Proudly Serving Volusia
& Flager Counties

Since 1985

Delayed Heart Care Results in Death | Flagler Personal Injury Lawyer

Delayed Heart Care Results in Death

When a patient with complications is treated at a smaller hospital with fewer resources, a contingency plan is warranted to determine what will be done if the patient’s condition worsens.

No such plan was developed for an elderly woman who developed complications after pacemaker surgery that led to her death.

This 71-year-old female had a cardiac pacemaker placed at her community hospital due to a heart rhythm problem.

After being discharged, she returned the next day to the hospital by ambulance, complaining of chest pain from shoulder to shoulder, accompanied by mild shortness of breath and lightheadedness. She was given nitroglycerine sublingual with some improvement and she became pain free after IV morphine.

The on-call cardiologist for this smaller hospital was a cardiology fellow who was moonlighting at another hospital and reached by phone. He recommended admission to the ICU and treatment for unstable angina. Treatment included aspirin, heparin, and nitroglycerine.

Nearly four hours later, she was seen by the covering cardiologist. Her vital signs had stabilized and her labs were normal. The chest X-ray suggested hypertrophic non-obstructive cardiomyopathy, which is a genetic disorder. Her diagnoses included unstable angina and aortic dissection.

The treatment plan called for an echocardiogram the next morning due to the X-ray findings. Since the hospital had no echocardiogram facilities after hours, transfer of the woman to a tertiary hospital was discussed but decided against because the woman appeared stable and her primary cardiologist was at this hospital.

Several hours later, the woman was found writhing in bed. She had difficulty breathing and was speaking in Portuguese, which her family said meant she was in severe pain. After an examination, the diagnoses now included: pericardial effusion (due to complication from pacemaker insertion); aortic dissection; ischemia; congestive heart failure; and pulmonary embolism.

The Heparin and Plavix medications were discontinued, and repeat tests (chest X-ray, arterial blood gas) were reassuring. A CT scan was ordered but not done immediately because the patient appeared to be more stable and was resting comfortably.

A moonlighting Infectious Disease fellow covering the ICU performed a limited echocardiogram that he thought might show a small effusion, but this procedure was not his specialty. On the phone with the on-call cardiologist, he reviewed all possible diagnoses, including pericardial effusion.

The woman did not have a fast or irregular heartbeat and did not have pulsus paradox, or a drop in blood pressure. Both are symptoms indicating cardiac tamponade, or a buildup of fluid around the heart.

It is not known if the Infectious Disease fellow informed the cardiologist that he did a limited echocardiogram. The cardiologist was still considering an aortic dissection for the patient. He planned to do another echocardiogram early in the morning.

About two hours later, the woman was restless and moaning in Portuguese again, with worrisome vitals. The covering cardiologist came and performed an echocardiogram, which revealed a pericardial effusion.

The woman was eventually transferred to a tertiary care facility, where an emergency pericardiocentesis removed one liter of blood. She then had a cardiac arrest; developed diffuse anoxia of the brain, went into a coma, and died four days later.

The woman’s family sued the two moonlighting physicians – the cardiologist and infectious disease fellows, alleging that they failed to diagnose and appropriately treat the cardiac tamponade that resulted in the woman’s death. This case settled for about $500,000.

The woman’s family had a successful medical malpractice case based on the following factors:

  • A perforation and tamponade should have been considered, ruled out or treated. When a patient’s status deteriorates and a more worrisome condition is added to the differential diagnosis, the urgency of ruling out the new potential cause should match the seriousness of the potential outcome. Unavailability of back-up personnel and proper facilities should not be allowed to hamper the effort to rule out or treat a potentially worrisome cause.
  • Lack of timely assessment. Although the covering cardiologist agreed with the assessment of a possible pericardial effusion, he did not come to the hospital to see the patient and perform an echocardiogram himself.
  • Transfer to a tertiary hospital was likely initiated too late. Moonlighting physicians should know what services are available at a smaller community hospital after hours and have a contingency plan of what will be done and when a patient’s condition deteriorates.
  • Incomplete communication between the physicians. It is unclear if the covering cardiologist knew the Infectious Disease fellow covering the ICU had performed an echocardiogram and what his findings were. Communication between health providers is crucial.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

More Testimonials