No one likes to think about risks associated with surgery. When we go into a surgical procedure, we trust that the surgeon has things under control. We’re busy planning ahead for a full recovery (and how we’ll pay the medical expenses).
We don’t expect to lose our lives to blood clots or pulmonary embolism.
Surgery complications injure thousands each year, but the deadliest injuries come from poor surgery aftercare.
Surgeons walk off leaving patients in the hands of undertrained PAs, nurses and residents during the critical recovery period – staff who continually fail to properly administer blood thinners.
Because of this, blood clots after surgery are the number one cause of preventable death in U.S. hospitals, affecting up to 600,000 Americans annually and taking the lives of up to 200,000. Patients having knee surgery, hip replacement surgery and abdominal surgery are particularly at risk.
I know what my clients are going through.
My father died of pulmonary embolism after minor knee surgery. I also understand how helpful financial compensation for a surgeon’s negligent acts can be, aiding with medical bills, lost wages, pain and suffering and funeral expenses.
If you are reading this, you may be or know someone who has developed blood clots after surgery. It can be helpful to have answers to the following questions:
- What risks are associated with surgery?
- Who is at risk for blood clots after surgery?
- How do surgeons prevent pulmonary embolism?
- What is blood clot medical malpractice?
The Florida pulmonary embolism malpractice attorneys at Kelley Uustal have prepared this guide and hope you find the information helpful.
How Risky is Surgery in Florida and Throughout the U.S.?
All surgeries, even the most common procedures, come with risks. It is difficult to state exact numbers when it comes to surgery survival rates because each patient goes in with different underlying health risks.
For example, patients over the age of 65 and obese patients often have higher surgery mortality rates than healthy young adults.
But as a general rule, the more complicated or invasive the surgery, the higher the risk of death.
With today’s medical advances and capabilities, why do people still die after surgery?
The fact is, most surgery injuries and deaths are associated with human error - mistakes made by the surgeon, anesthetist or surgical staff.
Some common mistakes made during surgery include:
- Anesthesia under dose or overdose
- Surgery on the wrong site
- Leaving surgical sponges or instruments in the patient
- Using poor techniques that lead to post-surgical infection
- Accidental injury to blood vessels, nerves or organs
Mistakes like these used to be much more frequent.
In the 1990’s and early 2000’s, U.S. surgeons were making high numbers of completely unacceptable, ludicrous mistakes – operating on the wrong patients, amputating the wrong body parts, and performing the wrong procedure entirely.
Error rates started to improve once doctors and hospitals gained some financial incentive to avoid these types of mistakes. In August 2007, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare would no longer pay for costs associated with these “Never Events.”
CMS Never Events are extreme medical errors that cause unambiguous, serious, preventable adverse events.
For example, today a surgeon will mark your left leg with a Sharpie to make sure he doesn’t accidentally amputate your right one.
Highest Surgery Danger During Post-Surgery Care
Unfortunately, this financial incentive doesn’t exist for postoperative care, and this is where many surgery patients are injured or lose their lives. A variety of complications can arise after an operation, including:
- Blood clots
- Internal bleeding
- Bowel leakage
- Bowel blockage
- Nerve damage
Some of these dangerous conditions arise because the surgeon failed to notice injuries that occurred during the surgery. For example, if a surgeon accidently nicks an artery and doesn’t spot it, the patient can suffer slow internal bleeding during the days after his recovery that may go unrecognized until it is too late.
But many post-surgery complications happen because there is no financial incentive for the surgeon to stick around and monitor the patient after the operation.
Your surgeon has the most knowledge about your health history, the surgery itself, and the potential complications that could arise after surgery. But according to the insurance companies, when a surgeon finishes the operation, they have finished their job.
At this point, the lesser-trained nurses, residents and physician assistants are left to close up the incision and monitor your recovery – a very dangerous approach to post surgery care.
The rush to get surgery patients out the door also contributes to the deadly nature of care after surgery. Most hospitals want patients discharged as quickly as possible after surgery to keep costs low and free up a bed for the next patient. Costs can quickly add up if an outpatient surgery suddenly requires an overnight stay.
