tPA Lawsuit Update
We covered a lawsuit last August alleging failure to give tPA promptly.
A patient was found with altered mental status.
He did not have stereotypical stroke symptoms and could not participate in neurologic examination (as is the case with numerous ED patients), therefore the emergency physician did not activate the stroke team.
A CT scan was done, and read as negative.
Ultimately they identified a left MCA stroke on MRI.
He was given tPA 4.5 hours after his last known normal.
This still wasn’t fast enough according to his family and their attorney, who sued the EM doctor, the neurologist, and the radiologist (for missing a dense MCA sign).
The EM doctor settled, but the lawsuit against the radiologist and neurologist continues.
The plaintiff has now disclosed another expert witness opinion, who is board certified in neurology and vascular neurology.
She claims that the neurologist should have arranged for a mechanical thrombectomy (the hospital did not have this capacity in 2016, when the case occurred).
She also suggests that the patient’s outcome would have been drastically different if he had been given tPA within 3 hours as opposed to nearly 4.5 hours.
The plaintiffs are still offering to settle with the neurologist for $2 million.
MedMalReviewer Analysis:
It is not the bedside neurologist’s job to set up a “Drip and Ship” algorithm. Expecting him to unilaterally set up this algorithm while caring for a stroke patient is a ridiculous criticism. This is a task for a hospital committee and likely takes weeks or months to set up.
This case occurred in 2016. While it is now clear that mechanical thrombectomy is critical for certain patients, the evidence was not as clear or widely disseminated 5 years ago. Transferring the patient may not have been as easy as the expert witness suggests.
This week’s new case (for paying subscribers) deals with a different type of neurologic disaster.
A prisoner reported headache and vomiting for nearly two weeks, and had fever, hypotension, and tachycardia. He was repeatedly refused transport to the hospital.
He was ultimately sent to an ED, where an LP was done before a head CT.
The patient herniated and died, although it is unclear what role the LP played in his death, and there were multiple confounding problems.
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