Sepsis is a silent killer that should be diagnosed and treated with the same urgency as a heart attack. But it is not treated with urgency and it is the one reason so many medical malpractice lawsuits in Maryland involve either missed sepsis diagnosis or a failure to adequate treat this infection.
Sepsis is a catastrophic health problem that is responsible for over 250,000 deaths per year in this country. There are over 20,000 cases of sepsis in Maryland hospitals every year. Do you think Donald Trump’s wall is too expensive? We spend more $20 billion dollars on the diagnosis and treatment of sepsis. It is the most expensive condition treated in hospitals and a lot of that cost is care rendered after a doctor makes a mistake.
Sepsis is an infection of the bloodstream from some other source. Severe sepsis can result in organ failure that can kill you. These are the symptoms of sepsis that should give put doctors and hospitals on alert:
- temperature greater than 100.4F or less than 96.8F
- white blood cell count greater than 12,000 or less than 4,000
- heart rate greater than 90
- decreased blood pressure
- respiratory rate greater than 20
- altered mental status
- low oxygen saturation
- Skin is cool, blue or mottled (because blood flow is reduced)
- failure of multiple organs
Many Malpractice Cases Begin with Ignored Symptoms
You can stop here for the birthplace of many Maryland wrongful death malpractice lawsuits. Often, the failure to investigate the sepsis appropriately by, for example, getting an infectious disease consultation these symptoms arise, can be a breach of the standard of care. But, really, it should not take an infectious disease doctor to know that any serious infection needs to be treated with antibiotics on an urgent basis and you have to make sure the patient does not have an infection. Maryland EMS’s have a protocol for sepsis. If there are 20,000 cases a year in Maryland, everyone who is seeing patients in a hospital or primary care setting has to be jumping on the symptoms to rule out sepsis.
When two or more of these are met, it is time to act. The good news is doctors have a ton of weapons at their disposal that can help the patient. Antibiotics, blood cultures, and fluid resuscitation are just some of the many tools doctors can have to diagnose and treat. Antibiotics are a big deal. The correlation between the prompt administration of intravenous antibiotics and survival is very strong.
- Example of a sepsis misdiagnosis lawsuit against Kaiser in Montgomery County
- Another sepsis misdiagnosis case, this one against Holy Cross
- Sample verdicts and settlements in sepsis cases
When we get to septic shock the horse is starting to get out of the barn. Septic shock occurs when sepsis is not treated and the body is not able to cope with the infection. The theory is that sepsis represents an over exuberant inflammatory response in response to invading bacteria or other pathogens in which various mediators released by white blood cells and tissues cause excessive activation of host defense mechanisms. This results injury to the patient. If a patient has septic shock, antibiotics will not get the job done. The source of ongoing infection must be identified and removed before inflammatory mediated damage can be reversed.
How Defense Lawyer Fight These Cases
A lot of sepsis cases are “what or earth were these doctors thinking?” cases. So what do defense lawyers do? Well, many patients with sepsis have a complex medical history. So the go-to leitmotif you hear is that the patient was going to die no matter what. There seem to be some — perhaps not so coincidentally well paid by defense lawyers– infectious disease and critical doctors who think that just about anyone who does die would have died anyway. There is no question that there are cases where this defense is valid. Not all 250,000 sepsis deaths every year are from malpractice. But far too many of these cases are medical negligence claims. The good news for plaintiffs is that if the doctor’s defense is “even if I hadn’t screwed up this patient would have died anyway” their patented “I am a doctor and therefore infallible” defense is already laying on the courtroom floor. If the patient would not have died except for the misdiagnosis, you will be able to marshal powerful evidence to prove the patient would have lived.
How do doctors try to get around missing the classic symptoms of sepsis? One common path is to say that the symptoms of sepsis are the same as many other serious ailments so they had reason to suspect something other than sepsis. This argument fails to understand that doctors can walk and chew gum at the same time. A differential diagnosis is to keep looking until you rule out possibilities. If you have a disease that kills 250,000 people every year, you want to keep that on your list of possibilities. You think the patient has pancreatitis? Fine. But keep testing to rule out sepsis.
Defense lawyers also know that juries want to blame someone when something awful happens that should not have happened. In those cases, the tried and true defense is blaming the patient. They will say the patient failed to disclose a possible source of infection (often because the wrong questions were asked) or that the patient’s own poor health choices caused the infection. Usually, if the defense is digging down this deep, you are in a pretty good position. These cases often either settle out-of-court or the jury sees it for just what it is.