Gambaccini v. Summa Health System

This case involved a 46-year-old male who presented substernal, non-tearing chest pain, without migration or radiation.⁹ Distal pulses, chest radiograph, d-dimer, and troponin were normal. He was admitted for observation and after an extensive workup, he was discharged. Thirty days after discharge, he died from an ascending aortic dissection. In a $14 million dollar demand, plaintiff’s counsel argued that not performing a CT aortogram was negligent. However, the plaintiff’s expert had difficulty arguing a breach of the standard of care when faced with extensive literature around the Aortic Dissection Detection Risk Score (ADD-RS).^10,11 Ultimately, the plaintiff expert had to admit that the chances of aortic dissection were extremely low when viewed prospectively. The jury returned a unanimous defense verdict after 14 minutes of deliberation, and the case was summarily dismissed.

Summary

While the customary care standard remains dominant in medical malpractice litigation, EBM is playing an increasing role. Enhance your care by performing and documenting an evidence-based history and physical exam and then using and documenting evidence-based clinical scores, guidelines, and tools. You’ll provide high-quality care for your patient and establish extra protection against litigation. The icing on the cake? The “remember that patient” question might not provoke as much anxiety the next time around!

Dr. Bedolla is assistant professor at the University of Texas Dell Medical School and national director of risk science at US Acute Care Solutions.

Dr. Aldeen is Chief Medical Officer, US Acute Care Solutions.

References

1. Gibson, J. Doctrinal feedback and (un) reasonable care. 
2. Henderson, JA. Learned Hand’s Paradox: An Essay on Custom in Negligence Law. California Law Review. 2017;105(1):165–177.
3. Aaron DG, Robertson CT, King LP, et al. A New Legal Standard for Medical Malpractice. JAMA. Published online February 26, 2025. doi:10.1001/jama.2025.0097
4. American Law Institute. Restatement of the Law Third, Torts: Medical Malpractice. Tentative Draft No. 1. The American Law Institute; 2023:4.
5. American Law Institute. Restatement of the Law Third, Torts: Medical Malpractice. Tentative Draft No. 1. §6(b). The American Law Institute; 2023:4.
6. Marsillo v. Dunnick, Supreme Court of Texas, 683 SW3d 387, January 12, 2024.
7. Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emergency Medicine. 2011;11:2. Published February 3, 2011. doi:10.1186/1471-227X-11-2.
8. Biomedcentral. Envenomation Consensus Treatment Algorithm. Published May 2010. https://crofab.com/envenomation-education/treatment-algorithm/interactive-guide.
9. Summit County Clerk of Courts. Susan Gambaccini v. Summa Health System. Filed September 17, 2019. Accessed July 28, 2025. https://clerkweb.summitoh.net/PublicSite/CaseDetail.aspx?CaseNo=CV-2019-09-3539&Suffix=&Type=.
10. Rogers AM, Hermann LK, Booher AM, et al. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation. 2011;123(20):2213-2218.
11. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease.Circulation. 2010;76(2):E4386.