This case involves a female patient who presented to the hospital complaining of chest pain. She described her pain as continuous and severe, originating in her chest and radiating to her arm. The initial assessment was musculoskeletal pain and combination with anxiety. Labs and an EKG were both normal, as was a chest x-ray. She was given medication for pain and anxiety, and neither the troponin nor EKG tests were repeated. She was discharged with a diagnosis of chest pain with anxiety and referred to follow up with the outpatient clinic. At home, she threw up her medications and complained that the pain in her chest was getting worse. EMS was called and she was brought back to the same hospital. Upon arrival at the hospital, an EKG confirmed that she was suffering a heart attack. However, cardiology was not called in by the cardiology nurse on duty for some time. Cardiac catheterization was finally performed some time after the plaintiff presented to the hospital this second time. Following the procedure, it was decided that she should be transferred to a different hospital for further management, where she died shortly after.
Question(s) For Expert Witness
- 1. Do you routinely evaluate and treat patients suspected of having a heart attack?
2. Based on this brief summary, do you believe that the outcome for the patient could have been better if the care rendered were different?
3. Are you available to review the medical records and opine on the standard of care? Have you served as an expert in a similar case?
Expert Witness Response E-007001
I am an Emergency Physician in a busy Level 1 trauma center in an inner city population that sees approximately 70K patients annually. I routinely evaluate patients suspected of having acute coronary syndrome (ACS), including a heart attack. I am also the director of the training program for EM physicians at my hospital, and as such, educate physicians about their practice patterns and standards for diagnosis. Based on this summary, it appears as though the patient spent at maximum roughly 11 hours with an untreated heart attack, leaving an already high risk disease (ostial LAD lesions have are high risk for treatment given their location as well as the large amount of heart muscle served by this vessel) at higher risk for a bad outcome. Evidence does suggest that patients with delayed interventions have higher morbidity and mortality.
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