Claim Scenario: Missed Cardiac Decompensation Following RPM Alerts
A 72-year-old patient with congestive heart failure enrolled in a remote patient monitoring (RPM) program following hospital discharge. The patient’s electronic scale and blood pressure monitor transmitted daily readings to the health care organization’s monitoring platform.
Over a four-day period, the patient experienced a 9-pound weight gain, increasing blood pressure readings and worsening shortness of breath documented through patient questionnaires submitted via the platform. The system generated multiple alerts; however, due to staffing shortages and an increasing volume of notifications, the alerts remained in a queue awaiting review.
Two days later, the patient suffered acute pulmonary edema and cardiac arrest at home. Although emergency responders achieved a return of spontaneous circulation, the patient sustained a severe anoxic brain injury and required long-term skilled nursing care.
The ensuing lawsuit alleged the organization failed to review and escalate warning signs of heart failure decompensation in a timely manner. Plaintiff experts argued that a physician evaluation, medication adjustment or emergency referral likely would have prevented the catastrophic injury.
Damages Claimed
- Lifetime custodial care expenses exceeding $4 million
- Past and future medical expenses
- Lost income and loss of household services
- Non-economic damages for pain and suffering
Outcome
The matter settled during mediation for approximately $2.8 million after discovery revealed multiple alerts had not been reviewed in accordance with the organization’s written monitoring protocols.
Risk Management Lesson
Key takeaway: RPM data can create powerful evidence for plaintiffs when abnormal readings are received but not addressed. Organizations should establish clear ownership of alerts, defined response time requirements, routine auditing processes and contingency plans to address staffing shortages.
Claim Scenario: Transmission Failure and Missed Respiratory Crisis
A telehealth provider offered an RPM program for patients with chronic obstructive pulmonary disease (COPD). Participants used home pulse oximeters that automatically transmitted oxygen saturation readings to a cloud-based monitoring platform.
Following a software update implemented by a third-party vendor, patient data from several monitoring devices stopped transmitting to the platform. Neither the vendor nor the health care organization had controls in place to identify prolonged interruptions in incoming data.
One patient experienced progressively worsening oxygen saturation levels over the following week. Believing the monitoring team would contact him if readings became concerning, the patient delayed seeking medical attention. He ultimately presented to the emergency department in respiratory failure, requiring intubation and an extended intensive care unit stay.
Although the patient survived, he suffered permanent pulmonary impairment and was unable to return to work.
The lawsuit alleged negligent program design, failure to monitor transmitted data, inadequate vendor oversight and failure to notify participants when monitoring services were not functioning properly.
Damages Claimed
- Significant lost wages and diminished earning capacity
- Ongoing pulmonary treatment expenses
- Future medical monitoring costs
- Pain and suffering damages
Outcome
The health care organization and technology vendor jointly resolved the claim for approximately $1.5 million. Discovery revealed no process existed to alert staff when expected patient data stopped flowing into the system.
