Forensic Pathology for Police - Brainshare Public Online Library

Therapy-Related Deaths 585
nature, or related to a non-traumatic, non-acute, natural physiologic response to
appropriately-implemented therapy. In contrast, if the intervention that contributed
to death is a true mistake or error, or if it is unexpected, acute, and temporally related
to the intervention, associated with mechanical failure of a medical device, or traumatic
in nature (Fig. 21.30), then the MOD ruling should be “accident.” Of note
is the fact that in a few jurisdictions within the United States, the MOD choices
include a sixth option: “therapeutic complication.” Unfortunately, such an option is
not available in most jurisdictions.
Fig. 21.30 A case where
chest tube placement
inadvertently penetrated the
lung, causing injury
Examples of cases where an intervention is believed to be contributory to death,
but the MOD is ruled “natural,” include the following: an elderly patient with underlying
heart and lung disease who develops post-operative pneumonia following
otherwise successful surgery; an obese patient who develops post-operative deep
venous thrombosis and dies suddenly from a pulmonary embolism, one week after
otherwise successful knee replacement surgery; a patient with cancer who develops
a severe infection and dies, following intensive chemotherapy. It should be noted
that in jurisdictions where “therapeutic complication” is available on the death certificate,
these cases can be ruled in this manner instead of “natural,” but when no
such option exists, it is appropriate to rule them as “natural.” Examples of cases
where an intervention is the cause or a contributory cause to death and the MOD ruling
is appropriately considered “accident” include the following: a fatal transfusion
reaction related to a clerical error; a patient dying from infusion of an intravenous
line with the wrong medication; a patient dying from an air embolism during laparoscopic
surgery; a patient dying from extensive internal hemorrhage initiated from a
femoral artery perforation, performed for a cardiac catheterization procedure; death
from peritonitis following dislodgement of a feeding tube; an idiosyncratic reaction