Durham County

Malpractice suit faults Duke, Lincoln for a ‘totally preventable’ death

Duke Regional Hospital, formerly known as Durham Regional Hospital, figures in a medical-malpractice case that targets Duke and the Lincoln Community Health Center.
Duke Regional Hospital, formerly known as Durham Regional Hospital, figures in a medical-malpractice case that targets Duke and the Lincoln Community Health Center. News & Observer file photo

A lawsuit that moved recently from state to federal court seeks to call Duke University Health System and Lincoln Community Health Center to account for a woman’s death in early 2015 from embolisms that went undiagnosed until her autopsy.

Christina Ceci, then 41, died at Duke Regional Hospital nearly six weeks after going to the Lincoln clinic to see why she was feeling numbness and weakness in her knees and why it seemed to her that she couldn’t take a deep breath.

The initial visit spawned a follow-up check a week later at the Lincoln clinic, but records indicate that a physician’s assistant thought Ceci’s symptoms might have an “anxiety component” that merited a referral to behavioral-health experts, according to a suit filed on behalf of her estate.

She was supposed to come in for a second follow-up a month later, but about the time that was due she suffered “chest and abdominal pain while sitting at her desk at work,” lawyers Joe Knott and Ellis Boyle said.

She went to Duke Regional, a county-owned facility leased to Duke. There, doctors and nurses began to run the 243-pound woman through some tests, but after one of them she suffered a seizure and stopped breathing. Attempts at resuscitation failed.

The subsequent autopsy found multiple blockages of her pulmonary arteries, including one that likely had been there for two months or more.

Ceci died a “painful, terrifying, totally preventable and unnecessary death” because doctors and other personnel failed to order tests that were both readily available and that should’ve come into play given her symptoms and risk factors, Knott and Boyle said.

The lawsuit had been pending in state court since May, but it became a federal case in mid-October at the behest of lawyers in Greensboro’s U.S. Attorney’s Office. They’ve asserted the federal government’s authority to stand in for the Lincoln center as a defendant because three of the medical staff involved there count, legally speaking, as employees of the U.S. Public Health Service.

Beyond asserting wrongful-death claims against Duke, Lincoln and one of the doctors who treated Ceci, the suit also questions the constitutionality of two state laws. One compels malpractice plaintiffs to have a medical expert certify before they sue that their treatment didn’t “comply with the applicable standard of care.”

The other, passed in 2011 and amended in 2015, limits the dollar amount of “non-economic” damages they can recover in court, in other words the penalty a jury can award malpractice victims to compensate for their pain and suffering.

Knott’s and Boyle’s Raleigh-based law firm specializes among other things in medical-malpractice law. Knott himself is a member of the UNC system’s Board of Governors and a one-time Republican candidate for state attorney general.

The lawsuit claims that Ceci’s treatment at Lincoln and Duke Regional was faulty across the board.

In her initial visit to the Lincoln clinic, for instance, even though she reported leg problems and had what lawyers assert was a markedly elevated heartbeat, a physician’s assistant didn’t size up her risk factors for suffering an embolism, check her legs for signs of thrombosis or order tests that could have helped doctors look for blood clots or other vessel blockages.”

The same omissions occurred at her follow-up visit to the clinic a week later, the lawyers allege.

After Ceci experienced chest and abdominal pain, she went to Duke Regional’s emergency room. There, a resident ordered a chest x-ray that turned up some abnormalities a radiologist thought merited further checks, and an electrocardiogram showed “inverted T-waves” that can signify heart disease or embolisms.

The doctor who ended up being assigned to the case had Ceci kept for overnight observation, and arranged for a colleague to perform a type of cardiac stress test that doesn’t involve the use of a treadmill or stationary bike. But like the physicians before her, she allegedly didn’t order tests to look closely at the possibility of embolism or thrombosis.

Ceci completed the stress test the next morning, with the doctor who conducted it reporting that her results were normal. But after she got back to her room, she began to hyperventilate, her pulse raced and she eventually “stopped responding,” Knott and Boyle said.

Ray Gronberg: 919-419-6648, @rcgronberg