You might ask yourself how an emergency room doctor can misdiagnose an EKG in the emergency room.
It's actually pretty difficult especially when the EKG monitor gives you a computerized readout and interpretation of what's going on with the EKG.
The patient had come in complaining of severe chest pain. He was a young man with a young wife and a very young child. Because of the unusual onset of his chest pain, he was given a full cardiac workup in this emergency room here in New York. That was the right thing to do.
He had a full blood workup. He had an EKG done. He had a cardiac sonogram done. They even kept him for two days in the hospital to monitor his labs and his electrocardiogram.
The emergency room doctor told him he was absolutely fine.
They gave him some nitroglycerin to alleviate his chest pain and they watched him while they fed him horrible hospital food over the next two days.
He was discharged home with specific instructions to follow up with a cardiologist. He was a very young man and had never been to a cardiologist before. The hospital recommended a cardiologist and he promptly scheduled a follow-up appointment.
A few weeks later he was seen for the first time by this new cardiologist and told him all the events that occurred in the emergency room.Ironically, in the days leading up to his first visit with this new cardiologist he began to reexperience the same type of agonizing chest pain that originally brought him to the emergency room.
In the office, the heart doctor did another EKG. He read it as normal. He took the patient's blood pressure and vital signs but never accounted for why the patient was experiencing this chest discomfort.
Importantly, the cardiologist never attempted to obtain the emergency room records or the emergency room EKG to see what was going on. Over the next month and a half the patient returned to the cardiologist three times as instructed.
On each and every visit, the patient continued to complain of chest pain and chest discomfort that radiated from his shoulder down his arm. The cardiologist told the patient that was simply anxiety and to take it a little easier at work. The patient was in a high stress job and he was a high-performing employee winning all sorts of awards for his outstanding work.
Three months after his initial visit to the emergency room, the patient was woken up in the middle of the night with excruciating chest pain. He was having shortness of breath. He was sweating. He felt cold and clammy. His wife immediately called an ambulance. He was taken back to the same emergency room that he went to three months earlier.
This time, a different emergency room doctor evaluated his EKG and concluded that he was having a massive heart attack.
Since this was a small local hospital, they did not have the facilities needed in order to properly evaluate and treat this patient. He was immediately transferred to a large university affiliated hospital. This new hospital had the most advanced cardiac life saving equipment and medical staff available.
By the time he arrived at the new hospital the doctors there concluded that he had not only a significant myocardial infarction, also known as a heart attack, but that 70% of his heart had been killed off because of this heart attack. His ejection fraction was only a fraction of what it normally should be. That measures the amount of blood the heart is pumping out on a consistent basis. When the heart muscle dies, it now affects how the heart pumps out blood.
If the heart cannot properly and effectively pump out blood to the rest of the body, now there is a builup of blood causing congestive heart failure. That puts additional pressure on the heart and then on the lungs to work even harder.
This once vibrant and healthy appearing young man was now reduced to a shell.
He had no energy. He had no strength. His heart would no longer function the way it used to.
While he was in this University Hospital, the doctors requested the original emergency room records from his original visit three months earlier. They wanted to see what had dramatically changed in that three month time.
What he learned, shocked him.
The doctors at this University Hospital did not outwardly criticize the original emergency room physicians but hinted that there was a problem with his original emergency room visit.
After he was discharged, he and his wife asked me to meet them at their home. They had lots of unanswered questions.
My first obligation was to obtain all the medical records and read through each and every page. Once I did that I then sent the records out a board-certified cardiologist for an expert review. A few weeks later my expert contacted me and told me that I had an excellent case.
Despite getting a positive review, there was something my expert said that made me question whether he was truly unbiased. That led me to retain a world renown heart surgeon to review these records as well. A few weeks later, I received the same positive review. This expert cardiac surgeon confirmed that there were departures from good and accepted medical care and that those departures were major factors in causing this young man's injuries.
Want to know what really happened?
In order to answer that I need to take you back to the emergency room visit-the very first one.
If you remember earlier, I mentioned that the patient was given a full cardiac workup when he went to his local emergency room. He was placed on an electrocardiogram monitor. The emergency room physician who read and interpreted the EKG determined that the EKG was normal.
However, the computer on the EKG monitor interpreted this EKG as being markedly abnormal. Repeatedly abnormal. Yet the emergency room doctor clearly ignored the EKG computerized interpretation. Had he listened and had someone else reevaluate the EKG, he would have seen that EKG was in fact wildly abnormal, suggesting that this patient had underlying cardiac disease known as cardiac ischemia.
Cardiac ischemia is a condition of decreased blood flow to the heart. It typically involves decreased blood flow to the coronary arteries. If not timely diagnosed and treated, it can clog off one or more arteries that feed the heart causing a massive heart attack.
