The arbitrator awarded the plaintiffs $791,000 in damages, which was reduced to $500,000 per the previous agreement and was paid by the cardiologist’s malpractice insurer. As agreed, the law firm took 40 percent of the awarded damages ($200,000) plus their expenses of $69,000. This left $144,000 for the patient’s wife and $43,500 for each of his two children.
There are several learning points from this case in regard to both medical care and documentation. A key concept is that fatal aortic pathology may not reliably localize to a specific anatomical area. If there is reasonable concern for aortic pathology, the entirety of the aorta should be imaged (a CT of the chest and abdomen/pelvis should be ordered for any aortic syndrome evaluation). (As a sidebar, it was later revealed that the patient’s reported anaphylactic reaction to contrast may not have been accurate, underscoring the importance of accurate medical record keeping in general.) Nonetheless, there are other options available for imaging the aorta, including MRI or transesophageal echocardiography. Emergency physicians should be prepared to advocate vigorously for the necessary testing, despite the fact that these are uncommon work-ups and may result in some pushback.
Finally, the documentation in this case presented problems for the emergency physician’s defense. Discrepancies between the physician and nurse created opportunities for criticism, even if management would not have been substantially altered by resolving that discrepancy in real time. More striking were discrepancies within the emergency physician’s own chart. This made it easy for the plaintiff’s attorney to suggest that a chest X-ray should have been ordered, potentially averting tragedy.
A review of the details of this case reveals a behind-the-scenes look at medical malpractice litigation, giving the reader practical tips to improve both their care and documentation. Interested readers can view more of the details from this case—including the original medical record, legal documents, expert witness opinions, and further analysis of the medical care and documentation—at www.medmalreviewer.com.
Dr. Funk is a practicing emergency medicine physician in Springfield, Missouri, and owner of Med Mal Reviewer, LLC. He writes about medical malpractice at www.medmalreviewer.com.