Poor post-surgery care and a rush to discharge patients cause thousands of injuries and wrongful deaths every year, particularly those involving blood clots and the use of blood thinners.
Number One Cause of US Hospital Preventable Death (Subtitle)
Blood clots in the veins after surgery (venous thromboembolism) are the number one cause of preventable death in U.S. hospitals, affecting around 300,000 to 600,000 Americans each year. Invasive surgery patients have a risk of developing two types of venous thromboembolism: deep vein thrombosis and pulmonary embolism.
An estimated 350,000 hospitalized patients develop deep vein thrombosis (DVT) each year. DVT is a blood clot that forms in a vein, usually after surgery (exposing blood to air), or in patients who are immobile for long periods of time. In most cases, the blood clot forms in a deep vein of the upper or lower leg.
This blood clot may grow to a size that damages or restricts the valves that help move blood to the heart. If this happens, blood will begin to pool around the area of the clot.
In pulmonary embolism (PE), that blood clot breaks free from its location in the leg, moves through the body, and becomes lodged in the small capillaries of the lungs. Hospitals diagnose between 250,000 and 300,000 U.S. patients with PE every year, 50,000 to 200,000 of those patients losing their lives.
Fractures, Knee Surgery and Hip Replacement: Highest PE Risk
A patient’s risk of developing DVT and PE varies based on their age, gender, health condition and the type of surgery. Deep vein thrombosis and pulmonary embolism risk increases significantly for patients 60 years or older. DVT and PE risk is slightly higher in women.
Any kind of invasive surgery can cause DVT and PE, but certain surgeries show an increased risk. Fracture repairs, knee surgery, hip replacement surgery and abdominal surgery are at highest risk for developing pulmonary embolism.
In addition, patients who are obese or pregnant, patients who smoke, and patients with ovarian cancer, lung cancer and pancreatic cancer show a higher risk of pulmonary embolism.
Symptoms of Pulmonary Embolism After Surgery
So how do you know if you have a blood clot after surgery?
The answer is, you likely won’t. Half of all patients with blood clots in the legs (DVT) show no symptoms at all. The other 50% may have swelling and pain in the affected area.
For PE patients, symptoms vary widely from person to person. Patients who are able to report symptoms of pulmonary embolism often experience:
- Shortness of breath (sometimes only while lying down)
- Chest pain
- Labored breathing, wheezing
- Loss of consciousness
Unfortunately, most pulmonary embolism patients die before experiencing any symptoms. In 25% of pulmonary embolism patients, the first symptom is sudden death. Another 10% to 30% of patients with PE die within one month after diagnosis.
Without treatment, approximately 33% who survive a post-surgery PE will die from a subsequent event within 10-years.
How Doctors Prevent Post Surgery Blood Clots
Because DVT and PE are so difficult to detect (many times presenting no symptoms at all) and can result in rapid death, treatment isn’t often an option. Surgeons and medical staff must therefore work to prevent blood clots before they happen.
Decades of research and clinical trials have formulated exactly what medications and precautions are successful in preventing these dangerous events. These prevention protocols have proven very effective, with just one catch – surgeons and surgical staff must follow them to the letter.
Interventions against post-surgery DVT and PE may include one or a combination of:
- Anticoagulants (blood-thinners)
- Antiplatelet medications
- Cyclical pneumatic calf compression
- Compression stockings
- Inferior vena cava (IVC) filter
Anticoagulants and Antiplatelet Medications
The most successful protocols for preventing postoperative blood clots involve the use of blood-thinning drugs (anticoagulants) and antiplatelet medications. These drugs slow or inhibit the body’s clotting process, reducing the patient’s risk for developing DVT and PE.
Proper blood thinner use can decrease deep vein thrombosis risk by as much as 86% and may prevent pulmonary embolism death in as many as 1 out of every 200 surgery patients.
