Bypass pt. denied 'directed' blood transfusion--death results.

DOES A HOSPITAL HAVE THE RIGHT TO DENY A PATIENT 'DIRECTED' BLOOD DONATIONS? That was just one of the issues with which courts were confronted in this unusual Texas case that was tried in Federal Court. The civilian spouse of a retired military service member requested that family members be allowed to give directed blood donations in anticipation of her impending coronary artery bypass surgery. The military hospital involved denied the patient the right to have directed donations. Instead, the blood supplied to the patient during her coronary artery bypass surgery was provided from the inventory of blood supplies that the hospital had on hand. Although the pre-transfusion inspection of the blood revealed no abnormalities, the patient developed septic shock and died in less than 48 hours after surgery. It was determined that her death was caused by a blood-born bacterial infection. This precipitated a suit against the United States of America.

ON SEPTEMBER 18, 1995, CRISTINA QUIJANO WAS ADMITTED TO BROOK ARMY MEDICAL CENTER (BAMC) COMPLAINING OF CHEST PAINS. She underwent diagnostic tests, which revealed blockage of her coronary arteries. Cardiologists recommended bypass surgery. The surgery was scheduled for September 26. On September 22, the patient's family members met with Dr. Alfred Gorman, one of the attending cardiologists. They requested that they be allowed to give directed donations of blood in case the patient required a transfusion during or after surgery. Dr. Gorman denied the request. During the course of the patient's surgery, she received a transfusion of two units of packed red blood cells. The patient died within 36 hours after the surgical procedure. It was determined that the patient's death occurred as a result of a bacterial infection introduced into her blood stream through the blood transfusion of blood from the hospital's blood supply. The patient's surviving spouse and her adult children brought a wrongful death and survival suit against the United States under the Federal Tort Claims Act (FTCA) in the United States District Court for the Western District of Texas. After a bench trial, the court entered judgment in favor of the plaintiffs and awarded the plaintiffs damages amounting to $400,000. The United States appealed the judgment of the trial court.

THE UNITED STATES COURT OF APPEALS, FIFTH CIRCUIT, REVERSED THE JUDGMENT OF THE LOWER COURT. The court held, inter alia, that the lower court made an erroneous application of Texas law. The court found that BAMC's policies, although highly discouraging, did not prohibit directed donations. The court found that the hospital's policy was consistent with the applicable standard of care. The court noted that in Texas, a hospital's internal polices and bylaws may be evidence of the applicable standard of care, but hospital rules alone do not determine the governing standard of care. The court noted that a hospital might maintain a higher standard of care than the prevailing community standard. The court went on to emphasize that the lower court's finding that BAMC's policy established the applicable standard of care was clearly erroneous. The court ordered the case remanded back to the District Court and ordered that it consider whether expert testimony offered by the parties established a "community standard of care" and whether the actions of the defendant's agents and employees breached that standard of care.

IN 1995, THE FOOD AND DRUG ADMINISTRATION HAD NOT PROMULGATED ANY SPECIFIC REGULATION APPLICABLE TO DIRECTED DONATIONS. Nor had the American Association of Blood Banks adopted a policy with respect to the use of directed donations. The plaintiffs expert, Dr. Dawson, testified that directed donations were safer than donations from volunteer donors. In 1995, directed donations were generally accepted by hospitals throughout the United States. Editor's Note: The United States Court of Appeals apparently chose to take the position that the hospital did not absolutely "prohibit" directed donations. However, there can be no denial that the summary rejection of the request for a directed donation had a "chilling effect." Did the court expect the family to create a disturbance to attempt to force the hospital to agree to accept a directed donation? We should be mindful of the fact that the fact situation set forth in the case occurred in 1995. One must wonder, in view of our experience since that time, whether a physician's summary rejection of a directed donation would subject the physician, hospital or both to liability under the facts of this case today. Quijano v. United States, 325 F.3d 564--TX (2003)

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Providence, R.I. firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievement as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, and Who's Who in America.