He's a personal injury attorney.
Here in New York.
I've known him for more than 20 years.
He called me one day.
I got some details and then called her number.
She was pleasant on the phone.
But, she was worried.
She was concerned.
Her husband was in a very bad way.
She didn't know if she had a case, but felt that something was done wrong.
She needed an attorney to look into it.
He was a young man.
Only 34 years old.
She was about the same age.
Together, they had a young child, almost five years old.
One night he woke up having severe chest pain.
He couldn't go back to sleep.
He was sweating.
He was cold.
He felt clammy.
The chest pain didn't go away.
The ambulance took him to the closest emergency room.
The doctors in the emergency room worked him up.
They did an EKG.
The drew blood.
They did a cardiac sonogram.
They recorded his vital signs.
They gave him nitroglycerin for the chest pain.
None of the tests explained why he was having chest pain, sweating, clammy skin or any other symptoms.
They kept him in the hospital for a few days.
They wanted to observe him.
They did a full cardiac workup.
At the end of their workup the doctors told him he was fine.
"Fine," they said.
"You are a healthy young man," they proclaimed.
That's exactly what he did.
He went to the cardiologist that he was told to see.
Every month after the emergency room visit.
He followed their instructions to the letter.
Each month for three months.
On each visit to the cardiologist he said the same thing.
On each visit he was told he was 'fine' and to continue taking the nitroglycerin every time he gets chest pain.
As I'm listening to these facts, I keep wondering in the back of my mind "Why is this young healthy 34 years old having significant chest pain that brings him to the hospital?"
"Did anyone look to figure out WHY he was having these problems?" I think to myself.
"Is the nitroglycerin simply a bandaid that's masking the underlying problem?"
"Did the cardiologist obtain the emergency room records to see what they had done and what their tests actually showed?"
Three months after his visit to the emergency room, this young man awoke from sleep.
It was exactly like what happened three months earlier.
He had crushing chest pain.
He was sweating.
He was cold.
He was clammy.
This wasn't good.
His wife called an ambulance.
He was taken to the SAME emergency room as last time.
This time was different however.
This time, when they hooked him up to an EKG they told him something that shocked him.
This hospital was ill-equipped to handle his problem.
They gave him some medication, stablized him quickly and then got him into an ambulance to be transferred to a large university affiliated hospital nearby.
"You'll get better care at this other hospital," he and his wife were told.
An ambulance took him to this university affiliated hospital in New York City.
To the emergency room.
They gave him medications.
They ran tests.
They did an EKG.
They did a cardiac echocardiogram.
They did an MRI of the heart.
They had cardiologists coming and going.
They listened to his wife explain the sequence of events that had transpired over the past three months.
He wanted to see the emergency room records from three months earlier.
He wanted to see what the tests showed.
He wanted to see what the EKG showed.
He wanted to see what symptoms the patient had and what was done for him in the ER.
He reached out to the other hospital.
He reviewed the records.
What he saw disturbed him.
What he read made no sense.
He asked both the husband and wife specific questions before raising his concerns.
"Did anyone at the other hospital tell you that you had heart disease?"
"Did anyone ever suggest a test known as an angiogram to you?"
"Did you have a test in an MRI machine to evaluate your heart where they gave you a dye so your coronary arteries could be visualized?"
"Did anyone at this other hospital tell you why you were having your chest pain and your symptoms?"
"Did anyone at that hospital discuss your electrocardiogram results from your initial emergency room visit?"
The answers were consistently “No.”
This cardiologist was even more worried than before.
Both husband and wife asked him what he was worried about.
The answers shocked them both.
Not just some evidence. Substantial evidence.
He couldn't understand why the doctors and the other hospital didn't recognize this.
He couldn't understand why the doctors didn't tell the patient and his wife about this problem.
He didn't understand why not a single doctor at the other hospital or even the cardiologist that he was following up with bothered to tell him that he needed to have additional testing to evaluate why he was having chest pain and other cardiac symptoms.
The patient asked him what tests they could have done which would have revealed the answers to his questions.
"If an angiogram had been done, it would have revealed that you had three coronary arteries that were almost totally blocked.
If you recognize this before you suffer a massive heart attack, then we can get you into surgery for coronary artery bypass known as a CABG.
It's critical to perform the surgery before you have a massive heart attack," he told them.
Tests at this university affiliated hospital revealed that his recent massive heart attack had killed off 70% of his heart.
He no longer had the capacity to pump blood through his body properly.
Fluids kept building up.
Fluid kept building up into his lungs.
His heart didn't have enough function and pressure to pump the blood throughout his body as needed.
He was continually out of breath now.
He had no energy.
His ejection fraction was horribly low.
That's the amount of blood that is pumped out by the heart with every beat.
It required further evaluation and intervention.
“Didn't your treating cardiologist request and look at the emergency room records?” he asked.
“Did your cardiologist recommend that you have a cardiac angiogram?”
“Did anyone schedule you to have an angiogram since you were having continued chest pain even while taking nitroglycerin?”
Once again, the answers were not comforting to this new cardiologist.
However, there was little either of them could do about it at that moment.
Their main focus was to get him better so that they could leave the hospital and return home.
They were also worried about what kind of life he would now have in light of this massive damage to his heart.
A few weeks later, they were allowed to return home.
His outlook was bleak. They were told his future would be difficult and very challenging.
What was previously so simple and would have taken him mere seconds ,now took him more than 10 minutes to cross the room.
His wife was in tears every time she saw the difficulty he had doing any type of physical exertion.
They didn't know how they were going to survive.
He was the breadwinner.
He worked. She didn't.
