By Anne C. Vitale
A family claiming that a man died from a misdiagnosed aortic dissection has reached a $2 million settlement in their Jackson County suit against his treating physicians and hospital.
The parties' identities have not been disclosed due to a confidentiality agreement.
John Doe, 58, went to a rural hospital's emergency room on Friday, Oct. 31, 2003. He was complaining of jaw pain, chest pain, arm and leg numbness and difficulty speaking, plaintiffs said.
Doe's symptoms spontaneously resolved after 15 minutes without treatment. Testing in the emergency room was consistent with coronary artery disease.
The ER doctor transferred Doe late that night to a Kansas City hospital for specialized cardiac care. Upon admission, Doe was stable and had no complaints other than the unusual 15-minute episode he experienced earlier that day. This information was presented to a resident doctor who examined Doe and ordered an echocardiogram for the next morning.
Although the echocardiogram was ordered for a Saturday morning, the hospital's echo lab was not routinely open on the weekend. The hospital's nurse testified that since Doe was to be seen by a cardiologist on Saturday morning anyway, it was unnecessary to change the order.
On Saturday morning, the cardiologist examined Doe and noted that although he had no complaints, his heart monitor was still abnormal and lab work revealed abnormally elevated cardiac enzymes in the blood stream. He informed Doe and his wife that these findings were typical of coronary artery disease and recommended that he remain on high-dose heparin, which would keep the blood thinned until an angiogram could be performed on Monday.
After further examination, the cardiologist also noted that he detected a slight diastolic heart murmur near the left sternal border of the heart. The cardiologist informed Doe and his wife that there might be a slight bacterial infection on the aortic valve, which would explain the murmur.
However, the cardiologist ordered an echocardiogram for Monday to determine if there were any serious problems with the aortic valve or the aorta. Specifically, the cardiologist ordered the echocardiogram technician to rule out the possibility of "aortic incompetence due to aneurism or dissection." This condition typically leads to death within a few minutes without emergency cardiothoracic surgery, plaintiffs said.
At 6 p.m. on Saturday, Doe died before any testing was completed. The cardiologist informed his wife that he likely died of a sudden heart attack due to the coronary artery disease. His wife declined an autopsy and Doe was buried a few days later.
After 18 months, Doe's body was exhumed. A post-mortem exam revealed the cause of death was aortic dissection, plaintiffs said.
Doe's wife and adult daughter filed suit just before tort reform took effect in July 2005. Plaintiffs alleged the emergency room physician, resident physician and cardiologist all missed the correct diagnosis of aortic dissection. Plaintiffs' experts argued that Doe presented with certain signs and symptoms that should have warranted an emergent CT scan of the chest to rule out aortic dissection.
Plaintiffs' experts further argued that had the echocardiogram been performed on Saturday morning as ordered by the resident physician, it would have diagnosed the aortic dissection in time to perform life-saving surgery. Finally, plaintiffs' cardiology expert was critical of the fact that although the treating cardiologist entertained the diagnosis of aortic dissection, nothing was done emergently to confirm or rule out the diagnosis.
Defendants argued that Doe's signs and symptoms were not typical for aortic dissection and were actually more consistent with coronary artery disease. Defendants also argued that even if the diagnosis of aortic dissection had been made, Doe would not have survived surgery.
About a month before trial, the parties reached the $2 million settlement.
Attorneys for the defendants, whose identities are also subject to the confidentiality agreement, confirmed the factual accuracy of this report.
Facts of the Case
Type of Action: medical malpractice/ wrongful death
Court: Jackson County Circuit Court
Case Number/Date: Confidential/Feb. 15, 2008
Verdict or Settlement: $2 million settlement
Judge: Sandra Midkiff
Plaintiff's Experts: Dr. Byron Adinoff, Dallas (alcohol and drug addiction); Dorothy Cooke, St. Louis (nursing); Dr. John A. Elefteriades, New Haven, Conn. (cardiothoracic surgery); Les Rosen, Novato, Calif. (employee screening); Dr. Jay N. Schapira, Los Angeles (cardiology); John O. Ward, Prairie Village, Kan. (economics)
Defendant's Experts: Dr. Thomas Baldwin, Olathe, Kan. (cardiology); Dr. David Campbell, Bannockburn, Ill. (cardiology); Ellen Daroszewski, Riverside, Calif. (nursing); JoAnn Shaw, St. Louis (health care policies and regulations)
Caption: Confidential survivors v. confidential cardiologist
Plaintiff's Attorney: The Hershewe Law Firm PC, Joplin
Defendant's Attorneys: Confidential
March 24, 2008
