An exercise stress test leads to a malpractice verdict

Tough case, unfortunate outcome where zero malpractice was committed. Sending a patient suspicious for coronary artery disease for a stress test is routine. This one had a massive MI post-test, leading to a verdict – will this lead to more patients going straight to a heart cath? (via a reader tip)

Comments

Anonymous
Sounds like the sodomites dropped the ER Physician. Wonder why? They could have said he was responsible for the fatal decision of ordering the Stress test, hired an ER physician Hack to say it’s not “standard of care”, grossed another million bucks. The attorney should be sued by his client for not maximizing potential profits.
Anonymous
Send them all for cath. Then maybe one without CAD will have a coronary artery perferated and dissected iatrogenically. Send them immedietly to the cardiothoracic surgeon. they then develop mediastinitis. Open the chest back up and have them suffer for another week of existance on a ventilater with an open chest.
Yeah, that would be a much better route to go
Anonymous
The expert testifying, Harold Marcus, retired from cardiology practice in LA a few years ago – following a med mal claim – guess it went in his favor as he has no judgements on the CA Med Board Website.
Anonymous
They should hang Harold Marcus in a public Square in Iraq next to Saddam; they could hang the Human Pice of shit attorney in between the two.
Anonymous
Basically what happened here is that there are 5-6 different cardiologists who disagree on whether this guy shoudl have undergone the test.
The law states that a doctor can only be sued if a “standard of care” is not met.
I’m sorry, but 6 cardiologists who disagree about a test is NOT a “standard” of care. A “standard” is set by a community of people. To break a “standard” requires a clear violation from accepted practice, not a mere disagreement among professionals.
Next time you hear that term “standard of care” used by lawyers, please proceed to laugh in their face. I dont care what hte law says, the bottom line is that these cases are decided on issues that has absolutely EVERYTHING to do with individual “expert” disagreements and NOTHING to do with “standard” of care issues.
The kind of logic used in this case would be similar to having a court case to decide if “less filling” or “tastes great” is better. Going either way has nothing to do with violating a standard and everything to do with individual preference.
Doctors should not be sued for individual preferences. Thats exactly what happened in this case.
Anonymous
Then maybe one without CAD will have a coronary artery perferated and dissected iatrogenically
And you think you are less likely to be sued for this than for someone having a heart attack during stress test?
What is the probability of the latter? What is the probability of the former?
Anonymous
A doctors PREFERENCE can change a human being or kill them. On a suregons preference card was a highly flammable skin prep that burned my mother. The hospital claimed spontaneous combustion in the chart??? What is wrong with this picture. http://www.surgicalfire.org
Gasman
I’m sorry to hear about your mother. In the end there will be bodies. We’ll have to see whether there are fewer with inflammable preps (more injury from burns), or non-flammable preps (more injury from infections). Because there is not yet evidence to conclude that either course of action is always, or almost always correct, then the surgeons preference is as good a method for selecting the prep as any.
The current trend now is toward chlorexidine with 70% alcohol as prep solutions. There will be more fires as a result. Time will tell.
Anonymous
Speaking of malpractice, check out the new campaign ad in the Tennessee Senate race addressing medical tort reform.
Harlod Ford on Tort Reform
adventures in disaster
well, I am a cardiothoracic nurse and I can tell you stress tests are on the whole worthless. In ten years I cannot count how many of my patients had stress tests that revealed nothing because the patients literally couldn’t do the tread mill long enough.
My husband had a completely normal stress test and had an inferior MI two weeks later and I do say thank you to the good surgeon in Nashville that did a lovely job.
No I didn’t sue the GP who had no business giving a stress test in the first place ..because I am a Canadian who just happened to be living and working in the US.
If your patient is a diabetic with hypertension ,high cholesterol and smokes a pack a day and complains of chest pain? Skip the stress and go straight for the cath.
Why bother screwing around? And the chance of perfing? That is a chance you have to take and by the way not every open heart patient becomes a disaster, the majority do just fine.
A cath can save someones life, a stress test is nothing but a crappy diagnostic tool.
I do not believe in suing doctors unless it can be demonstrated that they committed gross negligence..like taking off the wrong leg or being drunk/on drugs during a procedure.
Th majority of people in medicine do the best damn job they can with good intentions. Sometimes they make mistakes..because they aren’t robots thank God.
Anonymous
What I find interesting about the last author is that you mention you are from Canada and you support patients going right to Cath. I don’t disagree with you but if you live in Canada it takes forever to get a Cath, not to mention a CABG if you need that too. As we in SUE-CRAZY U.S. feel the need to test more and more patients at earlier ages for Coronary Disease, ie anyone over 21 with chest or epigastric pain, there has to be some kind of screening exam so not EVERYBODY goes to cath. It would be more useful to cath everyone in less litigous Canada, because at least there you can just tell 21 year olds with chest pain to take Tylenol and leave us Doctors alone.
Anonymous
I’ve always been curious about the person who is the opposite from ‘not-being-able-to-do-it’ types. Like athlets for example. Is stress test useful for them? Do you make it harder for them? I don’t know much about it, so I am curious.
An reason I am curious is that my 78-year old father who had an MI (very mild, he hadn’t learned about it until later) sometime between the ages of 50 and 59 and who used to be a competitive runner when he was young had always passed them with flying colors. Only recently did he start to even get tired during a stress test. When he did one at 68 and the treadmill was still at moderate speed, the doctor asked him: “How long can you walk like this?”. My father said “2 days”. When it was at max speed, they asked him “what about now?” He said – “about an hour”.
Anonymous
“When it was at max speed, they asked him “what about now?” He said – “about an hour”.
Sounds like he has a possibility of coronary artery disease. Since we can’t rule it out completely, you should go right to the ER and tell them your father needs a Chest CT Scan, MRI Angiogram, cardiac Catheterization, Dobutamine echo, and perhaps a $20,000 array of Blood tests to rule out exotic causes of his weakness. All “just in case”. I thought I’d save you some time because if you pursue your father’s weakness in the “CYA from attorney’s” world we fight every day, that’s what you’ll get.
The above paragraph in no way construes medical advice or information and in no way should be taken as such. If you have any real concerns they can only be evaluated in the presence of a licensed physician. I make no definitie conclusons in the above paragraph, and should not be held accountable should the statement be taken as advice. If you have further questions, please contact your personal physician or attorney.
Michael Rack, MD
“well, I am a cardiothoracic nurse and I can tell you stress tests are on the whole worthless”
Stress tests by themselves are worthless, especially in women. A stress test (either exercise or pharmacological stress) combined with nuclear imaging is a fairly effective test.

An exercise stress test leads to a malpractice verdict

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