Ocean County, NJ
$1,125,000.00 Recovery in a medical malpractice case involving cardiologist negligence and the negligent management of rare complication of rare dissection during angiography and inadequate stenting and negligent failure to seek consultation for bypass surgery leads to massive heart attack and need for cardiac transplant surgery.
This was a medical malpractice action involving a then 41 year old woman who contended that the defendant interventional cardiologist negligently failed to obtain a surgical consult after the patient suffered a rare, but known risk of a spiral dissection during a cardiac catheterization. The plaintiff also supported that the defendant, who attempted to deal with the condition by placing four stents, negligently left a gap between stents three and four. The plaintiff maintained that the plaintiff suffered a clot and massive myocardial infarction approximately one week later, and required a heart transplant. The evidence disclosed that the plaintiff underwent a nuclear stress test that was performed at the offices of a non-party physician. During the administration of the contrast material, the plaintiff fainted. She was brought to a non-party hospital, with the determinations that she was not suffering a significant neurological deficit, as mild abnormalities on EKG were made, and the plaintiff was transferred to the defendant hospital.
The defendant physician conducted a catheterization, and during the procedure, the plaintiff suffered a spiral dissection of the left coronary artery. The plaintiff acknowledged that although rare, such an event can occur in the absence of negligence, and there was no claim of a departure that caused the dissection. The plaintiff upheld, however, that the plaintiff was in need of urgent bypass surgery, and maintained that the failure to obtain a surgical consult constituted a deviation.
The defendant physician maintained that he was confronted with an emergent situation, and that it was essential to restore blood flow to the left coronary system. The plaintiff’s expert maintained that although this position had merit, the defendant still should have arranged for a surgical consult when it appeared as if the blood flow was restored.
The plaintiff also supported that the defendant physician who treated coronary artery dissection with four coronary artery stents, negligently left a gap between two of the stents, thereby not covering a portion of the dissection with a stent, significantly increasing the risk of a myocardial infarction. The plaintiff confronted the defendant with the manufacturer’s instructions for use that are packaged with the stents, and instructed not to leave gaps between them, in order to ensure the entire dissection is covered by stent. The defendant’s cardiologist contended that the defendant’s management of the dissection was proper, and that the need for the transplant stemmed from the complication, despite appropriate care. The plaintiff underwent heart transplant surgery, and maintained that although faring as well as could be expected, she will require anti rejection medication, and remain at risk for infection permanently.
The plaintiff contended that the plaintiff becomes fatigued after relatively mild exertion, is out of breath after climbing 1-2 flights of stairs, and will permanently suffer such symptoms. The plaintiff further contended that the risk of opportunistic infection because of the need for anti rejection medication is great, and that the plaintiff will be required to restrict the amount that she can travel, and even intermingle with larger numbers of people. The plaintiff’s expert would have also have testified that the plaintiff faces a significant reduction in life expectancy. The plaintiff made no income claims.
The case settled prior to trial for $1,250,000.00
REFERENCE: Plaintiff’s cardiology expert: Joseph Weiderman, M.D.
Patient requiring heart transplant v. Defendant interventional cardiologist
Attorneys for plaintiff: Charles A. Cerussi and David J. Pierguidi of Cerussi & Gunn, P.C. in Shrewsbury, NJ
COMMENTARY: There was no plaintiff contention that initial complication of the dissection during the catheterization stemmed from negligence, and the defendant contended that the heart damage leading to the heart transplant was a known consequence of this complication. The plaintiff had maintained that bypass surgery was urgently needed, and provided a good chance of the plaintiff recovering sufficiently to avoid the need for the transplant. It is felt that the plaintiff’s evidence that the defendant did not seek a surgical consultation, and that his records did not reflect that such a course was considered would have greatly undermined defendant’s case. Additionally, the plaintiff maintained that the defendants negligently left an uncovered portion of the vessel wall between two of the four stents that were placed with dissection. The plaintiff would have made effective use of the films taken in the normal course of the angioplasty to illustrate such a gap. Additionally, the plaintiff would have countered the defense contention that it is acceptable to leave a portion of the vessel wall uncovered, by pointing to the manufacturer’s instructions for use which advised not to leave gaps between the stents, and ensure the dissection is covered by stent.