Medical Malpractice Case Report: $225,000 settlement for 63-year-old man for failure to continue Coumadin resulting in stroke.

Firm partner Peter A. Schmit achieved a settlement of $225,000 in a medical malpractice case.  Read the following Minnesota Association for Justice (MAJ) Minnesota Case Report, Vol.28, No.3, June, 2009

Selected Results*

L.Z. is a 63-year-old man, husband, and father of four children. His past medical history was significant for diabetes, hypertension, peripheral edema, and kidney disease (specifically, focal segmental glomerulosclerosis). In June 2006, he suffered an embolic left brain infarct.

On September 7, 2004, Mr. Z. presented to his primary caregiver, Dr. A., with dyspnea on exertion, edema, fatigue, and erratic heartbeats. An electrocardiogram (“EKG”) demonstrated atrial fibrillation. Dr. A. started Mr. Z. on the anticoagulant medication Coumadin at 4 mg daily and scheduled him for an echocardiogram. The echocardiogram, conducted two days later (on September 9, 2004), demonstrated normal left ventricular size and systolic function; mild mitral insufficiency with mild stenosis; and trace tricuspid insufficiency.

On September 29, 2004, Mr. Z. returned to his primary caregiver. An EKG still showed atrial fibrillation, and Dr. A. noted that he would refer Mr. Z. to a cardiologist.

On October 14, 2004, Mr. Z. was seen by Dr. D. Dr. D. noted Mr. Z.’s echocardiogram (of September 9, 2004). The doctor also noted that Mr. Z. “has been started on Coumadin for the last several weeks and his INR is being adjusted.” Dr. D. assessed Mr. Z. with a “[n]ew onset atrial fibrillation” and “[p]ossible cor pulmonale with significant pedal edema.” Dr. D. discussed riskfactor reduction with Mr. Z. He planned for Mr. Z. to undergo cardioversion (that is, electric shock treatment to restore normal heart rhythm) in the next several weeks.

Mr. Z. underwent the cardioversion on November 16, 2004. EKGs taken prior to the shock treatment that day and on October 21, 2004 indicated atrial fibrillation. According to Dr. D., the EKG taken after the cardioversion indicated that a normal sinus rhythm had replaced the atrial fibrillation.

Mr. Z. was seen on December 21, 2004 by Dr. D. in follow-up of the cardioversion. Mr. Z. reported that "he believes that he had episodes of atrial fibrillation but is unable to tell." Dr. D. noted his impression that the shock treatment successfully returned a normal sinus rhythm. Dr. D. recommended that Mr. Z. continue with the Coumadin medication for another month. If there were no episodes of paroxysmal atrial fibrillation, he further noted, it would be okay to stop the Coumadin at that time.

Dr. D. also scheduled Mr. Z. to wear a Holter monitor. On January 6, 2005, Mr. Z. was hooked up to the monitor. Dr. D. noted that the monitoring did not display atrial fibrillation but did note some "PAC's, PVE's, [and] Wenckebach." Dr. D. gave the order for Mr. Z. to stop taking Coumadin and recommended that Mr. Z. contact the office with any changes in his heart rate or rhythm.  

On March 14, 2005, Mr. Z. called Dr. D.'s office and reported that he was back in atrial fibrillation. Nothing was done for Mr. Z. at this time; he would "see what  happens." When someone from the office called Mr. Z. to follow-up a week later (on March 21, 2005), Mr. Z. said that that he had converted back to a sinus rhythm two to three days after reporting the atrial fibrillation. 

On January 30, 2006, Mr. Z. was seen by Dr. H., an internal medicine doctor, for his atrial fibrillation, hypertension, kidney problems, and peripheral edema. Dr. H. noted that Mr. Z. had reported recurrent atrial fibrillation: "He notes a couple of nights ago his heart began fibrillating and he's noticed it since. . . . . He says it's done this before, but never has lasted overnight and in the day as it has now." On examination, Dr. H. reported Mr. Z.'s pulse to be 72 bpm and irregular. The doctor's notes from this visit were faxed to Dr. D.'s office on February 2, 2006.

Mr. Z. was seen by Dr. D. on March 8, 2006. Dr. D.noted that Mr. Z. had an irregular heartbeat a month ago but denied having an irregular heartbeat currently.   Dr. D. believed that Mr. Z. had a history of paroxysmal atrial fibrillation which was now in normal sinus rhythm. Dr. D. did not order an EKG or for Mr. Z. to restart anticoagulation medication. The doctor recommended seeing Mr. Z. again in six to twelve months.

On June 5, 2006, Mr. Z. was seen by Dr. H.. Dr. H. noted that Mr. Z.'s pulse was 72 and irregular.

On June 7, 2006, Mr. Z. called Dr. D. and left a message for a return call. Someone in the office returned Mr. Z.'s call and reported that Mr. Z.'s bloodpressure was 115/60 and that he was "having more arrhythmias." 

On June 19, 2006, Mr. Z. called Dr. D. again and left another message. The message stated that Mr. Z. "is calling because he is having [irregular] heart beats, that has been going on the last two weeks." It continued, "he is having troubling walking around[;] he is wondering if he should be seen right away or not. Please call Mr. Z. . . . ." L.C. of the office returned the phone call. She noted that Mr. Z. had a "history of documented SVT and paroxysmal SVT" and was "calling with increased irregular heart-rate." Sheinstructed, "Will have patient return to see Dr. D. regarding irregular rhythm." According to Mrs. Z., the office gave her husband an appointment on July 12, 2006. 

On June 24, 2006, Mr. Z. went to lie down after eating dinner. When his wife went to arouse him, he was confused and aphasic and unable to move his right side. An ambulance was called, and he was brought into the emergency room at their local hospital. The emergency room physicians had the information that Mr. Z. had a history of paroxysmal atrial fibrillation. A CT scan of the head was performed and was reported to show no bleed. Mr. Z. was diagnosed with a cerebrovascular accident, probably embolic due to his history of atrial fibrillation. Emboli appeared to involve the left middle cerebral artery location with right hemiparesis and expressive and possibly receptive aphasia. He was admitted to the hospital and placed on cardiac monitoring 

Dr. C., neurologist, evaluated Mr. Z. in the hospital on June 24, 2006. It was Dr. C.'s impression that Mr. Z. had suffered an embolic left brain infarct due to atrial fibrillation without preventative anticoagulation.

Defendant disclosed Dr. Thomas Davis and Dr. Gary Beaver who were prepared to testify that the care was appropriate in all respects. Among other things, defense contended that given Mr. Z.'s extensive drinking history, Coumadin was contraindicated. Mr. Z. has recovered but does have word finding difficulties and lack of stamina due to the stroke. He is back on Coumadin, and has limited his alcohol intake..

Settlement: $225,000
Attorney: Peter A. Schmit, Robins, Kaplan, Miller & Ciresi, L.L.P.