Malpractice defense: Coronary Artery Disease Leads to Recurrent MI and Premature Death

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,  Stroke after lung surgery,  Coronary artery disease vs. medication administration,  tPA administration leads to brain hemorrhage and Hysterectomy leading to vesicovaginal fistula.

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 health care 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 / MisdiagnosisD ental IssuesDigestive Tract IssuesEmergency RoomFemale ReproductionFilm Duplication/DigitizingFilm EnlargementHeart Attack & CardiacInfectionLasik Eye SurgeryMale ReproductionMedication IssuesSpinal Cord InjuriesSurgical IssuesGeneral Inquiries I.V. LibraryClick to view other editions:Fetal Assessment / ResponseStroke After Lung SurgeryShoulder DystociaSpleen Injury and Bleed Cardiac Artery DiseaseGastric BypasstPA InfusionRecurrent Hiatal HerniaHysterectomy / FistulaDiseased Coronary Bypasses

Judgment for the DefenseCoronary Artery Disease Leads to Recurrent MI and Premature Death PLAINTIFF'S CLAIM:The wrongful death of a 56-year-old man was due to an alleged significant delay in the diagnosis and treatment of recurrent coronary artery disease, thereby allowing his condition to progress to the point that he suffered another myocardial infarction (MI, heart attack) and died.DEFENSE'S ARGUMENT:The plaintiff had a history of coronary artery disease that was followed appropriately and treated with both non-surgical and surgical options.The plaintiff sustained his first myocardial infarction (MI) in 1984, when he was in his late 30s.  After his diagnosis and treatment for coronary artery disease, he subsequently lived symptom-free for 4 years.In 1988, the plaintiff was diagnosed with another MI.  An angiogram identified multiple blockages of major coronary arteries, and bypass surgery was recommended. In June 1988, he underwent a successful quadruple bypass surgery.In 2002, the patient presented with symptoms of recurrent coronary artery disease.  A cardiac catheterization was performed that showed occlusion of the grafts from his surgery 14 years ago.The plaintiff’s recurrent disease and subsequent treatments were not due to the previous care of his physicians and surgeons. Rather, the recurrent MIs resulted from the plaintiff’s unwillingness to change his lifestyle, ultimately resulting in his premature death.VISUAL STRATEGY: APS worked with the attorneys and experts to develop a visual strategy that would help explain to the jury in detail how the plaintiff’s procedures were done appropriately and without error. Also, APS illustrated the extent of disease that was seen on the plaintiff’s 2002 catheterization.We began by showing normal anatomy of the heart and location of the coronary arteries to orient the jury.We also illustrated a normal schematic of the coronary vessels.The cardiology expert who we worked with on the case had created sketches of the patient’s coronary system for use in court. Expert's Sketch 1 Expert's Sketch 2 From those sketches we created informative illustrations that were used to help the jury understand the plaintiff’s complex system of heart disease and coronary bypasses. The first illustration based on the expert’s sketches detailed the plaintiff’s condition on 4/28/88. The second illustration was of the plaintiff’s 6/6/88 quadruple bypass, which showed how the grafts were placed and their intended purpose to bypass the blockages. The third illustration based on the expert’s sketches was the 3/22/02 cath findings, which showed total occlusion in two of the four bypass grafts. This combination of illustrations helped the defense successfully explain that: Since the plaintiff’s first MI in 1984, his coronary artery disease and recurrent MIs were properly treated with both non surgical and surgical therapy. The stenosis found in the grafts on 3/22/02 was no fault of the plaintiff’s physicians and surgeons. Rather, it was the natural consequences of the plaintiff’s unwillingness to change his lifestyle, which allowed his condition to progress.  Ultimately, this resulted in another myocardial infarction that led to his premature death.  RESULT:The jury found in favor of the defense.Attorney Edward Hinchey called to thank us after the verdict:“Jurors were on the edge of their seats because of the illustration boards. My expert was great in his testimony and this was greatly attributed to the quality of the exhibits.”-- Attorney Edward Hinchey, Sloane and Walsh LLP, Boston, MA