I can’t breathe: Barbara Dawson should be alive today

December 27, 2015

Barbara Dawson, 57, collapsed and died while handcuffed in the street on the Monday before Christmas outside Liberty Calhoun Hospital in Blountstown, FL after she was arrested by police and forcibly removed from ER where she sought medical assistance to help her breathe. She died of a massive pulmonary embolism that could have been diagnosed within a few minutes and successfully treated by the medical staff upon admission to the hospital.

NBC News reports,

Police were called to the emergency room when Dawson, who had been discharged by physicians, refused to leave. She was charged with disorderly conduct and trespassing and was escorted out of the hospital in handcuffs.

Dawson then collapsed as she arrived at the officer’s car.

“Our officer asked for help once he realized the patient did indeed appear to be unresponsive and had medical staff respond to Ms. Dawson,” Blountstown Police Chief Mark Mallory said in a statement on Wednesday.

Dawson was readmitted to the emergency room — where she was pronounced dead an hour later. The Florida state medical examiner ruled on Wednesday that she died from natural causes due to a blood clot in her lung. The blood clot was due to Dawson being excessively overweight, officials said.

/snip/

Dawson’s aunt Angela Donar witnessed the incident, according to NBC station WJHG. Donar said her niece didn’t leave the hospital because she was still in pain, even though she was deemed medically stable to leave.

“When he got her to the car, he opened the door and tried to put her in the car and after then she collapsed,” Donar told the station. “They got the doctor to come out there and get a pulse of her and they couldn’t get no pulse. They bought a stretcher out there and took her back in the hospital.”

According to Chief Mallory, she was arrested for disorderly conduct and trespassing when she refused multiple requests to leave the ER.

According to CEO Ruth Attaway of the Calhoun Liberty Hospital, pulmonary embolisms are “difficult to detect and can be impossible to treat.”

Bullshit!

No reasonably competent medical professional in a hospital ER would refuse to treat, discharge and call the cops on a patient who came into the ER complaining that she was experiencing chest pain and having difficulty breathing. The staff would have been able to visualize the PE with a Chest Spiral CT.

Wikipedia explains what a pulmonary embolism is and this is what it looks like.

Saddle Pulmonary Embolism (PE) Dr. Nir Hus MD., PhD. Image #3
Photo courtesy of Dr. Nir Hus, MD, PhD at Flickr

Wikipedia does not list obesity as a risk factor for pulmonary embolisms.

Daryl Parks is representing Ms. Dawson’s family. He works with Benjamin Crump. I do not believe he is going to have any trouble piercing the victim-blaming smokescreen spewed out by CEO Attaway.

Victim blaming is disgusting. Blaming a patient for dying after you kick her out of your ER is unconscionable.

I can’t breathe.


Liability issues for the death of Jahi McMath

January 3, 2014

Friday, January 3, 2014

Good afternoon:

I never did figure out why the comments were closed on yesterday’s post. Crane deserves the credit for correcting the problem. She republished the post without changing it and deleted the original. I have no idea why that worked, but I’m delighted that it did.

Many excellent comments and I hope y’all will continue commenting as the tragic circumstances engulfing Jahi’s family touch us emotionally and focus our attention on the fundamental question of identity

Who are we and what is consciousness?

In what sense are we alive, if we are not conscious?

Do we want our body to be kept alive by a machine when we can no longer be conscious?

If you do not want your body to be kept alive by a machine after your brain ceases to function, please consider making a written document expressing your intent so that it can be provided to your physician if you should be in that situation.

Cielo commented yesterday about Jahi’s cause of death. Since this is a law blog, I’m going to answer her question and assume for the sake of argument that death may be defined as absence of brain activity. Pursuant to that definition, Jahi is dead and she should be disconnected from life supporting equipment.

Here’s Cielo’s comment.

