Malpractice defense: Coronary artery disease vs. medication administration

In addition to my consulting work and writing the Health Business Blog, I’m chairman of the board of Advanced Practice Strategies, a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety. Here's the Advanced Practice Strategies case of the month.For previous examples see Fetal assessment and response and Stroke after lung surgery.

Illustrated Verdict by APSEvery month APS's Demonstrative Evidence Group shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of healthcare providers. Please feel free to forward it to colleagues or clients.About UsAPS is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. To learn more, e-mail us or call 877.APS.4500.Case RequestIf you have an upcoming case in any of the following areas, please send us an e-mail and we’d be happy to show you some relevant examples of our work:Bariatric/Gastric BypassBirth Injury & DefectsBrain InjuriesCancersCosmetic SurgeryDelayed/Mis-DiagnosisDental IssuesDigestive Tract IssuesEmergency RoomFemale ReproductionFilm Duplication/DigitizingFilm EnlargementHeart Attack & CardiacInfectionLasik Eye SurgeryMale ReproductionMedication IssuesSpinal Cord InjuriesSurgical IssuesGeneral Inquiries

Judgment for the DefenseCoronary Artery Disease vs. Medication AdministrationA patient presented to the hospital with an increased white blood cell count along with presumed cellulitis of his leg. He was treated with antibiotics for this infection. During medication administration, the patient suffered a cardiovascular collapse and, despite the resuscitative efforts of the care team, could not be revived.PLAINTIFF'S CLAIM:The plaintiff claimed that the care team was negligent in administering the antibiotic medication and further that resuscitation efforts after the patient coded were ineffective due to further negligence. The plaintiff suggested that these incidents of negligence were the proximate cause of the patient’s death.DEFENSE'S ARGUMENT:Examination of the patient revealed severe cellulitis with a lymphatic streak up the leg. He had no palpable pulse below the groin on either side and was not receiving an adequate blood supply to his foot. To treat this condition, it was recommended he be admitted and treated with IV antibiotics. The medical history taken during the evaluation showed that the patient had a 20+ year history of diabetes, peripheral artery disease, hypertension, and coronary artery disease. He also had a history of two prior heart attacks. In fact, he had been treated for one at the same hospital and was discharged against medical advice after he refused to undergo recommended coronary bypass surgery.An autopsy found that the decedent’s heart was twice the size of a normal heart for a man of his age, indicating that it was working extremely hard as a result of cardiac disease. There was significant blockage in every single one of the decedent’s major coronary arteries. The autopsy further stated that myocardial infarction in the setting of coronary artery disease, aortic atherosclerosis, and peripheral vascular disease was the cause of death.VISUAL STRATEGY: We worked with the attorneys, their clients, and the experts to develop a visual strategy that would help explain the severity of the patient’s vascular disease to the jury. It demonstrated the relationship between the patient's vascular disease to the autopsy, which identified the cause of death as myocardial infarction in the setting of coronary artery disease, aortic atherosclerosis, and peripheral vascular disease. First, the normal coronary system of the heart was used to explain to the jury the complex system of vessels that feed the heart. We recreated the schematic of the coronary system typically used in patient charts to help physicians indicate the extent of the patient’s heart disease. Information gathered from the medical documentation and the experts enabled us to illustrate the severity of the atherosclerosis in the patient’s coronary arteries for the jury. An illustration of the hypertrophy and dilation of the heart showed the size of the patient’s heart, indicating how hard it was working to keep blood flowing through his body. Lastly, we compared normal and diseased cross-sections of the heart's ventricles and coronary arteries not only to illustrate the severity of the hypertrophy and dilation, but also to indicate the amount of disease present. This also enabled us to demonstrate evidence of the previous myocardial infarctions in the heart muscle. RESULT: Judgment for the defense.