$1,165,250 Settlement for Failure to Timely Diagnose Intracranial Bleed

On October 31, 2000, the plaintiff’s decedent went to a hospital with complaints of chest pain. After evaluation, it was found that he had sustained a heart attack and was admitted for observation. Although he had sustained little or no heart muscle damage, he was transferred to another hospital on November 7, 2000, to be admitted under the care of the defendant doctor. On that date, the defendant performed a diagnostic cardiac catheterization and found a significant blockage of the left circumflex artery and recommended a stent angioplasty, to be performed on November, 9, 2000. Due to the blockage and in anticipation of the angioplasty, the defendant ordered the decedent to receive anti-platelet therapy (aspirin and plavix) and anti-coagulation therapy (heparin) to reduce the risk of further clotting or occlusion of the heart vessel. The risk of starting anti-platelet and anti-coagulation therapy, however, is a propensity to bleed requiring that the anti-coagulation status be monitored. After starting the infusion of heparin at midnight of November 8, a partial thromboplastin time (PTT) test was performed to determine the anti-coagulation status of the decedent’s blood at 6.00 am. When the value was reported at 115 seconds, higher than the therapeutic range for this patient of 80 – 100, the defendant ordered the heparin infusion reduced. He did not order a follow up PTT to be drawn after six hours, as required under the standard of care, and no further PTT testing was performed until two days later. At approximately 5.00 pm, the decedent developed a series of symptoms, including a “terrible” headache, profuse sweating, nausea, vomiting and a markedly increased blood pressure consistent with an intracranial bleed (ICB). An ICB is considered an emergency situation, and can be fatal if left untreated. The defendant was advised of all of the symptoms by the defendant nurse on duty, and/or a cardiology fellow at 5.30 pm by phone. Despite testifying that he was “concerned” and that he immediately came to the hospital, he did not order a CT scan, seek a neurology or neurosurgery consult, nor endeavor to reverse the anti-platelet or anti-coagulation therapy at that time. Upon arriving at the hospital at 6.30 pm – with the patient in the same condition as an hour earlier, the defendant doctor, at 6.50 pm, ordered a stat CT scan of the head “to rule out bleed” and stopped the heparin infusion. However, he did not reverse the anti-coagulation with medication or platelets, or order any consultation at that time. He then left the hospital to go to another nearby facility to make rounds. At 8.30 pm, for reasons unclear in the record, the defendant ordered a neurology consultation at 8.30 pm. At approximately 9.15 pm, while being taken to radiology for the CT scan, the decedent suffered respiratory arrest and was resuscitated in the emergency room. A CT scan was then performed, showing a massive intracranial bleed which resulted in brain death. The case was tried from June 18 through July 3, 2007. The jury returned with a verdict in favor of the plaintiffs (the decedent’s wife and the estate), finding defendant doctor 95% liable and the defendant Nurse 5% liable. The defendant nurse and hospital entered into a High-Low agreement during the trial and will therefore pay $125,000. The verdict against the defendant doctor was $1,040,250.