She was a housewife.
He had a promising future.
He was a standout guy in a very competitive market.
He'd won all sorts of awards for his great work.
He was earning a very good living, despite being a stressful one.
Now, there was no hope of ever returning to work. Ever.
His condition became so bad that doctors tried to could get him on the heart transplant list here in New York.
He needed a new heart.
The one that he had, that he was born with, was no longer working the way it did.
It was no longer working the way it was supposed to.
It could no longer function as it was intended.
When I met with both of them, they were worried.
She was angry.
She was angry only because she didn't know if the doctors who treated her husband months earlier did the right thing.
She didn't know if certain tests had been performed would the outcome have been the same?
She liked her husband's new cardiologist.
He was smart. He made sense. His treatment plan made sense.
I decided to investigate.
Questions that could not be answered immediately. Questions that could not be answered with just the information they were given.
I needed to obtain all of his medical records.
I requested the hospital and emergency room records. I asked for his cardiologist's records.
Weeks later, I had finally received all of them. Then, I began the painstaking process of reading every single page of every hospital record I could get my hands on.
It's not like a book that has an index to tell you exactly where things are. No one has edited the records to clean up things that are not relevant to the story.
A really good medical malpractice attorney New York literally must scour page by page, line by line, every notation and every entry in the hospital record. He must do detective work to piece together exactly what was going on and what was recorded.
This process can take weeks.
Once I had completed reviewing all of the records including his most recent hospital records, I then contacted a cardiologist to evaluate all of these records.
A few months later this expert called me to tell me his conclusions.
This board-certified cardiologist told me that they were clear departures from good and accepted medical care that directly caused this patient significant harm and injury.
I then asked him a critical and simple question...
“100% sure,” he replied.
Now, you should know that in NY, a medical expert does not have to know the answer with 100% certainty. It's great if they do, but that's not the standard that's required to determine there's a valid medical malpractice case.
In fact, we only have to show that we're more likely right than wrong that the doctor violated the basic standards of medical care and those violations were a cause of the patient's injuries.
He told me that when the patient was first taken to the emergency room by ambulance, one of the first tests that he had performed in the emergency room was an EKG.
The EKG shows evidence of what is going on with his heart at that moment. It can also show some evidence of an injury to the heart that may have occurred in the recent past.
I asked him what type of investigation would have been needed.
“Had the doctor in the emergency room recognized that this patient had significance cardiac disease, he should have been sent for a coronary angiogram.”
I then asked him how that would have made a difference.
He told me that a coronary angiogram would have revealed whether any of his coronary arteries were clogged.
If they were clogged they could have tried to open them up using a stent. That's the least invasive method of trying to open up a clogged artery.
“And if that doesn't work?” I asked.
“What happens if the patient has the cardiac bypass surgery before suffering a heart attack?”
“Then the patient can go on and live a normal healthy life without any problem.”
“How is that different than what happened in this man's case?”
The doctor explained to me the sequence of events that got me very angry.
“This young 34-year-old man presented to the emergency room originally with classic symptoms of having a heart attack. He was having crushing chest pain that radiated from his shoulder down his arm. He was sweaty. He was clammy. These are all indications of having a heart attack. Medically, that's known as a myocardial infarction.
The tests that were performed were correct and appropriate.
The fact that they kept him in the hospital for number of days after his arrival was also appropriate.”
"If all these tests were appropriate I asked, what was the problem?" I inquired.
“The problem was not the tests that were being run.
The computer even analyzed the patient's emergency room EKG as abnormal. Yet the emergency room physician discarded that computerized reading and considered this test to be absolutely normal. That is a departure from good and accepted medical practice. That interpretation was a clear violation of the basic standards of medical care.
Any first year internal medicine resident reading this EKG would recognize there's a problem.
Any doctor, even someone who is not board-certified, would recognize that this patient required further evaluation. That's all that's needed.
You don't have to be a brilliant brain surgeon to recognize that this EKG is abnormal and requires additional testing. You don't have to know the answer immediately, but at least have to recognize that there is a problem that needs immediate follow-up.
Had this been done, the patient would have had a coronary angiogram while still in the hospital and that would have clearly revealed the patient's arteries were significantly closed.
He had ischemia.
That means his heart was not getting sufficient amounts of blood and oxygen. That's why he ultimately suffered his massive heart attack that killed off 70% of his heart.
In other words, this entire tragedy was preventable.
That's why I was angry. That's what I had to tell my clients about.
I knew they would be devastated.
Nobody wants to hear that the terrible injuries they now suffer from could have been prevented.
Only if the doctor had not violated the basic standards of medical care and recognized something so simple as to question why the EKG results were abnormal.
This young man and his family would now suffer for the rest of their lives all because of an incompetent emergency room physician who should have known how to read an EKG properly.
The good news for this family was that they truly did have a valid and meritorious case.
Not only did this cardiologist confirme that fact but I also had his medical records reviewed by two other well-known, board-certified cardiologists from different parts of the country.
Each one of them gave me the same conclusions and analysis.
Remarkably the defense refused to acknowledge that they did anything wrong.
Remarkably, when I had an opportunity to question the emergency room doctor who misread and misinterpreted this patient's EKG, he was defiant.
He felt he read the EKG correctly.
Even years later, during pretrial testimony, this emergency room doctor still believed that he was correct that there was nothing wrong with this patient's EKG.
An amount of money designed to compensate this unfortunate patient and his lovely wife and child.
The reality is that no matter how much money I was able to obtain to compensate them for his injuries and his losses, it would never bring him back to his original capacity of living a normal healthy life again.