Patient on Inquiry Notice that Anticoagulants after Botched Biopsy Caused Hemorrhage

A woman in her thirties suffered from lupus and antiphospholipid antibody syndrome (APS), an autoimmune, hypercoagulable disorder caused by antiphospholipid antibodies, which attack and damage tissues and cells and cause blood clots to form in the body's arteries and veins. The woman took several anticoagulant medications as a result of a stroke she suffered at age 20. She suffered another stroke and was admitted to the hospital. She was treated at the hospital for approximately three months. About a month into her stay she underwent a kidney biopsy. After the kidney biopsy she was again administered blood-thinning therapy, including the medication Lovenox. Several days after the kidney biopsy, the woman suffered a large hemorrhage from the area of the biopsy kidney, which had become infected. As a result, the woman developed renal and respiratory failure, multiple abscesses, aspiration pneumonia, and other serious injuries and complications for which she continues to require inpatient treatment years after her release from the hospital.


The woman sued the two radiologist surgeons involved in her kidney biopsy, their practice group, and the hospital. The complaint alleged that the radiologist surgeons were negligent in performing the biopsy, damaging the woman’s bowel and right kidney during the procedure, failing to provide proper and timely monitoring for hemorrhage and infection following the biopsy, and failing to provide proper and timely treatment for injuries sustained as a result of the biopsy.


During discovery, more than two years after filing the complaint, the woman filed a second lawsuit. The second lawsuit named the hospital and the two hematologists who treated her after the kidney biopsy. The complaint alleged that the hematologists were negligent in prescribing, ordering, and administering certain blood thinners and combinations of blood thinners following her biopsy; failing to properly monitor the woman while administering those blood thinners; failing to reverse the effects of the blood thinners in a timely manner; and carelessly causing the peritoneal hemorrhage, and damaging the woman’s right kidney. The woman moved to consolidate her first and second causes of action contending that they involve the same inpatient hospitalization, witnesses, and evidence. The Circuit Court of Cook County, Illinois, County Department, Law Division, granted that motion and consolidated the cases.


The hematologists and the hospital filed a motion to dismiss arguing that the cause of action was barred by the two-year statute of limitations. The motion argued that the two-year limitations period commenced when she was discharged from the hospital, or at the latest, at the time she filed her first medical malpractice action. The woman responded that she was unaware of the hematologists’ negligence until one of the radiologist surgeons named in the first complaint gave his deposition. During that deposition the radiologist surgeon testified that the blood thinner Lovenox in combination with other anticoagulants was responsible for the large hemorrhage from the woman’s right kidney. He testified that he discovered the connection between Lovenox and the hemorrhage when he reviewed the woman’s medical chart, including her radiological scans, in preparation for his deposition. The woman also asserted that even with the exercise of due diligence she could not have been aware of the hematologists contribution to her injuries prior to the radiologist surgeons deposition. Specifically, her medical records were 17,000 pages long due to her continued inpatient treatment and during her 88 day stay at the hospital she was administered hundreds of medications. Given this record, the woman contended that the date she filed a complaint against the hematologists was well within two years of the date when she reasonably could have known that her injuries were caused by the actions of the hematologists.


The trial court dismissed the cause of action as time-barred. The trial court noted that the woman was aware of her injuries and that they were wrongfully caused when she filed her first complaint. The expert physician upon whom the woman relied to attest to the legitimacy of her initial complaint averred that he had reviewed the woman’s medical records, which contained the fact that the woman was administered Lovenox with the other coagulants after the kidney biopsy.


The First District Appellate Court of Illinois, Fourth Division, affirmed. The court held that the woman was on inquiry notice of her injury and the cause of that injury at the time she filed her initial complaint.


The woman was on inquiry notice of her injury and the cause of that injury at the time she filed her initial complaint, for limitations purposes. The court held that the two year malpractice limitations period begins to run when the party knows or reasonably should have known both that an injury occurred and that it was wrongfully caused. A plaintiff knows or should know his injury was “wrongfully caused,” when the patient becomes possessed of sufficient information concerning the injury and its cause to put a reasonable person on notice to make further inquiries to determine whether actionable conduct is involved. The court found that the record established that at the time the woman filed her initial complaint she knew or reasonably should have known that the negligent performance of the kidney biopsy, including the continued administration of the drug Lovenox, was responsible for the massive hemorrhage in her kidney. The woman’s hospital records noted that her right kidney and renal artery were damaged during the biopsy and that she was subsequently treated with different blood thinners, including Lovenox. The woman’s initial complaint asserted negligence in the biopsy followed by bleeding complications, which necessarily implicated her subsequent hematology care. The court reasoned that the woman’s initial complaint established that she knew of her bleeding injury and that she received blood thinning therapy.


The First District Appellate Court of Illinois, Fourth Division, affirmed the trial court dismissal of the cause of action as time-barred.


See: Heredia v. O'Brien, 2015 IL App (1st) 141952, 2015 WL 1602155 (Ill.App. 1 Dist., April 9, 2015) (not designated for publication).


See also Medical Law Perspectives, March 2014 Report: Blood Draws, Testing, Transfusions: Venipuncture Injury, Inaccurate Results, Tainted Blood - The Liability Risks


See also Medical Law Perspectives, December 2013 Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death


See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication