Delayed Diagnosis of Pneumonia Leads to Pulmonary Edema and Cardiac Arrest

This case involves a recently incarcerated woman who had a history of drug abuse. One month after being in prison, the patient presented to the clinic complaining of a persistently elevated heart rate with nausea and vomiting. The infirmary observed the patient for four days and only prescribed fluids and Tylenol. On the fifth day, the patient started complaining of shortness of breath and was brought to a local hospital. Once examined, she was immediately transferred to the ICU. The patient had advanced pneumonia that was unable to be controlled. The patient’s condition deteriorated further as she developed severe pulmonary edema and congestive heart failure. The patient died from complications one week after her admission.

Question(s) For Expert Witness

1. Should this patient have been treated more aggressively from the outset, and should more advanced diagnostic tests been performed?

Expert Witness Response E-004662

Diagnostic testing in patients with suspected pneumonia is driven mostly by the possibility that the results would significantly alter empiric therapy and management decisions. Also, the physician needs to consider whether the test is likely to have a high yield. Additionally, diagnostic testing is useful in classifying the severity of illness and site-of-care decisions (outpatient/inpatient/intensive care unit). The most obvious indication for extensive diagnostic testing is in the critically ill patient. This patient did not appear to be critical when she presented in the clinic but some sort of empiric antibiotic should have been administered before she was transferred to the hospital to prevent further complications.