Heather Hansen and paralegal Lexi Romney recently received a defense verdict on behalf of an orthopaedic surgeon in Philadelphia County. A 65-year-old woman presented to the orthopaedic surgeon with knee pain. MRI demonstrated a non-displaced occult fracture of the distal femur. The patient was prescribed a long leg brace, instructed to remain non-weightbearing, and told to follow up with her primary care physician for purposes of anticoagulation to help prevent deep vein thrombosis. The orthopaedic surgeon contacted the patient’s primary care physician about his recommendations. Later the same day, the patient’s primary care physician contacted her on the telephone and discussed the options of using Coumadin or increasing her Aspirin dose from 81mg daily to 325mg daily. The patient chose to increase her dose of Aspirin.

Thereafter, the patient continued to follow up with the orthopaedic surgeon who noted that she was on anticoagulation per her primary care physician. The patient continued to go to work, but despite receiving a walker, she found it too difficult and preferred to use a wheelchair obtained by her husband. She did not tell the orthopaedic surgeon or her primary care physician that she was not using the walker.

Several weeks after her diagnosis, the patient started having nausea, vomiting, diarrhea, sweating and shortness of breath. Eventually, an ambulance was called to her home. After being loaded in the ambulance, the patient became unresponsive and coded. Resuscitative measures were unsuccessful. An autopsy reported the cause of death as pulmonary embolism, deep venous thrombosis, and immobility following femur fracture.

The patient’s husband brought suit against the orthopaedic surgeon and the primary care physician alleging that they were negligent by failing to ensure that adequate anticoagulation and deep vein thrombosis prophylaxis was provided. At trial, plaintiff presented expert witness testimony that Aspirin, an antiplatelet medication, was not standard of care and that an anticoagulant, such as Coumadin, should have been prescribed to the patient. The defense also presented expert witnesses who testified that the use of Aspirin was acceptable for this patient under the guidelines for anticoagulation set forth by the American College of Chest Physicians and the American Academy of Orthopaedic Surgeons. After a seven day trial, the jury found in favor of the defendants.