Forensics: Pantelimon Hospital Patient Likely Died from Noradrenaline Dose Reduction

The Superior Council of Forensic Medicine identified three major deficiencies in the provision of medical care to the 54-year-old patient who died at “Saint Pantelimon” Hospital in Bucharest and concluded that there is a more than 99% probability that “the death occurred at the time in which it occurred due to the decrease in the dose of noradrenaline”.

The forensic doctors came up with these clarifications and accused that erroneous information was propagated in the public space that demonstrates ignorance of the legislation. They recall that, during the expert examination, “the forensic doctor had at his disposal the entire file of the case, such as on-site investigation minutes, witness statements, medical documents, data extracted from injectomats”.

“Both in the press and in the statements of several doctors or professional societies, the conclusion was reached that the medico-legal expertise is not sufficient or is erroneous, due to the fact that forensic doctors do not know how to treat patients in an intensive care unit or that they do not have powers to do so. It is true that forensic doctors do not treat patients in ICU or in other medical specialties, but they have the legal competence and scientific ability to evaluate the correctness of the medical act either alone or in collaboration with specialists from other medical fields”, the press release of Friday of the Superior Council of Forensic Medicine.

The forensic doctors also talk about establishing the causal link: “The causal link requires the existence of an illegal act related to the medical act, which leads to a quantifiable harm to the patient. In this case, if we refer strictly to the cessation of vasopressor support, there were three significant deficits in the provision of medical care (the expertise did not refer to other potential deficits in the provision of medical care that were noticed even by some colleagues from the ICU or from other medical specialties in the press or social media – such as the need to supplement vasopressor support with other substances). The three deficits were: the brutal decrease (not in steps) of the dose of noradrenaline, the decrease of the dose of noradrenaline considering the blood pressure values ​​recorded at the time of the decrease and the failure to record the decrease in the dose of noradrenaline in the medical documents”.

Therefore, the reduction of a person’s life span, even extremely limited, if it is a consequence of an illegal act, must be considered damage (effect) in the causal chain”.

“The link of causality can be established, according to the European recommendations (the Guide presented above), by inductive methods, i.e. statistical laws – the method used in the present case, which is suggested by the fact that the conclusions talked about temporal concordance.

In this case, the patient was admitted to the ICU department for 10 days, with vasopressor support (noradrenaline), being kept alive. About 1 hour after the brutal decrease in the dose of noradrenaline, death occurred.

The probability that death would have occurred due to the altered state of the patient, if vasopressor support had been maintained, can be estimated by dividing the number of hours in which he was deprived of vasopressor support by the total number of hours in which this would have been required support, calculation that leads to a probability of about 0.4%.

Therefore, the probability that the death occurred at the time it occurred, due to the decrease in the dose of noradrenaline, is over 99%, even if we were to take into account a progressive worsening of the patient’s condition during the hospitalization in the ICU.

This is an extremely high degree of probability, which is rarely reached in the analyzes of deficits in the provision of medical care, which is why the medico-legal conclusions were so unequivocal”, the forensic experts say in the quoted press release.