A study recently published by The Physician Insurers Association (PIA) reveals that malpractice claims arising from missed heart attack diagnoses represent the third most prevalent scenario giving rise to malpractice claims, ranking only below brain damaged infantscaused by birth injuriesand missed breast cancer diagnoses as the most prevalent type of claims with the highest per incident payout by insurers.
There are reasons for the high incidencefor missed heart attack diagnosis. First, heart attack symptoms mimic other disease states, such as indigestion, anxiety, and musculoskelatal pain, which are frequent alternative working diagnoses. One reason why a heart attack is not first considered as a working diagnosis is that nearly 70 percent of all patients presenting to their physicians with symptoms suggestive of a cardiac event have no prior history of coronary artery disease or heart conditions. An electrocardiogram (EKG), which is the first line test for determining whether the heart is functioning properly, is frequently not ordered (28% of the time), and when ordered, is either misinterpreted or the results are not timely communicated to the provider.
According to the PIA study, in the majority of cases, the provider misread the EKG results. Of 304 providers sued for cardiac malpractice, 277 did not correctly diagnosis a heart attack in the face of compelling medical data. 220 of those providers did not refer the patient to a cardiologist or other specialist.
Other areas of malpractice involve a failure to treat heart attack symptoms appropriately. 154 cases reported by the study involved allegations of treatment errors, and of those, 109 involved allegations of treatment and diagnosis errors. The most frequent errors in treatment involved a failure to admit the patient to the hospital for observationand additional testing, including certain blood tests that can tell a physician whether a heart attack is in progress. Premature discharge from the emergency room is, not surprisingly, another frequent event of malpractice in the cardiac setting.
As part of its risk management suggestions, which physicians would be well advised to adhere to strictly, PIA recommends the following protocols:
(1) Document the results of previous cardiac studies and compare the results with present studies;
(2) Document all patient complaints relative to pain and pressure in the sternum and area of the heart;
(3) Take a thorough personal and family history for cardiac related illnesses;
(4) Do not ignore or automatically rule out heart attack in younger patients;
(5) Run all available tests to rule out an actual or impending heart attack;
(6) Do not discount a patient’s clinical presentation even in light of negative test results and continue to investigate;
(7) Treat all patients the same whether in an emergency or nonemergency setting;
(8) Report promptly any positive findings and refer the patient to specialists immediately.
Although the foregoing actions would seem self evident,unfortunately they do not occur at rates that are acceptable to avoid catastrophic heart attacks. The lawyers at Belsky, Weinberg & Horowitz, LLC have vast experience with cardiac-related malpractice claims and have succeeded in obtaining excellent results for our unfortunate clients whose conditions could have been timely diagnosed and treated with the proposed protocol recommended above.
Our job as lawyers is not only to obtain recovery for clients after an injury occurs, but is to serve as a deterrent against future negligent care by sending a message that an avoidable medical error will come at a heavy legal and professional price. The goal of the law is to promote better medical care and we hope our efforts in the courtroom and in publishing our informational articles will serve that ultimate goal. We encourage all of our clients and readers to be their own best medical advocates, to ask as many questions as necessary to understand how and why the physicians are doing (and not doing) what they are to treat the illness or condition,and to realize that the patient knows his or her body better than any health provider looking from the outside.
Do not take for granted that the medical community has your best interests at stake and that they are correct in their diagnoses, particularly in the face of inexplicable physical symptoms. If you must return home without a solid differential diagnosis or suitable follow up plan, get on the internet and see what you can figure out on your own. If you learn something important, return to the medical provider immediately with research, ideas and questions in hand. An educated patient is the best patient, and many physicians, recognizing that a patient has access to internet data, will ask the patient what they think is wrong and willincorporate the patient’s ideas into their evaluative process.
Should you need assistance with a case or would like to ask questions related to a possible claim, please contact our office.