Indiana medical malpractice lawyer discusses another reported case of missing a heart attack in the emergency room.
CIRCO/RMF the medical malpractice carrier for the doctors insured through Harvard identifies a number of case histories that have led to medical malpractice claims. The failure to timely diagnose a patient is a common scenario in Indiana and all over the country.
The failure of a hospital's emergency department to accurately diagnose a patient's chest pain rarely ends on a good note. The consequence of the doctor's negligence is usually death because the heart is so vital to life.
The Important Case Facts
- A 42 year old woman goes to the emergency room with chest pain and difficulty breathing
- The chest pain started 8 hours before the patient arrived at the hospital
- The pain was located under the right breast and started when the patient was in bed. She explained to the doctor that the pain increased when she took a breath in
- The initial EKG showed some changes that the emergency room doctor thought were non-specific
- The EKG showed a high heart rate (tachycardia)
- A second EKG showed the same changes that the doctor thought were reassuring
- The patient was discharged at 11:00 am with the diagnosis of rib pain
- At the time of discharge the patient still had a high heart rate (tachycardia) and high respiratory rate (tachypnea)
- 4 hours later the patient was readmitted to the emergency room and died
My Medical-Legal Analysis Of The Facts
As I have written about numerous times, the standard of care (what a reasonable prudent physician would do under like circumstances) requires a doctor to rule out the cause of chest pain before discharging a patient from the hospital. The process of ruling out chest pain starts with a differential diagnosis. A differential diagnosis is a list of conditions that can cause the symptoms. Usually, the most severe and life threatening conditions are placed at the top of the list and ruled out first.
When a 42 year old woman presents with chest pain, shortness of breath, increased heart rate and increased respiratory rate, the two conditions that are at the top of the list. Rib pain, the diagnosis here, is at the end of the list. In this case the standard of care required a number of tests. First, the EKG was abnormal twice even though it did not show a typical pattern for a heart attack. Second, the report does not disclose if blood enzymes were checked. We will assume the blood enzymes were normal because only a moron would discharge the patient with an abnormal EKG and elevated enzymes. So based on the first two test, the doctor was not able to rule in or rule out a heart attack.
Third, the next step; would be to rule out a pulmonary embolism as a cause for the patient's symptoms. Pulmonary emboli are blood clots in the lungs. The cause of a pulmonary embolism is blood clots that are in the deep veins of the legs. The test to rule out pulmonary emboli is called a V/Q CT scan. It is a computerized x-ray that takes spiral cuts through the lungs and will show if the lungs has blood clots.
In any event, this patient should not have been discharged from the hospital without a complete chest pain work-up as shown above. The insurance company for the defendant doctor reported that it paid over a million dollars to settle this case.
There is a lesson for all of us to learn in this case. If you are unfortunate enough to develop chest pain and have to go to the emergency room. Do not let the doctors discharge you until you have had a series of EKGs, a series of blood tests and a V/Q CT scan. If there are any abnormalities in your EKG and the doctors are unsure as to the cause, make sure they bring in a cardiologist and a pulmonologist to evaluate the condition.
If you have any questions about a missed heart attack or pulmonary embolism at St. Anthony's, Methodist, St. Mary's, St. Margaret, St. Margaret-Mercy, Community or St. Catherine's hospital, give our office a call at (219) 874-4878.