learning experience to me and I hope to never have to deal with it again. I'll surely not do what I did this time, I'm so glad it was summer and not winter as I litterally live in the middle of knowhere and I was almost home. If this was wintertime there is a good chance that I would not have been found for a long time.

  6. #6
    Join Date
    Oct 2010
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    US
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    16

    Default Re: Should I Have Been on Blood Thinners the Entire Time

    Quote Quoting wanabegates
    View Post
    It just seems to me that if I'm on something while in the hospital that there was a reason and that reason never went away just because of discharge.
    Well, one risk that generally does go away is immobility.

    I realize your post is more than two weeks old, but a few medical observations might make you feel better, insofar as the perceptions of possibly being handled incorrectly by the hospital. One risk factor for developing Venous ThromboEmbolism (VTE) is laying in a hospital bed - it makes circulation stagnant, so to speak. If you're curious, you can look up the ACCP guidelines on VTE from summer 2008. In general, prophylactic anticoagulation (post-trauma, post-surgical, etc.) is getting extended farther and farther time-wise. But still, I don't think those guidelines would as yet be considered legally as standard of care. Clinical trials are somewhat inconclusive.

    Your fever was also a risk factor for VTE, as is any inflammation. OTOH, VTE can also cause fever, as can a collapsed lung - though your eventual high fever was perhaps the result of infection... though you didn't mention if your initial treatment included any surgery.

    OTOH, taking warfarin has its own risks to be balanced. It's considered a very difficult drug to 'manage'. In some people, their blood gets far too thinned, even on a steady dose, and they end up with a bleeding stroke. (I assume you're on warfarin now, because presently having clots is a big indication for anticoagulation.)

    Blood thinners are not 100% protective anyway.

    So as you can see, it's medically complicated So that would likely mean no clear and easy legal case.

  7. #7
    Join Date
    Sep 2010
    Location
    Elbert, Co.
    Posts
    10

    Default Re: Should I Have Been on Blood Thinners After Hospital Discharge

    madmel, thanks so much for your responce to this post! I completely understand the complications behind what is going on with me. It's truly been a crazy time.

    I think my biggest question and wonder, how I was on certain medications while in the hospital as stated before, to be released without them after having a huge trauma (car wreck where both lungs were collapsed) This is hospital #1. Other than having the tubes shoved into my lungs to help them drain, nothing else was really done. So, if you want to consider that procedure surgery, so be it. I also had an epidural after that to control the pain. I'm not sure if this would be considered surgery, but I guess it could be.

    Within two days of release from hospital #1, I developed he fever and went to hospital #2 and one of the first things done, was to put me back on the blood the blood thinners I was on before. This hospital didn't know if I had pnumonia or something else and found blood in my plural space (I hope I said that right). It was a lot of blood.. a full two liters. . I also did have a surgery here to pull fluid from my lungs (a Bronchostomy) and found that I had some very compressed pieces of lung in there but not dead stuff. Once my breathing under control, I was released again with no blood thinners that I was on the ENTIRE time while in.

    I had an appointment the next day to see my pain management doctor and he almost didn't let me go, and wanted to put me in the hospital right away. I looked that bad. I went to the hospital that I was just released from and they did xrays and everything looked the same so I decided to not stay for observation. I was sent away again with no blood thinners. This very night I developed a HUGE DVT in my left leg from groin to foot. and a piece broke off went through my heart and lodged in the arteries in my lungs. Of course my fever shot up!

    I went to hospital #3 (the VA) and they found the DVT and the PE and put me right back on the same blood thinners as hospital #1 and #2. The ONLY difference here is that after treatment and letting me go, I was trained on giving myself the shots in the belly and sent home with enough to get me through until I was able to transition to warfarin and you are absolutely correct, that it has been a journey getting it under control, but I think we're there.

    Now after talking to friends that are in the medical profession, I am told that blood clots are common for months after having the kind of trauma I went through. To not keep me on them for x amount of time until we could be sure the chances were minimal and pull me off of them. I mean, to me, there has to be some level of common sense here. However, it seems hat common sense is lost when it comes to doctors. If I had been giving myself those shots all along, the chances of getting the DVT and the PE would have been greatly reduced as well as having these life threatening conditions.

    Now I'm back to work, with no filter in that leg with the DVT and a good sneeze could shake a piece loose and quite possibly kill me. Can you imagine the stress?

    David

  8. #8
    Join Date
    Oct 2010
    Location
    US
    Posts
    16

    Default Re: Should I Have Been on Blood Thinners After Hospital Discharge

    Quote Quoting wanabegates
    View Post
    Now after talking to friends that are in the medical profession, I am told that blood clots are common for months after having the kind of trauma I went through. To not keep me on them for x amount of time until we could be sure the chances were minimal and pull me off of them. I mean, to me, there has to be some level of common sense here.
    Yep, you'd very likely have avoided the problem with the post-discharge heparins. But the older standard of care was to anticoagulate until discharge in the absence of any signs of DVT. Maybe the hospital has it's own manual on that, which was or wasn't followed. The standards also vary from place to place. As an example, I believe they do lots more anticoagulation in Australia... because of people arriving on long flights from all over (like the guy from Jethro Tull 10 yrs ago).

    Did anybody ever do a D-dimer blood test on you to detect thrombosis? You might have had the DVT from early on, but it was subclinical until the fever made it progress.

    Btw, there are new oral anticoagulants on the way sometime, like dabigatran (which is essentially made from leech saliva)

    I see what you mean, being without the venous filter and the stress. As far as risk, you might compare your situation to those who are post orthopedic surgery as being similar, to see on what curve the risk declines. Good luck to you.

    Here are some case histories used in med mal risk management education:
    http://www.norcalmutual.com/cme/DVT.pdf

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