Topic: Failure of defendant cardiologist to timely authorize and administer thrombolytic therapy upon presentation to e.r. With infarct – heightened cardiac damage

Result: $ 532,000 Verdict

Title: Medical Malpractice Review; Medical Malpractice by Specialty; Cardiology

County: Nassau

Facts: The female plaintiff cardiac patient, age 39 at the time, had suffered an anterior wall myocardial infarction three months earlier and had also undergone an angioplasty with stenting two months prior to this incident. The plaintiff contended that when she presented to the hospital with chest pain at 5:47 a.m. and an EKG was diagnostic of a myocardial infarction, the defendant cardiologist, who was contacted by the attending E.R. physician who wanted to administer the thrombolytic agent Retavase, negligently insisted that such medication should not commence until he arrived at the hospital which was situated less than four miles from his home. The defendant also requested that the resident fax the EKG results to him, but the evidence reflected that the defendant’s fax machine was not functioning. The plaintiff maintained that although IV nitroglycerin and morphine are generally given with Retavase, the E.R. physician instituted nitroglycerin and morphine only because of the lack of authorization for administering Retavase. The plaintiff contended that this course produced no effect. The plaintiff further maintained that the defendant did not promptly arrive at the hospital and that the staff had to phone the defendant two more times before he finally arrived at the E.R. at 7:00 p.m. Testimony revealed that the medication should be administered within 30 minutes of the event, according to guidelines of the American College of Cardiology that were in effect at that time, in 1999. The plaintiff contended that the delay occasioned additional significant and permanent cardiac damage.

The plaintiff had presented shortly after the angioplasty with complaints of chest pain that led to a diagnosis of angina rather than an infarct. The defendant contended that in view of this history and potential severe side effects of Retavase, he acted reasonably in advising the E.R. physician to refrain from commencing the medication until he arrived. The defendant also denied that the plaintiff suffered additional cardiac damage and contended that an angiography supported this position. The plaintiff countered that an echocardiogram showed a significant deterioration of ventricular function as measured by ejection fraction, and contended that in this case involving reduced movement of the posterior wall, measurement by echocardiogram is more accurate.

The jury found for the plaintiff and awarded $ 532,000, including $ 400,000 for past pain and suffering and $ 132,000 for future pain and suffering.