Legal Review & Commentary: Heart attack and triage: $1.25 million FL settlement

News: In a hospital emergency department (ED), a 42-year-old insulin-dependent diabetic gave a triage nurse his personal and family history of cardiac disease, and reported the classic symptoms of pending myocardial infarction. The triage nurse told him to wait until his name was called. While he waited for an hour in the ED waiting area, he suffered a massive heart attack. He died 11 months later. His estate brought suit against the hospital and his cardiologist. The matter settled prior to trial for $1.25 million.

Background: A 42-year-old police officer who was an insulin-dependent diabetic with the known history of cardiac disease in his family, consulted with his cardiologist for a prophylactic evaluation of his health. Months later, he experienced extreme cardiac symptoms of chest pain, nausea, sweating, and shortness of breath. Rather than going to the hospital, he called on his physician, who saw him later that day. His cardiologist performed an EKG, which came back abnormal, but did not refer him for immediate hospital admission. Instead, the cardiologist requested that the patient come back next week for a stress test.

The man went home and continued to have chest pain. On his wife’s insistence, he went to the ED. The man gave the triage nurse his history of insulin-dependent diabetes and his family history of cardiac disease, and he presented the classic symptoms of a pending myocardial infarction — chest pain, nausea, sweating, and shortness of breath. The triage nurse instructed him to wait until his name was called.

After waiting an hour for his name to be called, he suffered a massive heart attack while in the ED waiting room. He suffered severe damage to his heart muscle and underwent interventional cardiac surgery. The heart attack and surgery left him disabled and he could not return to his duties as a police officer. After 11 months, he died of congestive heart failure.

His wife brought suit against the cardiologist and the hospital. According to a hospital nurse’s deposition, the patient made no further complaints to any nursing staff during the hour he waited and that he "simply fell through the cracks." The cardiologist settled the case for the policy limits of $250,000 prior to the case being filed. The hospital settled the case for $1 million prior to trial.

What this means to you: Medical errors are made, and patients are overlooked. Occasionally, hospitals and health practitioners must own up to it. This case is one of those times.

"The scenario described in this instance is a clear breach of the standard of care," states Sam Bishop, ARM, CHPA, vice president of compliance and insurance services, WellStar Health System in Marietta, GA. "Patients presenting to the emergency department with chest pain should be triaged as top priority and escorted directly to treatment. And certainly a patient reporting not only the chest pain but also all of the other classic health attack symptoms combined with his underlying diabetes and family history of heart disease should be rushed to a trauma room and monitoring and treatment begun immediately. To have done otherwise is substandard care for handling an emergency cardiac patient."

For this patient, the hospital’s breach of the standard of care was preceded by the breach of care of his treating cardiologist.

Unfortunately for this patient, the hospital's breach of the standard of care was proceeded by the breach of care of his treating cardiologist. The cardiologist had been caring for the patient for at least six months prior to his heart attack, and he was aware of his patient's underlying risk factors. Not only did the patient present to his office on an emergency, unscheduled basis with classic myocardial infarction symptoms, the cardiologist had the benefit of the EKG results, which indicated that there was a problem. And yet, the cardiologist sent the patient home instead of the hospital.

When medical malpractice is evident and that deviation from the standard of care results in an adverse income, risk managers and insurers must consider settlement as an option. "In cases where the liability is clear with no possibility to defend — settle. And, as seen in this case, providers prudently settled as soon as possible," concludes Bishop.


• Laura Pruette as PR of the Estate of Barry Pruette v. Adventist Health Systems/Sunbelt Inc., d/b/a Florida Hospital, Altamonte, Orange County (FL) Circuit Court, Case No. C10 00-348.

Audio conference clarifies final EMTALA regulations

The final version of the recently proposed changes to the Emergency Treatment and Labor Act (EMTALA) is expected to become effective on Oct. 1. Issues in the final regulations could include changes to physician on-call requirements, "comes to the emergency department" definitions, later-developed emergencies, non-hospital entities, and prior authorization. With all the confusion surrounding the proposals during the past year, make sure you know what it takes to comply with the final regulations.

To keep you on track, American Health Consul-tants offers the EMTALA: Complying with the Final Regulations audio conference, scheduled for Tuesday, Nov. 12, 2002, from 2:30 to 3:30 p.m. Eastern time. The conference will be presented by Charlotte S. Yeh, MD, FACEP, and Nancy J. Brent, RN, MS, JD. Yeh is medical director for Medicare policy at National Heritage Insurance Co. in Hingham, MA. Brent is a Chicago-based attorney, with extensive experience as a speaker on EMTALA and related health care issues. In June of this year, both speakers presented EMTALA Update 2002, one of AHC’s most successful audio conferences.

Each participant can earn FREE CE or CME for one low facility fee. Invite as many participants as you wish to listen to the audio conference for $299, and each participant will have the opportunity to earn 1 nursing contact hour or 1 AMA Category 1 CME credit. The conference package also includes, handouts, additional reading, a 48-hour replay of the live conference, and a CD recording of the program.

For more information, or to register, call American Health Consultants’ customer service department at (800) 688-2421 or (404) 262-5476, or e-mail When ordering, please reference effort code: 63221.