A pulmonary embolism (PE) is the blockage of the pulmonary artery (a major artery in the lung), usually caused by a blood clot. The severity of PE depends primarily on two factors: the size of the blockage and the speed of diagnosis and treatment.
A small PE can cause no symptoms and can have no significant effect on the patient’s health. A large PE can cut off blood flow to the lungs and can even be fatal.
PE is one of the most common preventable causes of hospital death in the United States. In this article, we discuss the risk factors for PE, identify guidelines that hospitals should follow to prevent PE, and describe what a medical malpractice case against a hospital for negligence causing PE might look like.
Risk Factors for Pulmonary Embolism
PE is very closely associated with a condition called Deep Vein Thrombosis (DVT). In most cases of PE, the patient develops blood clots in the deep veins of the calf or thigh. A clot (basically a hard lump of blood vessels) breaks off of a mass in the leg and travels to the lung, where it becomes lodged, causing the PE. Thus, the risk factors for PE are closely associated with the risk factors of DVT.
Some individuals are more at risk for PE and DVT than others. The following factors increase the risk of DVT and therefore PE:
- prolonged immobility
- major surgery, particularly of the hip or knee
- admission to intensive care units
- 60 years of age or older
- previous DVT or PE, and
- certain medical conditions (stroke with lower limb paralysis, sepsis, and inflammatory bowel disease).
Guidelines that Hospitals Should Follow to Prevent Pulmonary Embolism
Fortunately, hospitals have a defense against PE: anticoagulants (blood thinners). Anticoagulants reduce blood clotting. They are a great way of preventing PE, but they have a significant side effect. If a patient suffers an open wound while on anticoagulants, the patient may have difficulty stopping the bleeding. As a result, hospitals do not prescribe anticoagulants to every patient. The hospital must make a determination based on the unique circumstances of each patient.
For example, if an elderly patient who has previously suffered from DVT comes to the hospital in need of a total hip replacement, it is highly likely that the hospital will place the patient on anticoagulants. But if an otherwise healthy 20-year-old patient comes to the hospital for arthroscopic knee surgery, anticoagulants are probably unnecessary.
But the use of anticoagulants alone is insufficient to protect patients from PE. The hospital staff should also closely monitor patients at risk for PE for signs of developing DVT. Those signs include pain, swelling, warmth, and redness of the calf or thigh (especially if the symptoms occur in only one of the patient’s legs).
Since immobilization is a significant cause of DVT, walking is an excellent way to reduce the risk of PE. To the extent possible, hospitals should get patients walking soon after surgery.
Proving That Pulmonary Embolism was Caused by Malpractice
In order to hold a doctor or hospital legally liable for medical malpractice, the patient (usually through his or her attorney and a retained medical expert witness) will show how the health care provider deviated from the accepted medical standard of care — first walking the jury through what a reasonably skilled physician or hospital would have done under similar circumstances, and then showing how the chosen course of treatment in the instant case failed to meet that standard.