Misdiagnosed cardiac arrest causing brain injury: $5 million settlement

Man, 55, suffers catastrophic anoxic brain injury resulting from misdiagnosed cardiac arrest

Trial Lawyers Report, 2008

This case involves a now 55 year old man with massive brain injury following cardiac arrest. The cardiac arrest occurred in hospital and was captured on video. The defendants are 12 physicians who provided care during the 11 months leading up to and during the arrest. In the 11 months before the cardiac arrest, the plaintiff had abnormal cardiac testing that each of the defendants overlooked. The claim is that none of them properly recognized the abnormal cardiac testing and so, none of them offered or performed any cardiology evaluation Instead, they misinterpreted the plaintiff’s presentation as signs of a seizure disorder and directed all of their care towards seizure management. While being videotaped as part of a long-term, in-patient seizure evaluation, the plaintiff suffered an arrhthymia and, eventually, cardiac arrest. The staff, thinking only of seizures, did not recognize the evolving cardiac event, did not provide appropriate cardiac resuscitation and delayed calling the "code" team—all contributing to a significant period of oxygen deprivation with resultant brain injury. Today, the plaintiff is completely dependent on others for all activities of daily living. He is non-communicative. He requires round the clock personal care.

In August 2005, the plaintiff presented to the Faulkner Hospital having had what was thought to be a seizure. He was started on anti-seizure medication. While at the Faulkner Hospital, he had three abnormal EKGs and elevated cardiac enzymes, indicating an ischemic cardiac event. He was transferred to Brigham & Women’s Hospital where he was erroneously treated by the defendants in a variety of inpatient and outpatient settings—as a seizure patient.

On 9/6/05, the plaintiff presented to the Brigham & Women’s ER with fever, chills, nausea and vomiting. Again, he had an abnormal EKG. He was admitted to hospital for four days, treated by several of the defendants and then discharged with another prescription for anti-seizure medication, but, without having had any cardiology evaluation.

From September 2005 through February 2006, the plaintiff was treated at a new primary care practice where he was seen on several occasions by three of the defendants. None was aware of the abnormal cardiac testing. None reviewed the prior medical records which contained the results of the abnormal cardiac testing. None provided a cardiology referral.

Beginning in October 2005, the plaintiff was seen by several of the defendants as an outpatient in the neurology clinic at Brigham & Women’s Hospital. Despite the abnormal cardiac testing recorded in the medical chart, none of the neurology staff referred the plaintiff to a cardiologist.

In January 2006, the plaintiff was seen by two of the defendants at the Brigham & Women’s ER for another “seizure” episode. Again, neither picked up on the recorded abnormal cardiac testing and neither offered a cardiology referral.

On July 10, 2006, the plaintiff was admitted to hospital by the neurology service for long term monitoring of EEG with simultaneous audio and video recording in an attempt to determine the cause and treatment for unresolved "seizures. " An admission EKG was again markedly abnormal, showing changes from the prior EKG—which had also been abnormal.

One of the defendants, a neurology resident for just 10 days, noted the abnormal EKG results and ordered cardiac enzymes which returned later in the afternoon elevated. The resident did not consult a cardiologist and did not inform his superiors of the abnormal enzymes.

On July 11, 2006 at 2:30 a.m. the patient began to experience a cardiac event. The entire event was audio/video recorded. The oxygen monitor alarm sounded. Nurses came into the room and poked, shook and shouted at the plaintiff. None recognized an evolving cardiac event, believing instead that they were witnessing some manifestation of a seizure. The nursing staff discussed whether or not to call a "code" and initially decided not to.

At 2:37 a.m., the neurology resident covering the floor—the same resident who had been aware of the abnormal EKG and enzyme levels earlier in the evening—arrived and noted that the plaintiff was not breathing. No one attempted to ventilate the plaintiff until 2:40 a.m. when respiratory therapy arrived and began ventilation. No one checked the plaintiff’s pulse until 2:41 a.m. A "code" was not called until 2:46 a.m., after which CPR was undertaken. Adequate ventilation and circulation were restored and the code was completed at approximately 2:59 a.m., 28 minutes after the first alarm of the oxygen monitor. By then, the plaintiff had suffered tremendous brain damage from inadequate oxygenation during the cardiac event.

Later, a cardiac catheterization showed an ulcerated 95% stenosis in the proximal LAD for which the plaintiff was successfully stented. A treating cardiologist documented that in retrospect, many of the episodes of suspected seizures may have been breakthrough episodes of ventricular tachycardia.

The plaintiffs’ claim is that all of the defendants knew or should have known of the abnormal cardiac testing indicating an ongoing cardiac event and that none of them properly interpreted the signs—signs which were obvious, not subtle, not in need of interpreting, but, rather in need of action. The plaintiffs claim that each of the defendants rendered substandard care when he/she failed to refer the plaintiff to a cardiologist for workup of the abnormal cardiac testing and that such a referral would have led to timely catheterization, diagnosis and treatment of the cardiac pathology. Had the proper referral and workup been provided, the plaintiff would not have suffered the hypoxic event of July 11, 2006 during which he was alone in the hands of inadequately trained staff, ill equipped to recognize and properly respond to an obvious cardiac catastrophe.

The plaintiff survived the cardiac arrest, but is neurologically devastated. He is non-communicative. He cannot perform any single activity of daily life. He is fed through a tube in his stomach. He lives at home where his wife and two children provide round the clock care.

The case settled for $5,000,000 two months before the scheduled trial date.

Lubin & Meyer attorneys represented the plaintiff in this medical malpractice lawsuit.

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