Hart v. Defendant Emergency Medicine Physician

  • Circuit Court of Cook County (Richard J. Elrod)03/27/2012
    Client: Defendant Emergency Medicine Physician
    Outcome: Defense Verdict

Synopsis:

On March 27, 2012, a Cook County jury reached a verdict in favor of the firm's client, an emergency medicine physician represented by DBMS.

The plaintiff's decedent, a 35 year old single father of a 2 year old child, suddenly experienced abdominal pain at work and an ambulance was summoned. The decedent's co-workers testified that he complained of sudden onset of severe chest pain radiating to the back and abdomen and stabbing in nature. According to the co-workers, the decedent was writhing on the floor, crying due to "the worst pain of his life," associated with difficulty breathing, pale skin and heavy sweating. The ambulance report described abdominal pain and cold, pale, diaphoretic (sweaty) skin but vital signs were normal.

Upon arrival at the emergency department, the triage nurse noted the patient complained of mid-abdominal pain that felt like cramping. His vital signs were normal and his skin was pink, warm and dry. The emergency room physician noted complaints of constant moderate abdominal pain in the epigastric area with no chest pain. The pain had started about an hour earlier.

The physician's initial impression was of gastritis or pancreatitis but he ordered a cardiac workup to rule out acute coronary syndrome. The cardiac enzymes were normal but an EKG was abnormal consistent with cardiac ischemia or hypertension. A chest x-ray showed an enlarged heart consistent with his known history of hypertension.

Co-workers who visited the patient in the emergency department testified that it was very busy that day, the decedent was on a cart in the hallway instead of in a patient room, staff did not pay him much attention, and he complained of chest pain and spit up blood in the emergency department.

The patient was given a "GI cocktail" in the emergency room, after which he vomited and reported feeling better. Upon re-evaluation by the physician, he reported no more abdominal pain, and he was discharged with a diagnosis of abdominal pain, resolved, and hypertension. He was instructed to follow up with a physician the next day for his hypertension and enlarged heart. A nurse's note stated that he ambulated without difficulty upon discharge.

A friend of the decedent testified that when she picked him up from the emergency department, he was still in significant pain and had trouble walking out to her car. Five days later, the decedent was found dead in his home. An autopsy showed the death was caused by aortic dissection. The medical examiner opined that the dissection most likely was present at the time of the emergency room visit.

The plaintiff claimed that the defendant negligently failed to perform a proper history and physical which would have uncovered the signs and symptoms described by the co-workers. It was undisputed that the co-workers' description of the decedent's condition at the workplace was "classic" for aortic dissection. It was also undisputed that if aortic dissection was in the differential diagnosis, the standard of care required the defendant to order a CT scan, which most likely would have shown dissection if it were present. The standard of care then would require the defendant to immediately consult a surgeon and emergency surgery would be performed which most likely would have prevented the death.

The plaintiff further claimed that the defendant should have kept the patient in the hospital for an in-patient cardiac workup based on the abnormal EKG, which workup would have disclosed the dissection and led to appropriate treatment preventing the death.

The defense argued that if the decedent had such severe and dramatic symptoms as the co-workers described, he would have reported them to the paramedics, the triage nurse and the defendant, the co-workers' version of the history was never reported to the defendant, the defendant performed a thorough and appropriate history and physical exam, ordered appropriate diagnostic studies and medication, and appropriately discharged the patient in improved condition with instructions for out-patient follow up of his hypertension and cardiac enlargement.

In closing argument, plaintiff's counsel asked the jury to award $6.5 million. The jury deliberated approximately one hour over lunch and returned a verdict for the defendant.