- Common Anticoagulants
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- edoxaban (Savaysa)
- fondaparinux (Arixtra)
- rivarosaban (Xarelto)
- warfarin (Coumadin)
- Common Antiplatelets
- clopidogrel (Plavix)
- dipyridamole/aspirin (Aggrenox)
- eptfibatide (Integrilin)
- prasugrel (Effient)
- ticagrelor (Brilinta)
- tidodipine (Ticlid)
While blood thinners can save lives, they can also be dangerous if used inappropriately.
This means high risk patients taking anticoagulants must be carefully monitored - not for an hour or two, but for days to weeks after surgery.
Depending on your age and health status, your surgeon will determine which blood-thinner to use, when to start and stop the medication, and how quickly or slowly to start and stop the medication. Too much anticoagulant after surgery can increase chances of internal bleeding. Too little can increase your risk for developing blood clots.
Caregivers must balance reducing your risk for DVT and PE with preventing post-surgery internal bleeding. And each drug acts differently within the body.
For example, the anticoagulant Coumadin takes several days to start working and lasts several days after you stop taking it. Nurses will usually try to “bridge” this effect with shorter acting drugs like Heparin. Oral anticoagulants like Pradaxa and Xarelto are short acting, so they’re easier to stop and start quickly.
Most anti-clotting drugs also have counteractive drugs you can use in emergencies. For example, nurses can give Vitamin K1 to a patient on Warfarin who starts bleeding internally, allowing the blood to clot again. Xarelto is a particularly risky drug because there is no antidote.
Inferior Vena Cava (IVC) Filter
Doctors can use a more recent and somewhat controversial technique, the inferior vena cava (IVC) filter, to prevent pulmonary embolism in patients who can’t take blood thinners or are at extremely high risk for PE.
The concept is this: Blood flows from the lower body to the heart and lungs through the inferior vena cava. By placing a tiny filter in the inferior vena cava, any blood clots that form in the lower body will be trapped before entering the lungs, preventing pulmonary embolism.
IVC filters are only recommended for patients with a high risk of developing PE who cannot take anticoagulants, like those with hemophilia, active stomach ulcers, cerebrovascular hemorrhage, severely low platelet counts, or severe liver disease. This is because IVE filters have a high incidence of adverse events. They can migrate out of place, cause clots at the implant site, perforate the IVC or break up into sharp pieces.
Types of Malpractice Causing Pulmonary Embolism
While most surgeons and health care staff are passionate, caring professionals who want the best for their patients, today’s health care system challenges their ability to perform 100%. Hurried hospital staff must follow a cookie-cutter approach to patient care, unable to take the time required to properly treat each individual.
Indifferent insurance companies, big pharma and greedy medical conglomerates drive hospital and clinic policy.
Yet, a poorly functioning machine doesn’t excuse surgeons and hospitals from liability for injuries caused by negligence.
Medical professionals and health care facilities have a legal and moral duty to practice a specific standard of care – and injured patients and their families have a right to collect financial compensation when that standard of care is not met.
Despite the proven protocols for successful prevention of postoperative DVT and PE, many Americans, including myself, have lost loved ones to pulmonary embolism after surgery. Unfortunately, most cases of DVT and PE are the result of medical malpractice.
We see various types of medical malpractice involving negligence in DVT and PE prevention, including:
- Failure to follow anticoagulant guidelines
- Failure to diagnose DVT or PE
- Communication failures between medical staff
- Failure to evaluate patient risk
- Pharmaceutical drug manufacturer negligence
- Medical device manufacturer negligence
Failure to Follow Anticoagulant Guidelines
In pulmonary embolism prevention, every medical facility publishes practice guidelines for anticoagulation management.
This document is created from highly-researched evidence provided by the American College of Chest Physicians on antithrombotic therapy for venous thromboembolism. It also includes input from each relevant hospital department, including Hematology, Pharmacy, Cardiology, and Neurology.
These guidelines lay out carefully crafted algorithms that guide surgeons on doses for starting and stopping anticoagulants, using combined therapy, moving from one anticoagulant to another, and dealing with special issues like present blood clots, atrial fibrillation, cerebrovascular disease, coronary artery disease and heparin-induced thrombocytopenia.
Surgeons and staff who follow these guidelines reduce the incidence of DVT and PE significantly.
