CLINICAL NEGLIGENCE CASE REPORT
In the matter of LEON KAY (Executor of the Estate of Eileen Marion Kay)
Claimant
-v-
Dr. S.S. MUSHAHWAR, (cardiologist)
Defendant.
Background to the Clinical Negligence Claim
Eileen Marion Kay was born on 12th May 1937. At the time of her admission to the Highfield Private Hospital, Rochdale in October 2002 she was sixty-five years of age.
In 1984 she was found to be in atrial fibrillation and was commenced on an oral anticoagulant Sinthrome.
In 1989 Mrs. Kay had a mitral valve replacement with a Medtronic Hall Prosthesis. After this her target INR was 3.5 i.e. acceptable range 3.0-4.0.
In June 2002 Mrs. Kay was admitted to the Highfield Private Hospital Rochdale where she was treated with intravenous antibiotics and discharged on the 24th June 2002. During the course of that admission her INR was checked on a regular basis.
On the 7th October 2002 Mrs. Kay was admitted to the Highfield Hospital under the care of Dr. Mushahwar, Consultant Cardiologist for investigation and treatment of heart failure. Her temperature was elevated and it was thought that she was septic, possibly arising from an area of cellulites over her left elbow. At 11.00 hours on the 8th October she was transferred to the High Dependency Unit. She was commenced on intravenous Benzylpenicillin and Gentamicin
On the 8th October 2002, Mrs. Kay was prescribed Amiodarone, 200mg daily. The prescription chart confirmed that 200mg Amiodarone was given daily from the 9th October 2002 until the 14th October 2002.
On the 9th October 2002 Mrs. Kay INR was checked and this was found to be 2.5. She continued to take her prescription of Sinthrome during the course of her admission.
On the morning of the 14th October 2002, Mrs. Kay developed severe abdominal pain and the possibility of either a recto-peritoneal bleed or a haemo-peritoneum was considered.
An INR reading of greater than 10 was obtained at 11.57 hours. At 13.20 hours abdominal pain was generalised with a tense abdomen. At 14.45 hours hypertensive shock was developing with a pulse of 104 and blood pressure of 85/59. At 15.15 hours Mrs. Kay's abdomen was more tender with guarding.
At 15.30 hours an intravenous line was inserted via a right temporal vein as the notes record "due to high INR." The notes further recorded "impression intra abdominal bleed query recto-peritoneal, needs Warfarin reversal with fresh frozen plasma 6 units and Vitamin K (IV) … for CT Scan of abdomen and pelvis."
At 15.30 hours 10mg of intravenous Vitamin K was given. An untimed note in the clinical records stated "CT Scan suggested splenic rupture with subcapsular haematoma. Therefore give six units of fresh frozen plasma stat and transfer to Fairfield General Hospital (the local NHS Hospital)." The nursing kardex noted that a mobile CT Scan was performed at 16.00 hours. The CT Scan report concluded that Mrs. Kay had suffered a spontaneous rupture of the spleen associated with ileus.
At 18.35 hours, the administration of fresh frozen plasma began. A lab report for a further INR with an input time of 19.03 hours recorded 4.2. Further INR at 22.20 hours was recorded as 1.2.
Unfortunately Mrs. Kay died at 23.48 hours on the 14th October 2002. A death certificate issued on the 16th October 2002 gave the cause of death as:-
(a) Spleenic rupture.
(b) Overanticoagulation.
(c) Mitral valve replacement.
The allegations of negligence
The Claimant alleged that the Defendant was negligent in:-
a). Failing to establish a proper regime for monitoring Mrs. Kay's INR during the admission between the 7th and 14th October 2002. In particular it was alleged that the care afforded to Mrs. Kay fell below the requisite standard insofar as the deceased's INR was not checked by no later than the 12th October 2002 i.e. no more than three days following the previous INR reading on the 9th October 2002.
b). Failing to heed the risk that Mrs. Kay was at significant risk of overanticoagulation because she became septic, was given intravenous antibiotics and had been prescribed Amiodarone 200mg daily from the 9th October 2002.
On the issue of causation, the Claimant alleged that had an INR reading been taken on the 12th October 2002 on the balance of probabilities this would have been in excess of the therapeutic range. By this time, Mrs. Kay had been receiving Amiodarone for three days and intravenous antibiotics since her admission. Amiodarone in particular is known to enhance the effect of anticoagulants.
Upon receipt of an elevated INR, the Claimant contended that the Defendant ought to have adjusted Mrs. Kay's Sinthrome or taken such steps as necessary so as to bring her INR back to within the target range. Had Mrs. Kay's INR been properly managed then it was unlikely on the balance of probabilities that she would have died on the 14th October 2002.
A letter of claim was submitted to the Defendant's Solicitor together with a Part 36 offer in the sum of £13,000 representing a bereavement award together with an element for the deceased's pre death pain, suffering and loss of amenity and funeral expenses. Following investigation by the Defendant's Solicitor, the Claimant's Part 36 offer was accepted. Expert opinions were obtained on the Claimant's behalf from Dr. Stephen Brecker, Consultant Cardiologist and Dr. Trevor Baglin, Consultant Haematologist.
The Solicitor for the Claimant, Eddie Jones, JMW Solicitors, 5-7 Byrom Street, Manchester, M3 4PF.
Solicitor for the Defendant, Radcliffe LeBrasseur, 6-7 Park Place, Leeds, LS1 2RU.
JMW Medical Negligence Solicitors offer free initial advice on clinical and medical negligence claims, evaluating whether you have a case. We are able to deal with cases using public funding (formerly Legal Aid) or No Win No Fee in appropriate cases.
For an assessment of your potential claim, please click here to complete our online enquiry form and one of our specialists will contact you shortly or please contact us on 0845 402 0001.
