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$1,050,000 Settlement for Medical Malpractice Stroke After Surgery Related to Coumadin Levels

Essex County: In this medical malpractice action, handled by Barry R. Eichen, Esq., the plaintiff, 52 at the time of the recovery, who had undergone surgery to replace a leaking mitral valve, contended that the defendant internist negligently failed to properly monitor the plaintiff’s Coumadin levels. The plaintiff as a result suffered a stroke approximately 3 months after the surgery. The plaintiff also named the cardiologist who performed the surgery and who saw the patient several times in the approximate four-month period between the surgery and the stroke. The plaintiff had contended that the cardiologist should also be liable for the failure to properly monitor the Coumadin levels and there was no contention that the valve replacement surgery was performed in a negligent manner.

The surgery was performed on 2-28-00. The plaintiff then commenced a course of the blood thinner Coumadin, which was monitored by the defendant internist, who was the plaintiff’s primary care physician. The plaintiff’s expert internist contended that until the physician can determine the sensitivity the patient has to Coumadin, the physician should monitor the levels twice per week. The expert related that when it has become apparent that the therapeutic levels are sustained, the monitoring can be less frequent. The plaintiff’s expert further related that the levels are measured in terms of International Normalized Ratio (INR) and should be between 3 and 4 on such a scale. The plaintiff maintained that although the defendant internist monitored the plaintiff in a timely fashion during the first several week period, he negligently failed to continue to monitor the plaintiff at sufficient intervals between this period and the time of the stroke in June. The plaintiff contended that in March, the INR levels were between 9 and 10 and that the adjustments in the dosage resulted in a drop to a level below 2. The plaintiff maintained that despite such difficulties in obtaining the proper levels, the defendant internist continued to see the patient intermittently. The plaintiff also maintained that the cardiologist should have monitored the levels when he saw the patient approximately every other month. The defendant cardiologist maintained that he could validly rely upon the internist, who was the plaintiff’s primary care physician, to properly monitor the patient.

The evidence disclosed that in June, the plaintiff saw the cardiologist with signs and symptoms of atrial fibrillation and the cardiologist planned on treating this condition through electrical cardioversion using a defibrillator. In preparation for this treatment, the cardiologist performed a transesophageal echocardiogram and noticed signs of a blood clot. The cardiologist delayed the cardioversion, ordered that the dosage of Coumadin be elevated, but the plaintiff suffered the stroke the following day.

The defendant internist denied that the stroke was related to the Coumadin levels. The defendant maintained that the irregular heartbeat associated with the atrial fibrillation itself probably caused the clot. The plaintiff would have countered that any danger of the atrial fibrillation producing a clot rendered the need for proper monitoring of the blood thinner all the more crucial.