Yet, time and again, new doctors, nurses, physician assistants, residents and other undertrained care providers fail to follow these sensitive protocols, leading to death in many cases. They don’t pay attention to proper dosing, they don’t communicate with each other about who has given what, they don’t consider the patient’s health history in calculating doses.
In some cases, residents and nurses will chose not to give blood thinner at all, because giving a blood thinner means they will have to monitor the patient for hemorrhage and other difficulties. Giving a blood thinner could mean a longer patient stay, something doctors and nurses are trained to avoid.
Failure to Diagnose DVT and PE
One common act of negligence is a failure to diagnose DVT and PE.
Doctors who rush high risk patients out the door without performing blood clotting tests (PTTs, INRs, aPTTs) that monitor the body’s response to blood thinners post-surgery may fail to detect DVT. And 50% of DVT patients exhibit no symptoms.
Even when a patient does complain of pain or swelling in the legs, a busy doctor or nurse may brush it off as normal, potentially risking a life. But because DVT is such a well-known complication of certain surgeries, a doctor’s failure to diagnose DVT or PE is usually the result of negligence.
Failure to Communicate
Another act of negligence is a surgeon’s failure to clearly communicate with the post-surgery care team and vice versa.
In the most personal case I have ever handled, I settled a wrongful death lawsuit against the North Broward Hospital District for the death of my father, Rev. Robert P. Kelley.
In November 2008, my father checked into Broward General Medical Center for minor knee surgery – a high PE risk procedure. The surgeon, nurses and hospital staff failed to communicate, sending my father home with no blood-thinner medication after surgery. He died three days later at age 77 when blood clots from his leg caused a massive pulmonary embolism.
I truly understand what my clients are going through.
Pulmonary embolism malpractice lawsuits aren’t easy to win. Hospitals and insurance companies will pull out all the stops in defending their side.
In my father’s case, we went through five years of legal back-and-forth while the hospital denied the existence of critical documents. Finally, the documents were discovered in a hearing.
After arguing that the hospital was conspiring to shift blame and avoid responsibility. The court agreed that North Broward Hospital District was willfully concealing information, and the hospital was forced to settle.
Failure to Evaluate Patient History and Risks
In 2014, 60-year-old Jeanne Marks visited her orthopedic surgeon, Dr. Brian Coleman, for reconstructive foot surgery at Delray Medical Center. Dr. Coleman ordered a full report on Mrs. Marks health history prior to admitting her for surgery. He then proceeded to operate and sent her home on orders of 6-weeks limited mobility. Mrs. Marks died 12 days later.
Though Dr. Coleman had ordered an extensive patient history report on Mrs. Marks, he failed to read it, saying it was his surgical coordinator’s job to read it. The surgical coordinator said she was only trained to look for the word “cleared” in surgical clearance examinations, so she didn’t go on to read the rest of the document.
Unfortunately, had she or Dr. Coleman read the patient history, they would have seen that Mrs. Marks was taking Evista, a medication that contains an FDA warning that it significantly increases the risk of blood clots and pulmonary embolism with prolonged immobilization.
They had sent Mrs. Marks home after surgery on orders of 6-weeks limited mobility, increasing her risk for DVT three-fold. She began to form clots in her legs after surgery, which then travelled to her lungs and heart, causing shortness of breath.
Physicians at Cleveland Clinic attempted to remove the clots but the 60-year-old Mrs. Marks didn’t make it. Her husband, William Marks, lost his wife of 36 years.
In Mr. Marks’ wrongful death lawsuit against Dr. Coleman, his physician assistant Justin Bartl, and South Palm Orthopedics, the defendants claimed that Mrs. Marks disobeyed her prescribing doctor’s instructions to call her before resuming the Evista.
But in May 2017, a Palm Beach County jury found the defendants 65% negligent in their care and treatment of Mrs. Marks, awarding her husband $1.457 million.
Pharmaceutical Drug or Medical Device Failures
Drug and medical device manufacturers have a duty to provide safe and effective products. They must test their products for defects and market them only for FDA-approved uses. They must also inform doctors and patients of all risks involved in using the product.
