Malpractice Case: Could an ECG Have Saved This Woman?

Gordon T. Ownby

Disclosures

January 04, 2021

Two days after her last visit with Dr FP, the patient presented to the emergency room with shortness of breath and chest pain. At the hospital, tests revealed findings consistent with acute inferior lateral myocardial infarction, an occluded right coronary artery, global hypokinesis and inferior akinesis, and an ejection fraction of 30%.

A balloon pump was placed, but surgery could not proceed because of the clopidogrel administered in the ER. When a stent failed to establish reflow, the patient was treated with tissue plasminogen activator, verapamil, and nitroglycerin. After transfer to the ICU and intubation, the patient experienced multiple recurrences of cardiac arrest before CPR was terminated, followed by her death.

Family members filed a lawsuit against several healthcare defendants over the care rendered. In addition to alleging that Dr FP should have been more urgent in her cardiology referral, they claimed that Dr FP's failure to perform an EKG on the first of the visits contributed to her death. The lawsuit against Dr FP resolved informally.

Patients lacking insurance coverage may frequently decline a general practitioner's advice to see a specialist for more targeted care. Documenting the advice given and declined is important in the defense of a later lawsuit, but it will likely never be enough to overcome not doing a test routinely performed at a family practice.

This case comes from the "Case of the Month" column featured in the member newsletter published by the Cooperative of American Physicians, Inc. The article was originally titled "Specialist Referrals Are Not Always Enough."

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