The estate of a general surgeon named in a malpractice lawsuit over the improper administration of anticoagulants isn't off the hook for his share of a settlement struck by other defendants, an appeals court has ruled.

As a result, the estate of Ronald Kurstin, MD, will be responsible for contributing $1 million toward a settlement with patient Rosalee Blue.

During an April 2004 abdominal hernia repair at Sibley Memorial Hospital in Washington, D.C., Dr. Kurstin directed the anesthesiologist on the case, John Lordan, MD, to administer the low-molecular-weight heparin compound Lovenox. Dr. Kurstin had ordered the drug since, due to the patient's weight, clotting was a concern.

The drug caused spinal bleeding, however, and permanent post-operative injuries. According to Ms. Blue's attorney, Patrick Malone, she now suffers from bowel and bladder dysfunction, chronic pain and impaired mobility.

Court documents note that both the drug's manufacturer and the hospital's policy recommend against administering Lovenox until at least several hours following surgery.

Ms. Blue filed a malpractice lawsuit in August 2004, but before it went to trial, Dr. Lordan and his anesthesia practice arranged a $2 million settlement with her. In the agreement, Ms. Blue released all claims against the surgeons.

Dr. Lordan then filed a "contribution claim" against Dr. Kurstin, a legal action which seeks contribution from non-settling defendants toward funds awarded to a plaintiff. Ultimately, the appeals court judges rejected assertions by the estate of Dr. Kurstin (who died in August 2006, before the case was adjudicated) that Ms. Blue's release of claims barred Dr. Lordan from filing his contribution claim.

"The lesson for doctors," says Mr. Malone, "would be that when you are faced with a legal liability issue, and more than one person is responsible for injury, there are creative legal devices to bring everyone to the table for fair sharing of responsibility."

Andrew Baida, the attorney for Dr. Kurstin's estate, declined comment.

Ray Simon