This case takes place in Massachusetts and involves a middle-aged male patient who required hemodialysis after multiple rounds of treatment and tumor cryoablation for cancer. In addition to problems with his kidneys, he had a complex medical history with many comorbidities. At the time of the incident in question, the man was receiving treatment in the hospital, where he had been receiving heparin in order to guard against the formation of blood clots. He was walking to another location in the hospital with the assistance of hospital staff and a walker for dialysis when he tripped and fell. The patient fell to the side and struck his head on the floor, sustaining a visible laceration. Within minutes, the patient was unresponsive with fixed and dilated pupils. The injury was felt to be catastrophic and the patient would not benefit from surgery or medical therapy. The patient expired shortly thereafter. It is alleged that the patient would have lived for several decades longer, in spite of his need for dialysis, had it not been for this unfortunate accident.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Can you determine what the patient's potential life expectancy would have been given his past medical history and ongoing dialysis treatment?
Expert Witness Response E-009199
I do see many patients with similar conditions to the patient described. I am the Medical Director of the largest dialysis unit in my state. I personally have one of the largest panels of peritoneal dialysis patients in our state. I would be able to estimate this patient’s life expectancy based on my experience caring for folks in similar condition. As medical director of the largest dialysis unit in the state, I’ve been exposed to a great variety of dialysis patients during the past 10 years. I am a full time employee and an assistant professor at a major university’s medical school. I also give a number of lectures on dialysis, and am Clinical Director of the Renal Section at a major medical center. Despite the multiple comorbidities present with this patient it seems probable that his life expectancy could reasonably have been several decades longer had he not died in this hospital.
Expert Witness Response E-009201
I routinely treat patients similar to the one described in this case as I see numerous patients in both the inpatient and outpatient setting who are on dialysis. I am also the medical director of a Dialysis Unit affiliated with a major university medical system’s nephrology division. I am able to determine what the patient’s potential life expectancy would have been. Using life tables from the USRDS, one can make fair determinations as to a median life expectancy. Taking into account other factors such as comorbidities, hospitalizations dialysis vintage (time that patient has been on dialysis) and other dialysis associated factors (type of access, nutritional measures, and labs) one can compare a specific patient with others on dialysis to determine if median expectancy is likely to apply for the use case at hand. This is a clinical area that I am intimately familiar with.