Volume 10, Issue 5, May 2000

$1,700,000 RECOVERY - MEDICAL MALPRACTICE - FAILURE TO TIMELY TREAT CARDIAC TAMPONADE FOLLOWING CATHETERIZATION PROCEDURE - IRREVERSIBLE ISCHEMIC CHANGES TO LOWER EXTREMITIES - PARTIAL AMPUTATION OF BOTH LOWER LEGS.

Attorneys for plaintiff: Wil H. Florin and James E. Huddlestun, M.D. of Florin Roebig & Walker, P.A. in Palm Harbor and Clearwater.

This B>medical malpractice action was brought against two defendant cardiologists, who worked in the same practice group, as well as the hospital where the plaintiff was treated for Wolff-Parkinson-White Syndrome. Wolff-Parkinson-White Syndrome is a condition in which an abnormal cardiac electrical pathway can cause episodes of rapid heartbeat. The plaintiff alleged the defendants failed to timely treat cardiac tamponade following a heart catheterization procedure, resulting in partial amputation of both of the plaintiff's lower legs. The defendants denied any negligence and maintained that the plaintiff's amputation resulted from preexisting conditions which caused blood clots.

During 1996, the plaintiff a male age 40 at the time, began experiencing angina pectoris. Diagnostic work-up, including cardiac catheterization, revealed coronary artery disease and Wolff-Parkinson-White Syndrome. For treatment of his coronary artery disease, the plaintiff underwent multiple coronary angioplasties with placement of multiple intracoronary stints. The plaintiff was then able to return to his employment as a bus driver.

On January 28, 1997, while driving his automobile, the plaintiff experienced an episode of rapid, irregular heart rate followed by chest discomfort. He was admitted to a non-party hospital for evaluation where the first defendant cardiologist confirmed the diagnosis of Wolff-Parkinson-White Syndrome. The defendant arranged for the plaintiff to be admitted to the defendant hospital on February 13, 1997. On that date, the plaintiff claimed that the first defendant cardiologist unsuccessfully attempted to perform a radio-frequency catheter ablation procedure to treat plaintiff's Wolff-Parkinson-White Syndrome by eliminating the accessory electrical pathway in the plaintiff's heart.

In attempting the ablation procedure, the plaintiff claimed that the defendant caused an injury to the plaintiff's heart which resulted in a collection of blood in the pericardial sac surrounding the heart. The defendant allegedly knew that the ablation could cause a collection of blood and to check for this he ordered an echocardiogram for the following day. The plaintiff's experts explained that the blood in the pericardial sac can result in cardiac tamponade, a life-threatening condition in which the accumulation of blood in the pericardial sac compresses the heart thereby reducing the ability to pump blood, particularly to the patient's extremities.

When the first defendant cardiologist visited the plaintiff on Friday, February 14, 1997, he documented in his progress note the plaintiff was experiencing severe chest pain and tachycardia, that he had exaggerated drop in his systolic blood pressure and that the plaintiff's echocardiogram further demonstrated the fluid collection. Together with the plaintiff's elevated heart rate, the plaintiff's experts opined that there were clinical indications that cardiac tamponade was developing. Nevertheless, the plaintiff claimed that the first defendant cardiologist noted his impression that there was "no evidence of tamponade at this point," ordered another echocardiogram for the following day and turned the plaintiff's care over to his partner, the second defendant cardiologist, for the weekend.

On Saturday, February 15, 1997, after examining the plaintiff for the first time, the second defendant cardiologist wrote a progress note stating that the plaintiff was disoriented, short of breath, tachycardiac and should be observed closely. The plaintiff contended that the nurses employed by the defendant hospital, who attended the plaintiff that day, documented that the plaintiff was experiencing decreased pulses in his lower extremities, elevated heart rate, chest pain, shortness of breath, fatigue and disorientation, signs that the plaintiff was developing cardiac tamponade. The plaintiff alleged that the nursing staff failed to take appropriate action. On Sunday, February 16, 1997, the second defendant cardiologist visited the plaintiff again and reviewed the echocardiogram which had been performed the previous day. This defendant noted in his progress note for February 16, 1997, that the fluid collection had increased in size and there was an impairment of the function of the left ventricle of the plaintiff's heart. He also noted that the plaintiff had chest discomfort, shortness of breath and fatigue. The plaintiff claimed that the defendant failed to appreciate nurses' notes indicating that there had been further decrease in the pulses in the plaintiff's lower extremities as well as weakness in all of his extremities. When questioned by the plaintiff's spouse about the plaintiff's condition, the second defendant allegedly advised that he was "just a babysitter" until the first defendant physician returned.

Plaintiff's experts opined that the second echocardiogram clearly indicated a life-threatening cardiac tamponade at that time.

On Monday, February17, 1997, the first defendant's physician's assistant examined the plaintiff and immediately called for surgical consultation. Examination of the plaintiff again revealed poor circulation in the extremities. A third echocardiogram was read as showing a cardiac tamponade and the plaintiff was taken for emergency surgery to drain the pericardial sac. Unfortunately, by this time, the plaintiff had suffered irreversible ischemic changes to his lower extremities which ultimately resulted in partial amputation of both lower legs. An economist projected the plaintiff's economic losses and life care needs to be approximately $700,000.

The defendants contended the plaintiff's extensive pre-existing condition resulted in the heart throwing multiple blood clots which resulted in the circulatory loss to the plaintiff's extremities rather than reduced acardiac output from the alleged cardiac tamponade. The defense pointed to the fact that there has never been a documented case of cardiac tamponade causing lower limb amputation of any kind in the medical literature.

The parties entered a confidential settlement shortly before trial for a present value of $1.7 million. The defendant hospital paid $200,000 for the alleged negligence of the nursing staff. The first defendant cardiologist paid his policy limit of $1 million and the second defendant paid $500,000.