Also, you wrote: except to say that I believe the anesthesiologist may be liable for her death.” I would very much like to read your reasoning. Jahi made it through the surgery alive, conscious and wanting a popsicle. The complications began AFTER she was transferred to the ICU. Several things to remember that are NOT always mentioned in the news: Jahi was obese, had sleep apnea, uncontrolled incontinence and maybe diabetes. The tonsillectomy was NOT routine but complicated by the health issues as well as the fact that they ALSO removed additional sinus material. My personal belief is that Jahi fell asleep, had a sleep apnea episode, woke up coughing violently (I get occasional sleep apnea and it is very frightening to wake up unable to breathe), tore any number of internal sutures from the coughing, drowned on the blood draining to the lungs triggering a heart attack and then she died from being unable to get any oxygen. An autopsy could find the torn sutures UNLESS after 3 weeks, no such evidence could be found. I’ve read the body continues to heal. I’ve also read that the body begins to decompose, so I don’t know WHAT is happening inside the body right now. In either case, malpractice will be very difficult to prove. Were I on a jury of this case, I could easily see a tragic medical complication that was not caused by negligence or incompetence. Not every death is someone’s fault. Your thoughts?

My answer:

You may be right about her being OK until she suffered a sleep apnea episode in the ICU. Unfortunately for us, but understandable for the protection of Jahi’s privacy, the hospital records have not been released to the public. We need the records, our own experts to read and interpret them, and an opportunity to depose their witnesses under oath in order to determine her cause of death and identify who is responsible.

The problem for the hospital is that a 13-year-old girl died in the ICU after her tonsils and some excess sinus tissue were surgically removed. That result wasn’t expected and will have to be explained.

The legal doctrine of res ipsa loquitor may prevent the hospital from escaping liability by claiming that responsibility cannot be assigned to any particular person. The plaintiff, which probably would be her mother suing for wrongful death, would only need to show that she died while in their care and she would not have died unless someone was negligent.

I don’t believe there is any question about whether she died while in their care. Therefore, I will focus on what caused her death and whether it was a reasonably foreseeable event.

Under the circumstances you have described, death occurred in the ICU due to heart failure caused by excessive post-operative bleeding into the lungs from the surgically repaired area brought on by a fit of coughing and choking during a sleep apnea episode.

With all due respect, I am going to stick with my original best guess, which is to suspect the anesthesiologist. I suspect the anesthesiologist may not have inserted the endotracheal tube properly at the junction that leads to the two lungs or it may have become displaced during surgery resulting in an insufficient flow of oxygen to the lungs. Insufficient oxygen to the brain will cause brain death.

Alternatively, I suspect the surgeon may have nicked a blood vessel causing extensive bleeding that could not be stopped precipitating a heart attack.

I believe something went wrong during surgery or she would not have been placed in the ICU. She would have been intubated in the ICU, so the scenario you described is unlikely.

I do not believe the uncle who said she asked for a popsickle in the recovery room because she would have been intubated and unable to speak. I also believe she would have been taken directly to the ICU from the OR because she was in trouble or already dead and the ICU is better equipped to deal with an emergency than the recovery room.

Finally, I do not believe Jahi underwent a difficult surgery. On the contrary, I think it was an easy surgery and she should be alive today, but for negligent acts that occurred in the OR during surgery.

Liability in tort depends on the existence of:

(1) a duty to exercise due care to avoid injuring foreseeable plaintiffs;

(2) a breach or violation of that duty;

(3) injury to a foreseeable plaintiff; and

(4) injury proximately caused by the breach of duty.

Now, the analysis:

Jahi was a foreseeable plaintiff because she was a surgical patient and the surgeon who performed the surgery had a duty to perform it according to the medical standard of practice in his community. At this time, we lack sufficient information to conclusively determine whether he violated his duty, even though the episode of excessive bleeding suggests that he did.

We differ regarding when it happened, but even if you are right and it happened in the ICU, nurses are trained to deal with that problem and should have been able to stop the bleeding. If not, then the likely cause of the bleed was something that happened in the OR, not coughing or a sleep apnea episode since she would have been intubated.

The ultimate question is whether the cause of Jahi’s death was a reasonably foreseeable event and whether the hospital acted reasonably to prevent it from happening.

This case does not involve strict liability. The legal standard is negligence and proof of negligence requires evidence that it’s more likely so than not so (i.e., preponderance) that someone breached their duty to do something they were supposed to do and, but for that breach of duty, Jahi would not have died.

I think they are going to have a difficult time escaping liability, no matter how difficult the surgery may have been, because I doubt this surgery is considered to be risky and the ICU nursing staff should have been able to prevent her death.

This is our 831st post.


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