The defendants and plaintiff ultimately agreed to arbitration. At arbitration, the case is decided by a neutral third party, thereby sparing both sides the time and expense of a trial.
Before arbitration, they reached a high-low agreement, which guarantees the plaintiff a minimum financial recovery but also caps the maximum amount, regardless of outcome.
The arbitrator returned the following decision:
The arbitrator awarded the plaintiff $791,520, paid entirely by the cardiologist’s malpractice insurance. The actual amount paid was $500,000 due to the cap from the high-low agreement.
This case embodies an emergency physician’s worst nightmare. The patient had an extremely rare but life-threatening diagnosis. Multiple issues distracted the emergency physician from the diagnosis and necessary workup, including the patient’s insistence that he did not have chest pain and his prior allergy to contrast. However, this case highlights the critical importance of trying to avoid glaring discrepancies in the medical record, which can be easily used to make the physician appear inattentive.
The legal outcome here will also be surprising to many readers. Although it is relieving that the emergency physician did not lose the lawsuit, the fact that the cardiologist took the blame alone seems rather arbitrary and unjust. I would posit that if there is true medical liability in this case, it should have been shared among all parties.
Unfortunately, this case illustrates a pattern that has been identified in many malpractice cases. When a dissection is not diagnosed in the emergency department, the patient is often admitted to a chest pain observation unit or floor bed, where they suddenly decompensate. The true diagnosis eventually becomes identified, whether by echocardiogram or CT scan, but the patient does not ultimately survive to surgery. Reviewing the medical and legal outcomes in cases like these can help emergency physicians take better care of their patients and learn to document in a more effective and protective way.
Read the entire medical record from this case, as well as deposition transcripts from all parties and excerpts from the expert witness opinions.
Dr. Funk is a practicing emergency medicine physician in Springfield, Missouri, and owner of Med Mal Reviewer, LLC. He writes about medical malpractice.
To learn more about the diagnosis of aortic dissection, review the Novvember 2017 EM Cases article. https://www.acepnow.com/article/diagnose-aortic-dissection-without-breaking-bank/