Wednesday, March 28, 2012

Death by Ankle Sprain

A recent and unfortunate death is being highlighted due to the inability of medical officials to capture a life threatening condition. A 29 year old woman was in and out the Emergency room for several days complaining of leg pain. The patient originally suffered from an ankle sprain but the pain continued to persist and worsen. Appropriate tests were done with no definitive answers found to suggest a problem. The patient refused to leave the hospital. She was arrested for trespassing. Fifteen minutes after being incarcerated, the woman was found dead in her jail cell. What went wrong?

An autopsy revealed the young woman died of a pulmonary embolism, a blood clot in the lungs. The woman’s leg pain was likely due to blood clots in the legs also known as deep vein thrombosis (DVT) that eventually traveled to her lungs and resulted in her death. Blood clots are uncommon and complicate less than 1% of foot and ankle injuries. The risk factors are trauma, recent surgery, prolonged inactivity, hospitalization, smoking, obesity, and birth control. Pain or discomfort in the calf is typically the preceding symptom through many DVTs can be silent. Many patients who are at high risk are typically treated prophylactically with blooding thinning medication such as aspirin or heparin.

When a patient complains of such leg pain, it is the standard of care to screen for a DVT. Though hospital records are still being reviewed, Medicare and Medicaid reviewers have not found a deficiency in the patient’s care. So why did she die? Could it have been prevented? I was not there and I can only speculate the course of events but some reports are describing the patient as having drug seeking behaviors. The patient was known to be homeless, combative and uncooperative with healthcare professionals during her hospital visit. Once the appropriate tests were performed and were negative, her continued complaints were disregarded and many assumed she was falsifying her symptoms. The emergency room is well known to drug seekers and it is a daily, hourly occurrence to encounter a patient who’s complaints cannot be supported by medical reasoning. It is often very difficult and challenging to identify those patients with serious and legitimate complaints and those who have ulterior motives.

For this young lady, it is hard to speculate if further evaluation and persistence of medical health care workers in diagnosing her leg pain would have ultimately saved her life. By protocol, they did their job, they could not find a problem and diagnosed her with a muscle strain/cramping. It was not necessarily a misdiagnosis because they tested her for DVTs but did not find enough clinical evidence to diagnose her. Could an intervention have saved her life… maybe? This is the grey are of medicine and there wasn’t one big thing that was missed. Is there fault? I don’t know if one person can be blamed. It’s an unfortunate loss and when caught, a DVT can be treated and pulmonary embolisms can be avoided.

1 comment:

tahera said...

This is an emotional post. I'm sorry to hear about your state. Leg Pain Treatment Center Houston, TX