Medical Malpractice Case Report: $450,000 settlement for failure to diagnose and treat atherosclerotic heart disease and myocardial infraction during spinal surgery

Reached a $450,000 settlement for the family of a 55-year-old man who died after a failure to diagnose and treat atherosclerotic heart disease and myocardial infraction during spinal surgery.  Read the following Minnesota Case Report from the Minnesota Association of Justice (MAJ) Minnesota Case Report:

Selected Results*  

(Excerpts taken with permission from Minnesota Association for Justice (MAJ) “Minnesota Case Reports”)

On G.F., age 55, was involved in a car crash on March 31, 2001 in North Dakota.  He was brought to defendant Hospital’s ER.  He had been unseat belted and ejected from the vehicle and thrown 50-100 feet, sustaining severe injuries including a pneumothorax, fractured clavicle, multiple rib fractures, and multiple spinal fractures with a burst fracture of the thoracic spine, and a severed spinal cord.  He had resulting paralysis below the nipple line.  Surgical stabilization of his spinal cord injury was scheduled to take place 4 days after his injury.  There is no indication delaying this surgery would have been life threatening or worsened his condition from a neurological perspective.  During surgery, G.F. died from a cardiac arrest that Plaintiff alleged resulted from undiagnosed coronary artery disease and an undiagnosed acute myocardial infarction occurring during his hospitalization, 12-24 hours before his death.

Before surgery, G.F. had complaints of chest pain, elevated troponins, EKG changes documented on 4/1, 4/2, and 4/3.  An echocardiogram was done before surgery to rule out a cardiac contusion. It showed an elevated pulmonary arterial pressure, and no evidence of cardiac contusion.  Plaintiff’s liability experts were a board certified anesthesiologist, cardiologist and a physician triple board certified in internal medicine, critical care, and nephrology.  These   experts would have testified G.F.’s complaints and findings were indicative of cardiac ischemia that required further evaluation before surgery.  His cardiac condition should have been identified and treated before undertaking spinal surgery.  With appropriate treatment of his underlying cardiac condition, his intraoperative arrest and death would have been avoided. 

The defendants Dr’s L, P, and S attributed G.F.’s condition to the injuries he sustained in the crash, including a significant chest contusion.  Defendants’ board certified interventional cardiology expert would have testified that G.F. gave no history of risk factors for coronary artery disease.  Dr. L knew that G.F. had been on medication for hypertension and that his mother was recovering from cardiac bypass surgery at the time.  He would have testified that his clinical picture was entirely consistent with chest contusion and pain from the car crash.  Specifically, his troponin levels were not substantially elevated, and were more consisted with an older injury that was resolving than recent cardiac ischemia.  His EKG changes were typical of changes seen in patients with substantial pain, and the results of the echocardiogram were not sufficient to delay surgery.

On April 4, 2001, G.F. was brought to surgery.  Defendant Dr. P administered general anesthesia.  A decompressive laminectomy and stabilization of G.F.’s spine with rods, was performed by defendant Dr. S. At the end of surgery, as the wound was being closed, G.F.’s blood pressure dropped.  CPR was started, and stopped when no pulse was noted.  G.F. was pronounced dead.  Plaintiff’s anesthesia expert would have testified that, in addition to his failure to adequately screen G.F. as a surgical candidate, defendant Dr. P. also failed to appropriately monitor and treat G.F. during surgery.  G.F.’s blood pressure was low during surgery, and accepted standards of medical practice required that an arterial line be placed.  Invasive monitoring would have provided much more precise information concerning G.F.’s intraoperative vital signs, including his blood pressure, vaso pressure management, and fluid management.  A large amount of fentanyl and Phenobarbital was used which led to moderate to severe hypotension.  G.F. was also fluid overloaded, and this led to decreased cardiac output and increased heart rate in a heart that was already experiencing ischemia. 

Defendant’s board certified interventional cardiology expert would have testified that patients with catastrophic spinal cord injury are at high risk for hemodynamic instability and arrhythmia during surgery.  He would have testified that G.F. became severely hypotensive in a very short period of time, and that the likely cause of his death was an arrhythmia combined with severe hypotension. He would further have testified that, even if G.F.’s underlying cardiac condition had been identified, the treatment options in his case would have been very limited, with many of the more popular treatments for coronary artery disease being contraindicated due to his severe injuries.  Defendant’s double board certified critical care / anesthesiology expert would have testified that G.F. was appropriately evaluated before surgery, and the decision to proceed with surgery met accepted standards of practice.  He would further have testified that G.F. rapidly developed hypotension during surgery that the interventions used were appropriate, and that alternative interventions would not have altered the outcome. 

G.F.’s autopsy demonstrated severe atherosclerotic heart disease with a 80 – 90% occlusion of multiple vessels and evidence of an acute myocardial infarction 12-24 hours prior to death.                         

G.F. was survived by his wife of 24 years and two adult children.  He had worked for more than 16 years as a journeyman electrician.  Since G.F. no longer had the use of his legs, his future employment was uncertain.  Defendants’ rehabilitation expert would have testified that, even assuming that a handicapped adaptations could be made to permit G.F. to continue working in his field, the projections of Plaintiff’s economist regarding G.F.’s future income failed to take into consideration the severity of G.F.’s injuries.  Specifically, she would have testified that in addition to the loss of function in his lower extremities, G.F. likely would have experienced other problems related to his paraplegia (such as emotional problems, bowel & bladder dysfunction, muscles spasms, etc.) that would have significantly impaired his ability to work full time. 

This case settled prior to trial.