The Echo reported earlier this week of a man in Liverpool, England, who suffered the effects of a mismanaged IVC filter—on top of several other hospital errors—with life-altering consequences.
Prior to surgery to treat a patient’s cancer of the esophagus, doctors for a 63-year-old taxi driver implanted in him an Inferior Vena Cava (IVC) filter designed to reduce blood clot risks. These filters are constructed with an umbrella-type metal frame that catches clots before they make it to the hear or lungs.
Although the implantation and subsequent surgery were successful, these filter devices are designed to be temporary and should have been removed by July 27, 2019—within eight weeks of the fitting date. Unfortunately, they failed to do so, even after a couple of outpatient follow-ups. It was only when the patient visited with a general practitioner, seven months following the fitting, that the IVC error was detected.
By this time, the IVC filter had become embedded in the patient’s body. As such, doctors could not safely remove the filter, which sentenced the patient to a lifetime of having to inject himself every day with anti-blood clotting medication. The effect of this error also put the patient at higher risk of stroke. Sadly, the risk came to bear three months after the neglected IVC filter was spotted.
As a result of the stroke, the mere act of swallowing food presents a challenge for this patient—who also suffers partial paralysis—and he must be fed through a tube to decrease any choking risk.
Further adding to the patient’s woes, the COVID-19 pandemic forces him to endure days alone in the hospital, with visiting restrictions preventing him from receiving visitors.
Ultimately, the trust that runs the Aintree Hospital (where the IVC filter was first embedded) apologized for the facility’s error in failing to remove the IVC filter.
Unfortunately, they would have more to apologize for in the days following the patient’s stroke, including the grave error of telling the patient’s family that his cancer had returned—which it had not. The hospital’s prognosis gave the patient two weeks to live and justified their recommendation to not treat the stroke, but rather begin end of life care.
Today, the patient requires 24-hour care and will be discharged to a facility a considerable distance from his family’s home.
An investigation report revealed several operational issues that led to the hospital’s failure to remove the patient’s IVC filter and to catch the error afterward. In conclusion, the report authors attributed the series of errors to the lack of a “robust central process” for tracking patients with IVC filters.