Dr. Meenakshi Prabhakar, an infectious disease specialist, probably wishes August would hurry up and end already. Earlier this month, we wrote about Prabhakar's receptionist, who sued the doctor for allegedly forcing her to get an abortion. Why? Tough to say. But someone from Prabhakar's office told us it was a "shakedown."
Now, per a Dallas state appeals court opinion, the doctor may be out $5.2 million to compensate a patient who developed a nasty, hospital-acquired, antibiotic-resistant case of pneumonia that necessitated the amputation of every necrotic limb by the time Prabhakar and others diagnosed it. David Fitzgerald, the plaintiff, says their bumbling cost him his body.
In 2003, Fitzgerald showed up at RHD Memorial in terrible shape -- rapid weight loss, stomach pain, nausea, vomiting and a history of reflux. Dr. Richard Holmes, the admitting doctor, diagnosed him with an ulcer that would require surgery. He discharged Holmes from the hospital and performed the surgery 11 days later. Everything seemed to go well, and Holmes placed Fitzgerald on a course of antibiotics. In three to five days he should have been ready to go home. But after three days, he got worse. His blood pressure fell, and his temperature rose. His body showed all the hallmarks of sepsis, with infection attacking his entire body. By that evening, Fitzgerald slipped into septic shock, meaning his vital organs weren't receiving enough blood.
Enter Prabhakar, the infectious disease expert, who suspected the patient was suffering from peritonitis, a surgery-related abdominal infection. Prabhakar, the opinion says, prescribed a broad-spectrum antibiotic that would wipe out most common pathogens -- except Methicillin-resistant Staphylococcus aureus (MRSA), a hospital-grown superbug most antibiotics can't touch.
Other specialists were brought in, but none could find the source of infection. Meanwhile, Fitzgerald was slipping away. His body went into survival mode, pulling blood away from his extremities and to the vital organs. A few days later, his arms and legs were cool to the touch from lack of circulation. The doctors prescribed a drug called Xigris to keep blood moving through Fitzgerald's limbs. Holmes performed an exploratory surgery, but didn't find the abdominal infection Prabhakar predicted. In the process, he had to discontinue the use of Xigris temporarily. Fitzgerald's kidneys failed. A consulting nephrologist gave him a dose of Vancomycin, an antibiotic intended to prevent skin pathogens from infecting the dialysis injection site. The drug also happens to kill MRSA.
After a few days, they began to suspect Fitzgerald might have pneumonia, not peritonitis. They sampled mucus from his lungs, grew it in culture and treated the bacteria with Vancomycin. What they found was MRSA pneumonia, that stubborn, antibiotic-resistant disease acquired in the hospital. Fitzgerald recovered, but the damage to his limbs due to poor circulation was already done. He developed gangrene. Both arms were amputated below the elbow and both legs below the knee.
Holmes and the other physicians settled with Fitzgerald before trial, but Prabhakar held out. Fitzgerald claimed he would still have his limbs if Prabhakar had prescribed Vancomycin to treat what turned out to be the second-most common hospital-acquired infection. The jury agreed, and found the doctor 100 percent responsible for Fitzgerald's injuries and awarded him nearly $18 million in damages. The court reduced the figure to $5.2 million to reflect the state statutory cap on damages and the settlements already paid by the other doctors.
The appeals court upheld the trial court's award Friday.