Man may have been discharged during heart attack

On Feb. 2, 2007, a patient, 54, was taken by ambulance from a walk-in clinic to the ER. He had a two-day history of increasing shortness of breath, fever and non-productive cough.

The patient’s medical history included insulin-dependent diabetes, chronic obstructive pulmonary disease, hypertension and pneumonia, for which he had been hospitalized several times in the past year.

An internist admitted the patient with a diagnosis of pneumonia and COPD. Noting a “slight increase in CPK” and no acute EKG change, he wrote that the patient may have had slight ischemia secondary to respiratory distress. By the following morning, CPK-MB and Troponin-1 test readings had increased; however, the internist felt that the patient’s breathing had improved and coughing had decreased.

Another EKG was reported as borderline with normal sinus rhythm and possible left atrial enlargement. The doctor wrote that although the patient had a slight increase in cardiac enzymes, he had no symptoms, no EKG change and a normal echocardiogram in June 2006, and concluded that he probably had strain secondary to respiratory distress.

The patient was discharged that morning. Later that afternoon, his wife called the hospital to report that her husband had been taking a shower and was having difficulty breathing. A nurse said he probably over-exerted himself in the shower. His breathing improved within 20 minutes.

That evening, the patient suffered an acute myocardial infarction and was found unresponsive by his wife, who initiated CPR and called emergency medical services. He was taken by ambulance to the ER and was transferred to a tertiary hospital, where he remained on life support until he died three days later.

The widow’s expert was prepared to testify that the defendant failed to comply with the standard of care. When deposed, the defendant conceded that the available information indicated that the patient may have been having an acute MI upon discharge.

The parties reached a settlement of $650,000.

Type of action: Medical malpractice

Injuries alleged: Failure to diagnose and timely treat acute coronary syndrome, death

Date: May 2009

Submitted by: Patrick T. Jones and Donna R. Corcoran, Cooley Manion,Jones, Boston (for the plaintiff)