When a patient is injured or dies because a drug or medical device manufacturer fails to take these steps, that manufacturer is liable for damages.
Currently, patients are filing lawsuits against Janssen Pharmaceuticals and Bayer AG for failing to inform physicians that their anticoagulant drug, Xarelto, has a high risk of internal bleeding. Equally as frightening, there is no known drug that can reverse the type of internal bleeding caused by Xarelto.
The risk for internal bleeding is higher for Xarelto than for other blood-thinner medications, resulting in the death of several patients. In addition, Xarelto instructions do not require doctors to monitor patients as closely as with other blood thinners.
Defective IVC filters are also causing numerous injuries and deaths. Many individuals are filing lawsuits against IVC filter manufacturers Cook Medical, C.R. Bard, Inc., and Cordis Corporation after patients experienced serious, sometimes fatal complications like organ perforation, device fracture and migration.
In 2010, the FDA received at least 921 adverse event reports involving IVC filters. Of the 921 reports, 328 involved device migration, 146 component detachment, 70 perforation injuries, and 56 filter fracture (sharp metal pieces broke off and entered the heart or pulmonary artery).
In 2014, the FDA told doctors to remove IVC filters as soon as PE was no longer a threat, ideally between 29 and 54 days after implantation.
How to File A Pulmonary Embolism Malpractice Lawsuit
If you are reading this, you may be or know someone who has developed blood clots after surgery or has been injured by blood thinners or IVC filters.
Grieving families who’ve lost loved ones to pulmonary embolism want answers.
Many patients injured by inappropriate use of blood thinners are going to need medical care for the rest of their lives.
My first piece of advice is to speak with a legal advocate who specializes in cases involving VTE, DVT and PE. Someone who has been there and can counsel you moving forward. As a pulmonary embolism malpractice attorney who has lost a family member to PE, I am happy to answer any questions you may have.
Second, if you feel that a surgeon’s negligence or other medical professional’s carelessness caused your injury or a loved one’s death, I encourage you to consider filing a medical malpractice lawsuit.
You can learn more about Florida medical malpractice lawsuits in our free Guide for Medical Malpractice Victims and Florida Families.
Not only does filing a malpractice claim help you collect the compensation you need to recover mentally, physically and financially, but it also helps shape the policies and regulations that guide the actions of American surgeons and hospitals.
Malpractice claims literally prevent the injuries and deaths of future patients.
Winning a Florida medical malpractice lawsuit can mean collecting financial compensation to cover:
- Lost wages
- Medical expenses
- Future lost wages
- Future medical expenses
- Loss of earning capacity
- Mental anguish
- Pain and suffering
- Funeral expenses
- Loss of companionship
In order to collect the maximum available financial compensation, it is important to hire an experienced Florida pulmonary embolism malpractice lawyer with (1) access to renowned medical experts and powerful investigative resources who (2) knows how to negotiate against powerful entities for a strong settlement amount.
Remember, always choose a lawyer who doesn’t charge you anything until you win your claim.
Don’t wait too long to file. Under Fla. Stat. §99.11(4), most Florida medical malpractice lawsuits must be filed within two years of the time the patient or family member learned or should have learned (with reasonable diligence) that an injury occurred and was possibly caused by medical malpractice.
This deadline can be extended for minors and in certain other situations, so don’t give up if you think your case has expired.
An experienced medical malpractice lawyer can help you determine the time limits placed on your specific case.
We hope that you never have to file a medical malpractice lawsuit, however, if you or a loved one have been harmed by a surgeon’s negligence or defective drug or medical device, we can help you take action against the wrongdoer and claim what is rightfully yours.
If you have further questions about filing a medical malpractice claim, your rights as a patient, or other concerns, please call Bob Kelley at 954.522.6601 or Connect Online.
The Kelley Uustal Florida Medical Malpractice law firm represents clients in Cape Coral, Coral Springs, Fort Lauderdale, Hialeah, Key Largo, Marathon, Miramar, West Palm Beach, Pompano Beach, Miami, Pembroke Pines, Port Saint Lucie, and across the state of Florida. In some cases we join local attorneys in other states.