Our claims team obtained a defense verdict at the Supreme Court of the State of New York, Westchester, on behalf of an emergency medicine physician in a case alleging the wrongful death of a 57-year old man. On the day in question, the decedent had arrived in the emergency department complaining of a moderately intense squeezing chest pain of one day’s duration radiating to the left shoulder, neck, and jaw. A cardiology consultation was requested by the emergency medicine physician and the decedent was worked-up for a myocardial infarction. The workup, which included an EKG and cardiac enzymes, was negative and the patient was discharged approximately 7 hours after arrival. Three days later, the decedent was brought back to the emergency department by ambulance and arrived in cardiopulmonary arrest. Resuscitation was unsuccessful, and an autopsy revealed the cause of death to be a ruptured aortic dissection. The deceased’s spouse brought suit against the emergency medicine physician, alleging that he was negligent in failing to evaluate the patient for an aortic dissection.

Defending the case was not without its challenges. One issue of concern was that, on the day in question, the nurse had documented a complaint of chest pain radiating to the back – a classic hallmark for an aortic dissection. Two other problematic issues were the facts that:
(1) A new heart murmur was noted on the physical exam.
(2) The chest x-ray ordered by the defendant showed a questionable distortion of the mediastinum.

Both of these findings can be associated with an aortic dissection in the setting of chest pain.

Despite these obstacles, our defense team mounted a vigorous defense on behalf of the emergency medicine physician. The defense was able to show to the jury that the nurse’s documentation of chest pain radiating to the back had occurred after the decedent had been pain free for six hours and while the decedent was being given discharge instructions by the nurse. Since the emergency medicine physician had already discharged the decedent, the nurse should have communicated the new complaint directly to the ED physician rather than merely documenting it in the discharge note.

Key to the defense was the use of high-quality expert physician witnesses from both emergency medicine and cardiothoracic surgery who effectively refuted testimony brought forth by the plaintiff’s physician experts. Skillful cross-examination of the plaintiff expert witnesses helped to inform the jury that the decedent’s presentation was quite atypical in quality and severity for a patient with an aortic dissection and that the decedent’s symptoms had completely resolved prior to discharge. The defense was also able to cast doubt upon the significance of the new heart murmur which was shown to be a murmur type that is inconsistent with an aortic dissection. As well, the defense counteracted the alleged significance of the decedent’s chest x-ray and demonstrated to the jury that the emergency medicine physician had the patient properly evaluated by a cardiologist.

Ultimately, the jury determined that the emergency medicine physician had not departed from good and accepted standards of care when evaluating and treating the decedent.

**Although the disposition of this claim predates the formation of EmPRO, the management of the claim was handled by EmPRO’s management company (PRIMMA, LLC). To learn more about the EmPRO story, click here.