John Ritter and the $67 million malpractice trial

Big time malpractice case is currently being tried regarding the unfortunate death of John Ritter from an aortic dissection. The family is seeking $67 million against the radiologist and cardiologist.

I commented on the case back in 2004:

Working in the ER, the first priority would be to ensure the cause is not one of the four “sudden death” causes. If the pattern didn’t fit an MI, a chest X-ray (routinely performed) would rule out a pneumothorax. That leaves dissection and pulmonary embolism as causes next to rule out. Chest CT would be the key test that would have caught the dissection (98 percent sensitivity). If PE was suspected, a CT angiogram would have been ordered.

Since the hospital’s working diagnosis was acute MI, and then pericardial tamponade (likely diagnosed via echocardiogram), I suspect that the chest CT wasn’t performed quickly enough, since dissection wasn’t high enough on their differential diagnosis (again, I’m just speculating).

I can only sympathize with the emergency room that night. With an acute aortic dissection, seconds count, and it was an unfortunate event for all concerned. Was it malpractice? Tough to say. The question I’d be interested in would be how long it took for the ER to order that chest CT scan.

Update:
Dr. RW with further analysis of the case.

Update 2:
ER physician Shadowfax with his detailed take.

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  • Anonymous

    The end of the article states that the family will use the proceeds to educate the public about aortic dissection. Hmmm. Educate the public about a rare condition that has a poor survival and no screening tests.

  • Anonymous

    Jackpot.

  • Anonymous

    As a Radiologist, the details of the case are confusing but here are some thoughts. Chest x-ray is useless. CT scan could have been done to exclude both PE and dissection at the same time. I did not read anywhere that one was even ordered. CT would not have been considered if an MI was the working diagnosis. What has not been mentioned is that Type A dissections can dissect back into the coronary arteries and block them, causing an acute MI. Also, all reports I have read state the aorta was not enlarged on the original CT from 2 years prior.

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