... A thorough review of the medical care reveals a pattern of care that fell far below the applicable standard of care, violating fundamental medical guidelines and Joint Commission (TJC) accreditation standards. These failures were not isolated incidents but constituted systemic negligence that directly caused Mr. Ruiz's deterioration and death. We hereby demand full and fair compensation for the wrongful death, conscious pain and suffering, and related damages suffered by Mr. Ruiz and his family.

1.Failure to Adhere to Sepsis Management Standards (Surviving Sepsis Campaign Guidelines & TJC Standards):

Violation: Untimely administration of antibiotics. The Surviving Sepsis Campaign (SSC) Guidelines (2021) mandate intravenous antibiotics within one hour of sepsis recognition (SSC Bundle Element). TJC Core Measure SEP-1 and NPSG.07.01.01 emphasize timely antibiotic administration for serious infections.

Deficiency: Records lack documentation proving antibiotics were administered within this critical window. This delay allowed the infection to progress unchecked.

Violation: Inadequate fluid resuscitation and hemodynamic monitoring. SSC Guidelines require an initial fluid bolus (30 mL/kg) with frequent reassessment to guide further therapy or vasopressor initiation. TJC Standard PC.02.01.07 requires a plan for deteriorating patients, including shock management.

Deficiency: While a bolus was ordered, no reassessment of blood pressure, lactate, or urine output was documented. Persistent hypotension (MAP <65 mmHg) on Day 3 demanded immediate vasopressors and ICU transfer, which were delayed for days.

Violation: Failure to measure lactate clearance. SSC Guidelines and TJC SEP-1 Core Measure mandate repeat lactate measurement within 2-4 hours if initial lactate is elevated (>2 mmol/L).

Deficiency: Initial lactate was 3.5 mmol/L. Despite a plan to repeat it q6h on Day 3, no repeat lactate was documented until the terminal event (Day 11, 6.2 mmol/L), preventing assessment of resuscitation effectiveness. 

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