Case Theme

Plaintiff - This is a case about a failure to timely diagnose ischemic chest pain resulting in irreversible injury to the heart.

Defendant: This is a case about an M.D. who appropriately focused on the complex orthopedic history. 

Opinion: This case is meritorious because there was a significant delay in diagnosing and treating the Myocardial Infarction which caused significant and irreversible heart damage. 

Recommendations: (For both plaintiff and defense)

-locate testifying experts

-research chest pain, cervical spondylolysis, EKG interpretation, anterior MI, morbidity statistics and MI, pericarditis, thrombolytics

-request additional medical records, past and present (physician’s office, medical bills, and employment file)

-request table of contents for policy and procedures including emergency room

-in-depth review standards of care: JACHO, ENA, AHA,

-Defendant may consider an independent medical exam 
 

Duty: duty was established by all the following

-ABC Hospital and Corporation

-Dr. X, Dr Y, Dr Z and associated physicians groups.

-Nurses from emergency: Nurse X,Y, and Z

-Nurses from observation unit: Nurse P, and Q

-Mr. Rad in radiology 

Negligence:

-Defendant may argue plaintiff was negligent based on previous cardiac history with continued drinking, and smoking. Failed to follow-up with physician for routine physicals.

-Hospital and corporation under respondent superior. Policies and procedures out of date, negligent supervisor, poor staffing

-Dr X failed to document chest pain, failed to consult cardiology, did not respond timely, did not respond timely to knowledge of abnormal EKG.

-Dr Y failed to r/o ischemia, rather focused on orthopedic history. Failed to timely stabilize patient

-Dr Z failed to notify emergency room staff of abnormal EKG interpretation

-Emergency room nurses inadequate assessment, failed to perform EKG, failed to notify emergency physician of persistent chest pain.

-Observation nurses failed to follow chain of command when physician did not respond to page. Failed to assess symptoms properly. Failed to administer medications as ordered.

-Radiology tech failed to notify emergency nurse or physician of episode chest pain and diaphoresis while in radiology department 

Injuries and Damages: Acute anteriolateral myocardial infarction with irreversible heart damage, loss of consortium, excessive medical bills 

Causation defenses:

Plaintiff caused his own MI by delay in seeking treatment, poor health history, non compliant with regular physicals.

Treatment was appropriate for history and symptoms.

MI was inevitable and unavoidable.

Emergency room and observations nurses may blame physicians for not ordering appropriate procedures.

Physicians may blame nurses for not notifying of change in condition, additional symptoms, and abnormal test values.

Cardiologist may blame family doctor for not consulting sooner.

Heart damage was from first MI not this episode. 

Possible problems with defenses:

For Plaintiff – MI was inevitable due to lifestyle, weight, etc

For Defendant – multiple offenders, finger pointing, could turn into comedy of errors.  

No evidence of chart tampering or missing records. 

Possible Testifying experts:

Physicians – cardiologist, internal medicine, emergency department

Nurses – ICU, emergency department, emergency observation

Life care planner

Hospital administrator