Correction: The article incorrectly stated the verdict was against Thomas Jefferson University Hospital. The verdict was only against Rothman Orthopaedics & Dr. David Nazarian.  

A Philadelphia jury returned a $2.5 million verdict against Rothman Orthopaedics & DAVID NAZARIAN,  M.D. in a wrongful death suit, finding the Clinical Team NEGLIGENT in failing to properly treat an elderly patient following hip surgery, which led to a lower left extremity deep vein thrombosis and a pulmonary embolism.

The case, Koesterer v. Thomas Jefferson University Hospital, was tried for three days before Philadelphia Court of Common Pleas Judge Gwendolyn N. Bright, with the suit stemming from the death of Virginia Koesterer, after she suffered a massive venous thromboembolism (VTE).

Koesterer's estate alleged her death was the result of negligence on behalf of numerous health care workers and health care facilities, claiming her VTE originated from a deep vein thrombosis (DVT) formed during or soon after her hip surgery the morning before.

Daniel Koesterer, as executor of Koesterer's estate, sued defendants Thomas Jefferson University Hospital, Thomas Jefferson University Hospitals, Thomas Jefferson University Physicians, Jefferson Health, Jefferson Health System, Reconstructive Orthopaedic Associates II, Reconstructive Orthopaedic Associates II, and Dr. David Nazarian. At trial against the Reconstructive Orthpaedic defendants and David Nazarian, he claimed the defendants failed to properly treat Koesterer for her increased rise of venous thromboembolism development, which he claimed was a breach in the standard of care.

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"I am extremely happy for the family of Mrs. Koesterer. The verdict vindicated their feelings that the life of their mother, who was age 86, was worth more them a nominal sum. It seems to dispel the insurance industry myth that the life of an elderly person is minimal and confirms that no matter the age, all lives are precious," said Koesterer's attorney, Thomas Sacchetta of Sacchetta & Baldino. "The carrier only valued Mrs. Koesterer life at nuisance value. The jury in our case took their job seriously, considered all the evidence, and delivered a fair verdict based on all the evidence."

According to the plaintiff's pretrial memorandum, Koesterer "clearly had a significant past medical history with known increased risk of development of venous thromboembolism," yet all of her anticoagulation medications were stopped before her left total hip arthroplasty.

The plaintiff alleged that Koesterer wasn't adequately mobilized during her postoperative period, and that her blood pressure wasn't adequately maintained, despite the acknowledgment that it should be. Sacchetta claims her orthopedic providers were made aware of her hypotensive episodes.

"This combination of lack of adequate care was a breach in the standard of care and led to the development of Ms. Koesterer's left lower extremity DVT, which ultimately led to a PE that caused her death. Had the standard of care been met, by adequately caring for Ms. Koesterer with maintenance of her aspirin, a bridging anticoagulation therapy, appropriate mobilization, and/or maintenance of her blood pressure to prevent hypotension, Ms. Koesterer would not have developed a left lower extremity DVT that led to a PE and her death," the plaintiff argued in the filing.

The memo further alleged that NAZARIAN failed "to follow the cardiology recommendation of aspirin immediately following surgery," and that this was a breach of the standard of care and "increased the risk of harm to Ms. Koesterer contributing to her death." The hospital, Thomas Jefferson University Physicians, and Thomas Jefferson Health Systems "violated their duty to Ms. Koesterer to ensure her safety and well being while under their care," by failing "to properly oversee all medical providers to ensure that patients safety and that proper medical care was provided," according to the memo.

"Additionally they failed to formulate, adopt, and enforce adequate rules and policies to ensure that quality care for patients including Ms. Koesterer by failing to have proper policies and enforce said policies as is relates to anticoagulation. The breaches of care by the hospital with regard to their failure to enforce the policies and to oversee the medical personnel was a direct violation of the standard of care and caused and increased the risk of harm to Ms. Koesterer thereby causing her death," the plaintiff's filing said.

Defendants, Nazarian, Reconstructive Orthopaedic Associates II, and Reconstructive Orthopaedic Associates II, argued in their pretrial memo that the plaintiff's claims were without merit and denied all allegations of negligence.

According to the defendants, Koesterer was admitted to the hospital for a planned hip replacement by Nazarian. Approximately 1,000 units of heparin were administered intraoperatively, and after the procedures, and Nazarian ordered a 2 mg tablet of warfarin, and entered an order for 2.5 mg warfarin tablets to be given to her once a day.

Koesterer was later seen by Dr. Kenneth Rosenberg at the request of Nazarian. Rosenberg noted that Koesterer "had permanent atrial fibrillation on warfarin with a controlled rate of diltiazem and recommended continuing it unless her systolic went under 100," that the Jefferson Antithrombotic Service (JATS) was following Koesterer for warfarin management, and that Koesterer was on Plavix, which "Dr. Rosenberg felt that aspirin was acceptable for a few days for DVT prevention," according to the defendants.

According to the memo, the morning of Sept. 19, 2019, it was noted that Koesterer denied chest pain, shortness of breath, and bleeding, and that Dr. Taki Galanis planned to start warfarin 2.5 mg that evening and check Koesterer's internal normalized ratio the following day. Galanis also noted that bilateral compression devices were to be continued.

The defendants claim that the cardiology and orthopedic surgery teams were working on plans for antiplatelet resumption, and that the present plan for Koesterer was to continue the current dose of warfarin the evening she died. According to the memo, Koesterer became hypotensive that night, and was later found in ventricular fibrillation and declared dead.

Marcie A. Courtney, a principal at Post & Schell, represented Thomas Jefferson University Hospital, Thomas Jefferson University Hospitals, Jefferson University Physicians, Jefferson Health, and Jefferson Health System.

Marshall L. Schwartz, a partner at O'Brien & Ryan, served as counsel for the defendants Nazarian, Reconstructive Orthopaedic Associates II, and Reconstructive Orthopaedic Associates II.

Neither attorney immediately responded to messages seeking comment.