Slow treatment of pleural effusion can be deadly
Extra fluid around the lungs can lead to a serious infection and respiratory distress
You may have heard about U.S. Sen. Rand Paul’s recent injury at his home, in Kentucky, when a neighbor tackled him while he was mowing his lawn. Sen. Paul ended up with several broken ribs and pleural effusion.
As a Houston, Texas medical malpractice lawyer, the diagnosis of pleural effusion comes up from time to time as a significant issue in cases.
The pleura is a thin covering that lines the outside surface of the lungs and the inside of the chest wall. Pleural effusion is a condition in which a person has an unusual amount of fluid in the space between the pleura and the lungs.
With pleural effusion, too much fluid can accumulate, impairing the ability of the lungs to move smoothly and operate normally. While some people have no symptoms of pleural effusion, others can experience a cough, shortness of breath, chest pain, or fever.
When there is reason to suspect pleural effusion, the standard of care requires the physician to order radiology imaging to verify or rule out the condition. This can be done through a chest x-ray, CT scan, or ultrasound.
There are many potential causes of pleural effusion. Pulmonary embolism, which is a blood clot blocking an artery in one of the lungs, can cause pleural effusion. There can be leaking from other organs, with liver disease, kidney disease, or congestive heart failure. In this circumstance, fluid generally builds up and then find its way into the pleural space. Lung cancer can cause fluid accumulation and pleural effusion. So can lung infections, such as tuberculosis or pneumonia. Patients with autoimmune disorders, including conditions like rheumatoid arthritis or lupus, are prone to pleural effusion.
In situations where a patient has extensive pleural effusion, doctors may drain the excess fluid through a needle, chest tube, or catheter. The standard of care also requires investigating the cause of pleural effusion, and then treating it appropriately. Medical therapy could include antibiotics for an infection or diuretics for congestive heart failure.
An example of pleural effusion malpractice
I recently read about a medical malpractice case in which a patient presented to a hospital emergency room with complaints of back pain, cough, and fatigue. The emergency physician appropriately ordered a chest x-ray, which revealed a small pleural effusion in the right lung. The patient was discharged, with instructions to see a primary care provider.
The next day, the patient saw a nurse practitioner, who ordered another x-ray. The pleural effusion was still present, and the provider could not rule out the possibility that it was being caused by an active infection. Unfortunately, the nurse practitioner chose to refer the patient to a lung specialist (pulmonologist), rather than sending her to the hospital for drainage of the excess fluid surrounding her lung, testing to culture the type of bacteria causing the infection, and appropriate orders for antibiotic medications.
By the time the patient got in to see the pulmonologist, two weeks had passed. The pulmonologist documented in the medical records that the patient continued to have shortness of breath, was coughing phlegm, and had a history of prior pleural effusion. The pulmonologist diagnosed the patient with a medium pleural effusion of an unclear cause.
The standard of care requires doctors and mid-level providers, like nurse practitioners and physician assistants, to go through differential diagnosis process. This is an organized process that begins with identifying each potential cause for an illness, and then using an organized process, including testing, to rule each potential cause out before arriving at a diagnosis. Skipping any step in the differential diagnosis process is a violation of the standard of care and needlessly endangers patient safety.
Unfortunately, the pulmonologist failed to drain the excess fluid caused by the pulmonary effusion, but ordered more testing for another date. Before that could occur, this 58-year-old lady was rushed to the hospital in severe respiratory distress and labored breathing. She coded and died.
An autopsy showed that her pleural effusion had become a smoldering infection, including pneumonia in both lungs, pulmonary abscesses in the right middle lobe and empyema of the right pleura.
Sadly, each of the healthcare providers contributed to a terrible lapse in the standard of care and cause the avoidable death of this woman.
We are here to help
At Painter Law Firm, in Houston, Texas, we focus on handling medical negligence cases. If you or someone you care for has been seriously injured as a result of medical malpractice, call us at 281-580-8800, for free consultation about your potential case.
Robert Painter is a former hospital administrator who is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He represents patients and family members and medical negligence and wrongful death cases against hospitals, doctors, surgeons, nurse practitioners, and physician assistants.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine