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Air enters the artery through the Introducer Sheath and Stent Meshing.

Dr. William Rush implanted a biliary stent that was not designed for the renal artery causing permanent injury. Cook Medical promoted the stent for use in the renal artery.

Dept. of Health Prosecution Services Unit
Florida Healthcare Professions Complaint form (pdf - 158kb)



From the ECRI Institute:

Air Embolism and Exsanguination from Separation of Two-Piece Side Port  / Hemostasis Valve Cardiac Catheter Introducers



From the FDA:


ECRI - Air Embolism and Exsanguination from Separation of Two-Piece Side Port/Hemostasis Valve Cardiac Catheter Introducers   

FDA - Percutaneous sheath introducer: TAKE THESE PRECAUTIONS TO AVOID AIR EMBOLISMS.    


Holy Cross Hospital is a "Primary Stroke Center" and has "Advanced JCAHO Certification"

Report a Complaint about a Health Care Organization

Find a Joint Commission Certified Stroke Center

Below is a screen shot from a Holy Cross employee newsletter quizzing them on proper stroke procedure as prescribed by The Joint Commission...


Holy Cross is certified as a "Primary Stroke Center." Why didn't the Stroke Team take appropriate action?


See how Holy Cross fell short. Stroke Performance Measurement Implementation Guide


Due to the fact that Mrs. Horrillo's stroke went unreported until 24 hours after she was last seen normal, any chance for reversal was lost. Note: Last time seen normal is 5/31?



Nurses Notes:

5/31/07  At 9:00 patient was "awake and alert." At 10:05 Nurse Pamela Moore "pulled" the Introducer Sheath and called "a report to the floor for transport."

Nurses notes:

5/31/07   At 8:10 patient was, "off floor for renal" procedure. By 11:10 patient was reported as, "Forgetful, disoriented to date and time, generalized weakness, (illegible), diminished breath sounds..." Abnormal findings were checked off for Neurologic, Cardio and Respiratory from 12:00 forward.

Why wasn't a Code issued that morning in compliance with JCAHO standards?

Nurses notes:

6/1/07   8:35 "Inability to see in left eye, unable to move left arm and left leg..."


By 6/1/07 Dr. Cimera's notes state patient is not a candidate for stroke intervention.




Cell phone logs confirm that the family, patient and family's attorney knew of the stroke long before it was belatedly acted upon.




NOTE: According to Dr. Prego-Lopez Margaret Horrillo's behavior was the result of Uremic Encephalopathy, possibly Morphine as well as the withdrawal of Xanax.




NOTE: Margaret Horrillo's renal insufficiency was mainly caused by anemia, dehydration, and a bleeding ulcer. Dr. Prego-Lopez that "TIME may be of benefit." The doctors instead rushed into a dangerous and unnecessary interventional procedure which led to permanent injury.





Previous malpractice claim against Dr. William Rush for failure to diagnose lung cancer from x-ray resulting in death to the patient.

Search to see if your doctor has any insurance claims against them:
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