Nine months later, her family’s pain has not lessened. Emily Adkins drank deeply of life. She played basketball and soccer growing up, also enjoyed piano or marching in the school band. A sense of purpose carried her into healthcare, and she was handling human resources for her father’s two adult living facilities when she fell and broke her ankle.

Less than six weeks later, she was dead. The cause was a pulmonary embolism, her family said. The same medical event kills tens of thousands every year.

But unlike heart disease and cancer, blood clots often go underestimated, said Dr. Jeffrey Kline, a professor and research chair at Wayne State University School of Medicine. A longtime emergency room physician and editor-in-chief of Academic Emergency Medicine, Kline named blood clots the third leading cause of cardiovascular death in the United States, and the second-leading cause of sudden unexpected death behind acute coronary syndrome.

“Despite it being a killer and being extremely common – the estimates are that somewhere around a 1 in 1,000 people will develop blood clot in the lung sometime in their life – we don’t know the exact epidemiology because it’s understudied, it’s underfunded. We have a lot better data on stroke and heart attack.”

Doug Adkins, Emily’s father, complained to the state’s Department of Health that Emily’s death was preventable and should be investigated. His objections go beyond Kline’s critique of medical readiness to Emily’s unique risk factors.

Among them are being overweight and having had both gallbladder surgery and the ankle injury within five weeks of each other, coupled with instructions from her orthopedist he regards as overly conservative, discouraging her from putting any weight on the ankle.   

Nor was Emily prescribed blood thinners or even aspirin, her father said.

He recalls the phone call he got from Dr. Shane Shapiro, the orthopedist, on Oct. 24, offering condolences three days after Emily died.

“He said it’s just one of those things, we don’t know why this happens,” Doug said. Doug told the doctor, ‘Look, I don’t know what the standard of care is in orthopedics. But I’m going to find out.’”

At that point, he said, Shapiro mentioned prescribing anticoagulants, or blood thinners, but said the field was divided on that issue, that there was ‘broad disagreement.’”

Doug contends that those kinds of disagreements don’t speak to his daughter’s special conditions. 

“They want to talk to you about broad disagreement about blood thinners,” he said. “But what there’s no disagreement about is these risk factors – overweight, family history, immobilized for four weeks, recent surgery – and if you have an ankle fracture, hands down it’s a different ballgame in terms of surveillance, detection and prevention. All the literature agrees on this.”

The Adkins have another point of contention with Dr. Shapiro, who did not return multiple calls for this story. It concerns the online medical record of Emily’s visit on Oct. 13, after she got her cast off. 

Her mother, former state Rep. Janet Adkins, was with her. Janet Adkins remembers waiting in a small examining room waiting for the doctor, Emily’s fresh x-rays visible on the computer screen. 

“The ankle really didn’t look like we thought it should look,” she said. “And I remember Emily saying to me, ‘Let’s just wait for the doctor. Let’s not make any assumptions.’”

When Shapiro arrived, he apologized for mother and daughter having had to wait for the cast to come off, Janet said. The consultation with Shapiro lasted 10 to 12 minutes. She remembers sitting closest to him, with Emily further away, in a wheelchair. 

During that time, Janet said, Dr. Shapiro never left his position from behind his computer. 

The hospital initially declined to give Doug the online record Shapiro made of that visit, made eight days before Emily’s death. But his attorney succeeded in retrieving it. It notes the lack of deformity in her lower leg but a mild swelling, and ankle fracture itself and then this: “Calf squeeze is unremarkable.”

That’s a problem. Janet Adkins, a woman accustomed to detail, Nassau County’s current supervisor of elections, recalls no such calf squeeze. Such a maneuver would have been prudent – perhaps even basic – given that physicians can sometimes physically feel blood clots in the calf, a finding that would inform next steps to reduce the danger to patients. 

But as Janet remembers that Oct. 13 visit, Shapiro never left his computer. And to get to Emily in that room, he would have had to step past Janet. 

“I was there the whole time for that appointment,” she said. During that time, Shapiro never touched her daughter, she said.

The report is dated Oct. 23 – a Sunday – two days after Emily Adkins died.

On April 14, the Department of Health responded to Doug Adkins’ complaint against Dr. Shapiro, alleging negligent care. The letter from the Prosecution Services Unit of the Office of the General Counsel said the case will undergo a legal review, a process that could take several months. 

“The panel will then decide whether to initiate formal disciplinary proceedings,” the letter stated.

– Andrew Meacham is a former reporter for the Tampa Bay Times.