$4.75 million settlement for failure to respond to elevated Troponin results in heart attack

2005 Medical Malpractice Settlement Report

Failure to Respond to Elevated Troponin I Level results in Heart Attack and Catastrophic Anoxic Brain Injury to 41 year-old man just hours after evaluation in the Emergency Room

Attorney for the plaintiff: Andrew C. Meyer, Jr. , and Krysia J. Syska.

The plaintiff was 41-year-old man on July 3, 2000 when he presented to the emergency room for evaluation of chest pain. The chest pain had developed suddenly that morning while he was walking down stairs. The plaintiff reported to the nurse in the ER that he had experienced sweatiness and dizziness in addition to the chest pain, and that his pain was a 6 on a scale of 10.

At 9:00 a.m. that morning, the defendant physician evaluated the plaintiff. In addition to performing an EKG, blood work was ordered to test for elevated enzymes indicative of myocardial or cardiac injury. One of the tests, which were ordered by the defendant, was a Troponin I. At that time, the Troponin I was relatively new and was being sent to another hospital’s laboratory for interpretation. The blood was drawn that morning in the emergency room and sent out for evaluation. The plaintiff remained in the ER while the test results were pending. The EKG and routine lab results were reported as normal. Chest x-ray was normal. At 12:00 noon, the nurse noted that the plaintiff wanted to go home. At 1:00 p.m., he still had right-sided chest pain, but the nurse noted that it was less than 1 on a scale of 10. His blood pressure was still elevated at 1:30 p.m.

At 2:05 p.m. the plaintiff was discharged by the defendant despite the fact that the Troponin I test result was still pending. The defendant noted that the plaintiff was being discharged home, improved and ambulatory with chest pain of unclear etiology and hypertension. There is no mention anywhere in the discharge papers or instructions that the critical test indicative of myocardial injury was still pending at the time of discharge. The defendant’s plan was for the plaintiff to see his PCP, take aspirin for chest wall pain, and that he would probably need a stress test in the future.

At 2:10 p.m. that same afternoon, only 5 minutes after the plaintiff was discharged from the ER, the Troponin I level came back from the outside laboratory. The levels were elevated and stated clearly on the report that the value was indicative of myocardial injury. The ER nurse who had treated the plaintiff in the department received the results. In a nursing entry timed later that afternoon, the nurse indicated that she attempted to find the patient prior to his leaving the parking lot, but that the patient had already departed hospital grounds. The nurse also noted that she had informed the defendant physician of the test results. Other than this note stating that the abnormal results had been received and that an initial attempt had been made to find the patient before he left the hospital grounds, NO other attempts to contact the plaintiff were made by either the defendant physician or nurse. The plaintiff was never contacted regarding the elevated Troponin level and was never informed of the need to return to the hospital for immediate evaluation and testing as the source of his prior chest pain was now clearly cardiac and had caused injury to his heart muscle.

At deposition, the defendant physician stated that he was made aware of the abnormal test results on the afternoon of July 3, 2000, but that he made no attempt to reach the plaintiff as he felt that the results were not critical and that the plaintiff would not return to the hospital for more testing even if informed of the results. The defendant indicated that he had a conversation with the plaintiff prior to his discharge wherein he explained that the Troponin test was still pending but that the plaintiff stated that he was not interested in the results of this test and if all other tests were normal then he wanted to be discharged as soon as possible. None of this information could be found or verified in the medical records and was contrary to what family members reported from this day.

On July 4, 2000, at approximately 3:50 a.m., the plaintiff was found at home gurgling and breathing abnormally. He then stopped breathing and his family called 911. The ambulance crew found him pulseless and apneic. Resuscitative measures were begun. The amount of “downtime” (without oxygen) was uncertain. The ambulance transported the plaintiff to the hospital where it was noted that he was unresponsive and intubated. He was treated with TPA, Lopressor, Aspirin and Nitrates. Myocardial infarction was confirmed the next day (Peak CPK lab results were 7,420). The plaintiff’s anoxic brain damage, reflected by his unresponsive neurologic state, was attributed to the significant “downtime” he experienced before he was resuscitated.

The plaintiff has remained in a persistent vegetative state since this time. He has two sons, ages 16 and 20 years at the time of the incident.

The defendants were prepared to testify at trial that the Troponin I test was new test being utilized in the emergency room and that the levels, which were indicative of myocardial injury, were not clear and were changing from facility to facility. The defendants were prepared to testify that the plaintiff’s test results would not be considered abnormal in all circumstances. The case was settled several weeks prior to the scheduled trial date of June 13, 2005.

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