Physician Legal Review & Commentary

Fatal heart attack yields $3.74 million jury verdict

News: A 59-year-old man suffered chest pains, and he was taken by ambulance to a nearby hospital. After the hospital staff determined that the man had not suffered a heart attack, the hospital staff discharged the man home. The man then subsequently presented to his primary care physician, who advised him to stop taking aspirin. The primary care physician did not refer the man to a cardiologist for further evaluation, despite his recent episode of chest pains. Four months later, the man suffered a fatal heart attack, and an autopsy showed coronary heart disease as well as prior heart damage. A jury awarded the decedent’s family $3.74 million after finding that the primary care physician provided negligent medical care to the decedent.

Background: In February 2006, a 59-year-old Harvard, MA, man suffered chest pains while he was at work. The man called 911, and he was rushed by ambulance to a nearby hospital. The emergency medical technicians who responded to the call and transported him to the hospital provided cardiac intervention methods, including aspirin. At the hospital, the medical personnel determined that the man had not suffered a heart attack. He was discharged home. The hospital personnel did not rule out other possible coronary problems before discharging the man home. Thereafter, the man presented to his primary care physician and reported his recent episode of chest pains. In response, the primary physician advised the man to stop taking aspirin. The primary care physician did not refer the man to a cardiologist for a consultation or for further evaluation. Four months later, the man experienced another episode of chest pains, and he reported his complaints to his primary care physician. However, the primary care physician did not find any problems related to cardiac illness. Shortly thereafter, the man experienced more chest pain and called 911; however, the man went into cardiac arrest and died when he was transferred to a nearby hospital. According to the autopsy, the man suffered from coronary heart disease and had prior heart damage.

In 2007, the decedent’s estate commenced a wrongful death action against the primary care physician. The decedent’s estate argued that the autopsy showed severe coronary artery disease that had started at least three months before the decedent died. After more than a weeklong trial, the jury found that the physician was negligent in his care and treatment of the decedent and returned a verdict for $3.74 million.

What this means to you: Understandably, jurors are empathetic in cases in which patients have clearly made an effort to seek medical care and, therefore, have placed their trust in the physicians providing that care. Jurors find in favor of the plaintiff when the evidence presented demonstrates that the physician failed to comply with the applicable standards of medical care. Jurors typically award larger verdicts when they believe that the physician’s “wrongdoing” led to a patient’s death.

When evaluating and treating a patient, it is imperative that a physician fosters two-way, clear communication with the patient and his/her family members. Accurate documentation and meticulous recordkeeping serve as risk reduction strategies. Ultimately, the physician must decide the best treatment plan to address a patient’s health concerns and problems that is within evidence-based practices and current standards of medical care. In this fatal heart attack case, it is difficult to fathom why the decedent’s primary care physician did not refer him to a cardiologist in light of his recent medical history and multiple chest pain events. The primary care physician’s failure to utilize the knowledge and expertise of a specialist — here, a cardiologist — evoked perceptions of negligence for the jurors and an eventual verdict against the physician.

The primary care physician’s rationale for instructing the decedent to discontinue taking aspirin was presumed to be insufficient to support the defense of the physician’s actions. It also appears that the primary care physician did not take sufficient measures in response to the decedent’s complaints of chest pain. Were blood tests obtained prior to making the clinical decision to discontinue aspirin therapy? If so, did the blood test results indicate anticoagulation was not necessary? Where any tests done to rule out cardiac disease and/or damage based on the patient’s recent chest pain episodes? Apparently there was no supportive documentation available to defend the primary care physician’s actions.

The autopsy confirmed the presence of severe coronary artery disease, which was determined to be present for at least three months prior to the patient’s death. This timeframe indicates that the initial chest pain episode occurred in February 2006. Four months later, the patient was no longer taking aspirin therapy on the advice of his primary care physician, and he suffered another episode of chest pain. The primary care physician determined that the patient had no evidence of cardiac illness after this second episode of chest pain. However, what evidence did the physician use to determine that there was no cardiac illness? Without a referral to a cardiologist after the first chest pain episode, the second episode of chest pain would have been a prudent time to request a cardiology evaluation for follow-up. Shortly thereafter, a third chest pain episode claimed the life of the 59-year-old man.

It is interesting the hospital was not held liable for failure to rule out other possible coronary problems prior to discharging the patient during the first chest pain episode. It is likely that due to the coronary artery disease findings on the autopsy, the timeframe eliminated the hospital as a potential defendant.

Nonetheless, due to the failure to diagnose and treat by the primary care physician, a family lost a beloved one, and a man lost his life. The jury sympathized and acted accordingly in delivering their verdict. The physician’s evidence was not able to warrant a defense verdict. This was another wakeup call that was too late.

This case demonstrates the risks for healthcare providers when they attempt to walk the line between appropriate medical care and reimbursement issues. All too often the request for diagnostic test approval is denied by parties who do not accept any responsibility for patient outcomes or safe practices. As a result, patients and practitioners are caught in the conflicted and confusing world of payment for services rendered. Who or what drives the final decision for services and payment? What is the best action in light of the most positive outcome for the patient? These regulating practices not only place the patient at risk, but they place the practitioner at risk as well.

Reference

State Court of Massachusetts, Middlesex County Superior Court, Index No.: 074416.