He was 90 years old. He had cancer. But those are not the reason he died.
This veteran had been receiving anti-coagulation treatment (medicine which limits your body’s ability to slow bleeding) because of a pulmonary embolism and, with the help of his daughter who was his full-time care provider and was trained as a nurse, was injecting the medication into his abdomen.
He reported bruising at the injection site and nose bleeds, some lasting as long as 20 minutes, to the anti-coagulation clinic multiple times. Eventually, he also developed severe abdominal pain and reported to the VA emergency room. He was given a CT which showed a hematoma, which is a collection of pooled blood, in his abdomen.
Despite this, his VA care provider discharged him and instructed him to continue injecting the anti-coagulant medicine. Four days later, the veteran was brought back to the ER by ambulance and was placed in the ICU. Further imaging discovered that his original hematoma had grown and that he had developed additional ones. Over the course of the next seven days his condition worsened. One week after he presented to the ER for the second time, and less than two weeks after he first presented to the ER with evidence of a hematoma, he died of "acute low output heart failure."
VA care providers - knowing this veteran had blood pooled in his abdomen - failed to stop a medication which prevents bleeding from stopping on its own. Because of that, he bled internally until his heart no longer had enough blood to pump.
On its surface, the case seemed fairly straightforward and an administrative settlement from VA might have seemed a foregone conclusion. The VA even provided what is known as an institutional disclosure of an adverse event to the veteran's family. At an institutional disclosure, hospital executives meet with the victims of a bad medical outcome or their family and detail what they believe occurred and, in many case, apologize for the outcome. However, there were some complications to this case.
Part of the complication has to do with way courts calculate what a person might be legally entitled to. The amount of money you might be entitled to is called your "damages." Different laws in different states allow for different reasons for damages. Personal injury, for example, is usually a different set of laws than wrongful death, and they often have a different set of allowable damages. Generally speaking, there are two types of damages which might be available: economic damages and non-economic damages.
Economic damages include things like any income lost because of an injury or death, or medical expenses incurred because of that injury or death. These are relatively easy to show because there is often a receipt, bill, or earnings statement to show precisely what income was lost or what money was spent. Here, the veteran was receiving all of his medical care from the VA. So, he had no medical costs. He also had long been retired and was not receiving any income that could have been stopped by his death. So, there were no substantial economic damages available.
Non-economic damages differ markedly from state to state, those available for personal injury differ from those available for wrongful death. For personal injury, non-economic damages are often of the nature of pain and suffering. As you might imagine, this can be difficult to meaningfully assign a precise dollar value to. In Virginia, in addition to the pain and suffering damages available to a person who suffers prior to their death, the wrongful death of a person allows damages for a number of non-economic damages including sorrow and mental anguish.
These damages can be limited, though, if the person who died could potentially have died soon even if the care providers had not committed a wrongful act. In this case, the veteran was 90 years old and already had advanced cancer. This seriously limited the amount of money which would have been recoverable. Because there were no economic damages, and because of this veteran's advanced age and condition, the potential damages could have been severely limited. The cost of bringing a lawsuit would have been high - perhaps taking a significant portion of the total the veteran's family would have been able to recover.
Because of the high cost of bringing a suit and the potentially low amount of damages, VA might have decided not to settle, believing that the veteran's family would not have thought it worth the expense or that the lawyer would not have thought it worth the time to sue (lawyer’s fees in these cases are limited by law to 20% of an administrative settlement and 25% of a recovery made after a suit is initiated).
However, we made sure to let VA know that we were ready and willing to bring them to federal court: we drafted the complaint (the document which starts suits) and let VA know that they shouldn't expect this to go away if they denied the claim. VA decided to make an offer of an administrative settlement, and we negotiated the settlement up to $125,000.
But we weren't finished yet. In Virginia, any wrongful death settlements must be approved by a state court. We had to file a petition, schedule the hearing, and present the case to a judge in a Virginia court.
We were able to get the family compensation, even though the settlement was less than for a veteran with economic damages or no limits on his non-economic damages. But, this work is important to us. We do this work not only because we serve veterans, but because we are veterans as well.