Man who suffers stroke due to his physician’s failure to monitor heart condition awarded $6.4 million
By Jonathan D. Rubin, Esq., Partner, Kaufman Borgeest & Ryan, New York, NY
Justin V. Buscher, Esq., Associate, Kaufman Borgeest & Ryan, Garden City, NY
Bruce Cohn, JD, MPH, Vice President, Risk Management and Legal Affairs, Winthrop University Hospital, Mineola, NY
News: In 1996, A 42-year-old male patient was diagnosed by his physician with mitral valve prolapse. Although the condition must be monitored regularly because it can lead to heart valve infections, after 2001 there are no notations of the condition in the physician’s records, and he failed to order any follow-up testing. When the patient began to exhibit symptoms of fatigue and weight loss in 2007, the physician ordered several tests but failed to refer him to a cardiologist or recommend any heart related testing. Just a couple of months later, the patient suffered a stroke, significantly impairing his motor skills and short-term memory. The patient and his wife sued and alleged that the physician failed to properly monitor and treat the condition, thereby causing the patient’s stroke. The jury agreed and awarded the plaintiffs $6.4 million in damages.
Background: In 1996, the 42-year-old male patient’s physician sent him for an echocardiogram and diagnosed him with mitral valve prolapse, a condition in which a valve of the heart does not close tightly and allows blood to flow backward into the heart. Significantly, the condition can lead to endocarditis, an infection of the heart valve, and therefore must be monitored regularly. The condition was confirmed in 2001 after a follow-up echocardiogram, but no subsequent echocardiograms were ordered. In fact, there is no record of the patient even having the condition following March 2002.
In April 2007, the patient became very ill and complained of fatigue, weight loss, appetite loss, and abdominal pain. The patient scheduled an appointment with the physician and complained that he felt "like I am dying." In order to diagnose his condition, the physician referred him for blood work, a panendoscopy/upper endoscopy, a colonoscopy, and bone marrow tests, but he was never referred to a cardiologist and no heart tests were ordered.
While still awaiting the test results, about a month later, the patient’s wife called the physician and implored him to admit her husband to the hospital as his condition continued to deteriorate. However, the physician advised against admitting the patient at that time. The physician informed the wife that they should wait until the tests results from the hematologist arrived.
Another month later, the patient, at the age of 53, developed a bacterial infection on his heart valve and suffered an acute stroke. The stroke caused paralysis of the right side of his body and short-term memory loss, and it limited his ability to process words. It has been a process for him to relearn how to use his right hand and foot. The patient had previously been employed as a bank examiner and information technology specialist for the Federal Reserve Bank in Missouri, but he has not been able to work since the stroke.
In 2011, the patient and his wife sued the physician and his medical group. They alleged that the physician was negligent in failing to refer the patient to a cardiologist or admit him to the hospital after he became ill in 2007. The plaintiffs further argued that the physician was negligent in that he failed to monitor the patient’s heart condition and order follow-up testing, or even note the condition in the patient’s charts. The plaintiffs contended that had it not been for the physician’s negligence, the infection would have been diagnosed and treated, thereby preventing the stroke. The defendants argued that the injuries were the result of unknown medical conditions peculiar to the patient and that were not foreseeable to the physician. They contended that the patient’s own "allergies, sensitivities, medical conditions, reactions and/or idiosyncrasies" were the cause of his death and not the negligence of defendants.
After a jury trial, the couple was awarded $5.8 million in damages to compensate for pain and suffering, economic losses, and medical expenses. Another $610,000 was awarded for the wife’s loss of consortium claim. The verdict is one of the largest awards ever in the state of Missouri.
What this means to you: This case is troubling for a number of reasons; perhaps the most significant is that the condition was diagnosed and then not followed. In 1996, the patient’s physician appropriately sent him for an echocardiogram, which diagnosed the mitral valve prolapse (MVP). This condition has the potential to lead to serious complications and is generally followed closely at regular intervals. The condition was confirmed five years later, although it is unclear what was done in the interim. There is no indication that the patient was sent to a cardiologist or that there is further mention of the condition in the physician’s office records.
In 2007, the patient became ill with a combination of symptoms. The treating physician went everywhere except to the MVP as an answer to the patient’s complaints. Again no cardiologist is consulted and no heart-related testing is done in spite of the fact that the patient’s MVP is known to this physician.
One month later, the patient’s wife calls and asks the doctor to admit her husband as the condition has only gotten worse. The doctor declines and suggests waiting for the results of hematological testing. The patient eventually develops a bacterial infection on the heart valves, which led to a stroke and significant neurological defects.
This case presents a number of issues, most of which revolve around the treating physician’s failure to follow up. It is also what some lawyers call a "failure-to-rescue" case. At various times during the patient’s long interaction with the physician, there was the opportunity to diagnose the patient and prevent the negative result. In 2001, after confirmation of the heart condition, the physician does not monitor the patient closely. More to the point, the physician fails to refer the patient to a cardiologist. When the patient becomes ill in 2007, the doctor, knowing the patient’s has a pre-existing condition of MVP, does not do anything with this knowledge. Perhaps the failure to refer or do further testing resulted in the physician forgetting that the condition was there. It is unlikely that as the patient came in periodically, the physician went all the way back years into his notes.
The call from the wife was the last clear opportunity that the treating physician had to diagnose the actual condition. Whether the doctor was aware of the MVP at this point and eliminated it from his differential diagnosis or simply did not have the condition on his radar is unknown. What is clear to a jury of his peers is that the failure to refer and failure to follow up on a condition that has the potential to cause significant injury has no excuse and therefore appears to be a direct cause and effect of what a layperson will consider sloppy care and the patient’s injuries.
In this situation, the patient also was clearly an intelligent, relatively high-earning individual. Along with the lack of demonstrated standard of care and the squandering of multiple opportunities to make the diagnosis, this situation, not surprisingly, led to a large verdict.
- 11SL-CC02366 (Miss. St. Louis County Cir. Ct. July 5, 2013). F