In this case, that's exactly what happened.
My experts confirmed that if the emergency room doctor had correctly interpreted this patient's EKG, he would've been sent to have a cardiac angiogram to evaluate if any of his coronary vessels were clogged.
That test would have revealed that he had two coronary arteries that were clogged almost 100%. Once that would have been recognized, the patient would either have had stents put in to those coronary arteries to reopen them up or he would have undergone an elective coronary artery bypass surgery, also known as a CABG procedure.
Had either of those two treatments been done, the patient would've gone home without any damage whatsoever to his heart. He never would have suffered a massive heart attack.
What's even worse is that this tragedy was entirely preventable.
The pretrial testimony was revealing...
I want to share with you what actually occurred during pretrial testimony when I had an opportunity to question the emergency room doctor about his reading and interpreting this patient's EKG.
This was one of the most interesting and fascinating pretrial question-and-answer sessions I have ever done. Within the first 10 minutes, I had clearly established that this emergency room doctor had no idea what he was doing. What made this question and answer session under oath even more interesting is that this doctor had no idea what I had just accomplished in the span of only 10 minutes.
When questioning a doctor in a medical malpractice lawsuit here in New York during the pretrial litigation phase, it is critical that I have a clear-cut agenda of issues that need to be covered.
I need to have the doctor establish what were the basic standards of medical care at that time. Using the doctor's own words about the standard of care I can often get the doctor to recognize that if certain facts are true, then the treatment that was rendered was inappropriate and violated the basic standards of medical care.
We can often accomplish that using hypothetical questions, as I did in this case.
I didn't ask him the usual questions...
Most attorneys will typically start out questioning an opposing doctor by asking about their credentials. I find that to be a total waste of time. I know before I start questioning the doctor, from research I have done, exactly what the doctor's credentials are. I usually save that for the end. Instead, I want to start this question and answer session with the most important question in the entire case. Most doctors and their attorneys do not expect this approach and it often works well to throw the witness off guard.
In his deposition, which is sworn pretrial testimony, in the first few questions, I got this emergency room physician to admit that he never looks at or considers the computerized EKG's interpretation. He feels that his knowledge and experience allows him to better interpret an EKG.
In the first few moments, I asked him to look at the patient's EKG when he came into the emergency room.
I was questioning him almost 2 years after this incident had taken place. I presented him with the patient's EKG and asked him to interpret it for me as we sat in his attorney's office. He came to the same conclusion that he had reached two years earlier.
I will also share with you that after I had retained my second cardiac expert, I had taken those same records and sent them off to another cardiologist who had advanced specialty in reading and interpreting EKGs. My expert confirmed that the EKG was wildly abnormal and indicated the patient had significant cardiac ischemia and needed further follow-up testing and treatment.
Not only did I have one expert, but I had two and even three experts all telling me the same exact thing. They all confirmed that this emergency room physician clearly did not know how to interpret an EKG correctly. When I questioned the emergency room doctor about the EKG, he denied that there was any problem whatsoever. When I confronted him with the EKG machines' own interpretation being abnormal, he dismissed it as if he were dismissing a little child asking for candy.
He literally said that he never looks at or considers the EKG machines computerized interpretation, and that since he has been doing this for so many years, he has much more clinical knowledge and experience in evaluating this type of test.
I knew, right then and there, that the defense could never support their position that they did nothing wrong.
Interestingly, when we took a break a short time later one of the attorneys who represented another party in the case leaned over to me and said in hushed undertones that he can't believe that this emergency room physician just said what he did. He also could not believe that the emergency room doctor had no clue that I just established liability without him even realizing it.
Months later when I went to visit my client at his home, I felt so bad for him that he could not get up out of his chair and walk 10 feet without stopping continuously for air and to regain his strength with every step.
His condition was so bad that he developed massive fluid build up not only around his chest and his heart but throughout his entire body. He was required to take almost 40 pills per day. He suffered many side effects of these pills. At one point his doctors recommended that he needed a heart transplant in order to survive.
He began to get evaluated for a heart transplant. However, because of the multiple side effects and because some of his organs were shutting down, he was ultimately deemed unqualified to participate in a heart transplant program.
We settled this case immediately before jury selection...
I will also share with you a little secret that the amount that I was able to recover for this young man and his family was the most amount of compensation I have ever obtained in my career.
The harsh reality is that no matter how much I was able to recover for this young man it would never restore his health to what it once was. His family's life would never be the same. He would never be able to do any of the things he used to do. He would never be able to work again-ever. His old life, as he knew it, was over.
The money would only provide creature comforts to his family.
Whenever I spoke to him or his wife, I kept coming back to the reality that this all could have been avoided if the emergency room doctor was not so arrogant and paid attention to the EKG computer printout and if he had simply understood how to properly read and interpret an electrocardiogram.