Complex Death Associated with Intra-Hospital Adverse Events and SARS-CoV-2 Pneumonia: Court-Appointed Medico-Legal Evaluation

Background: Among the deaths recorded during the COVID-19 pandemic, some were caused by clinical manifestations of venous thromboembolic disease, mainly pulmonary embolism. Several litigations were settled worldwide for professional malpractice associated with COVID-19 and anticoagulant therapy management. The authors aimed to discuss, as court-appointed consultants in civil court, a case settled for compensation against a healthcare facility associated with SARS-CoV-2 infection. Case report: We described the case of an old patient in therapy with a direct oral anticoagulant for thrombotic diathesis, hospitalized for COVID-19 pneumonia, who died after two intra-hospital adverse events influencing coagulation imbalance. Discussion: Two health professionals’ malpractice hypotheses were discussed related to the adverse events’ occurrence: one related to the administration of an enema, resulting in rectal perforation, and the other related to proper anticoagulant prophylaxis and comprehensive coagulation imbalance management after the rectal perforation in a patient at high risk of venous thromboembolic disease. Intra-hospital adverse events complicated the hospitalization and then significantly reduced the concrete possibility, even uncertain in terms of time and extent, of the patient’s living longer, representing the damage of reduced possibilities of survival, also called loss-of-chance damage. Conclusions: The case discussed as court advisors, characterized by clinical and legal complexity, together with SARS-CoV-2 infection, underscores the vital role of forensic examiners in cause-of-death ascertainment and as interpreters of statistical-probabilistic data according to naturalistic, logical, and scientific criteria.