Man discharged from ER with chest pain dies later that day

A 57-year-old retired man presented to his local ER on April 9, 2005, with tight substernal chest pain. His medical history included hypertension and smoking one pack of cigarettes per day.

An EKG was performed by the emergency physician and was interpreted as having no abnormalities. The patient was treated with various medications, including Donnatal, Lidocaine, Maalox and Zantac, which gave him little or no relief from his chest pain. When morphine was administered, the patient began to experience lightheadedness and nausea and became pale and diaphoretic. Also, his blood pressure fell precipitously low.

A repeat EKG indicated “borderline.” The doctor noted that the repeat EKG showed “normal sinus rhythm compared to previous.” His notes reflected that after four hours in the emergency room, the patient continued to have mild discomfort in the chest but was much improved.

The doctor discharged the patient, who was still having chest pains, with a diagnosis of “atypical chest pain” and gastroesophageal reflux disease. He was given a prescription for Protonix and advised to keep hydrated with clear liquids and eat frequent, small meals.

Within seven hours of his discharge, the man’s wife found him unresponsive. He was transferred by ambulance back to the emergency room where he was pronounced dead. The death certificate listed the cause of death as cardiac arrhythmia due to cardiac ischemia secondary to coronary artery disease.

The plaintiff’s experts were prepared to testify at trial that the defendant failed to recognize that the first EKG was abnormal, that his medical and social history placed him at increased risk for coronary artery disease and that his symptoms were cardiac in nature. They were further prepared to testify that applicable standards of care required serial enzymes, continued cardiac monitoring, administration of aspirin or heparin and in-hospital cardiac evaluation and testing.

The case concluded with a $750,000 settlement.

Type of action: Medical malpractice

Injuries alleged: Myocardial infarction,

wrongful death

Date: January 2010

Submitted by: Robert A. Shuman, Law Offices of Robert A. Shuman & Associates, Sharon (for the patient)