First of all, you have to start out with the scientific theory of "cause and
effect". The "effect" are the symptoms presenting themselves (upper
abdominal pain and nausea) and the "cause" is what the emergency room has to
determine and stabilize.
I am not a doctor, but
(1) I do know there are many conditions that can cause upper abdominal pain
(2) Also, I am not familiar with what many tests can determine. For
example, an ultrasound of the abdominal area may not show something that a
CT scan or MRI of the abdominal area can show.
>>>> The hospital did an ultrasound of his abdomen and told him he was fine
and was given pepcid. <<<
This test indicated there was no problem (that can be determined from that
TYPE of test) coming from the abdominal area. OK. Then why give him pepcid
and send him home? The ultrasound apparently was not the appropriate test
to diagnose his symptoms - but OK, they were able to eliminate one of the
very many possibilities. They still have not determined what the man's
problem is...and sent him home.
>>>> Several weeks later, Mr. S went back to the hospital this time with
terrible chest pains, and shortness of breath. Several tests were done at
the hospital to determine whether Mr. S was having a heart attack.
The tests, including an x-ray, stress test, EKG, cardiac enzymes all came
back normal. An echocardiogram was not done and the cardiologist never asked
the patient to follow up with him. After being discharged Mr. S still felt
horrible. He continued to have chest pain and shortness of breath.<<<
Mr. S. should have never been discharged from the hospital. He should have
been admitted and testing should have continued until his problem was
diagnosed. Chest pains and shortness of breath are life-threatening
symptoms. An echocardiogram should have been done and the cardiologist
should have followed up with him.
This scenario only mentions specific tests,. However, only another doctor
can be more specific as they would know what OTHER tests are available to
rule out specific problems. If there are other diagnostic tests available
and those other tests were not ordered, then there is negligence.
>>>He continued to have chest pain and shortness of breath.Mr. S called his
primary care physician(PCP) who did not call back the cardiologist but
instead called a gastroenteroligist.<<<
The PCP should have an idea of the many conditions that would cause the
symptoms Mr. S. had. He should have known that there were other tests
available to check for other heart CONDITIONS. A heart attack is one of
MANY heart conditions although it should have been re-checked. He, too,
IMO, was negligent.
>>> The PCP believed that Mr. S had a complete cardiology work-up at Sands
Hospital but did not have the records at the time of making the referral to
the gastroenterologist <<<
He ASS-U-MEd incorrectly. The tests Mr. S. DID have is NOT a complete
cardiac work-up. He made decisions that were not based on his patient's
medical records - which he did not have possession of. The PCP could have
easily called Sands Hospital and had the records faxed to him so he could
make an educated decision - not a poor presumption.
>>>> Several months went by and now Mr. S was short of breath, fatigued,
loss of balance and dizzy. He went back to Sands hospital. Sands told him
they didn't know what was going on, all of his tests were normal. <<<
Negligence/malpractice. Were these tests current tests done with this new
ER visit? Whatever tests were "normal", obviously not the appropriate tests
to diagnose an ongoing problem that is life threatening in nature. Hello!
Anyone home? They should have pursued it, obviously. They should have
gotten their heads out of their ........ and should have done work-ups in
other areas. With the symptoms possibly being cardiac, Mr. S. should have
received all tests available and exhausted them all to determine there was
NOTHING wrong with his heart and simultaneously, should have been tested in
other areas where his symptoms could be produced by other organs or
An MRI of the brain is OK, as long as it would have been done simultaneously
with other tests.
>>>> An EKG was done during this visit which showed an old heart attack.<<<
It has to be determined if the original EKG could have missed a heart attack
(when he was first complaining of the symptoms) or if this occurred SINCE
then, and obviously missed during his subsequent doctor/ER visits because it
was assumed it wasn't his heart. (negligence)
>>>> By this time Mr. S was not able to work or drive. The PCP put him on
anti depressants, Mr. S told him he wasn't' depressed. In December of the
same year, Mr. Scott went back to the hospital and told them of his
shortness of breath and his upper abdominal pain. Sands' ER doctors told him
his was fine and to take some more pepcid.<<<
Sure, when in doubt - when you can't or don't figure out what is wrong with
a patient, call it DEPRESSION, fill him up with pills and what the heck,
some pepcid too.
>>>> defense's experts will say:
> A CT-scan can't accurately determine muscle size and therefore the doctor
did not fall below the standard of care.<<<
No, but other tests can. And omission is what killed this poor man.
>>>> 2. The defendant's cardiologist argues that all the cardiologist was
supposed to do in the hospital was rule out whether the patient was having a
heart attack at the time. He is not required to do all testing in an
emergency setting. <<<
It is true that he is not required to do all testing in an emergency
setting. However, the symptoms were strong enough to require a different
evaluation. He should not have been sent home and should have been admitted
to the hospital from the onset.
I believe all doctors are culpable.
----- Original Message -----
Sent: Thursday, January 01, 2004 12:15 PM
Subject: [infoguys-list] could Mr. Scott be saved?
> Mr. S. was married and had a 10 year daughter when he died.
> On 3-22-98 Mr. Scott, a 33 year old, 245 pound security guard who was 5'6
> went to the emergency room at Sands Hospital complaining of upper
> pain and nausea.
> The hospital did an ultrasound of his abdomen and told him he was fine and
> was given pepcid.
> Several weeks later, Mr. S went back to the hospital this time with
> terrible chest pains, and shortness of breath. Several tests were done at
> hospital to determine whether Mr. S was having a heart attack.
> The tests, including an x-ray, stress test, EKG, cardiac enzymes all came
> back normal. An echocardiogram was not done and the cardiologist never
> patient to follow up with him. After being discharged Mr. S still felt
> horrible. He continued to have chest pain and shortness of breath.Mr. S
> called his
> primary care physician(PCP) who did not call back the cardiologist but
> called a gastroenteroligist.
> Mr. S had told PCP what had happened at Sands hospital and advised him of
> complaints. The PCP believed that Mr. S had a complete cardiology work-up
> Sands Hospital but did not have the records at the time of making the
> referral to the gastroenterologist
> .The gastro was told by PCP that a complete cardiac work up was done at
> Sandler. The gastro performed tests and found that Mr. S did have some
> and a small hernia but it could not be the cause of all Mr. S's
> Several months went by and now Mr. S was short of breath, fatigued, loss
> balance and dizzy. He went back to Sands hospital. Sands told him they
> didn't know
> what was going on, all of his tests were normal.
> Sands' ER doctors did not call in a cardiology consult despite the fact
> many of his symptoms were cardiac in nature.
> Mr. Scott called back his PCP and went to see him. He told him of his
> complaints and of the fact that he was also unable to sleep. The
> referred him to a neurologist. the neurologist did a brain MRI and he told
> Mr. S he
> was normal.
> By this time Mr. S was not able to work or drive. The PCP put him on anti
> depressants, Mr. S told him he wasn't' depressed. In December of the
> year, Mr. Scott went back to the hospital and told them of his shortness
> breath and his upper abdominal pain. Sands' ER doctors told him his was
> and to
> take some more pepcid.
> An EKG was done during this visit which showed an old heart attack.
> 3 days later Mr. S died of an enlarged heart caused by heart disease.
> The radiologists were sued along with PCP, the cardiologist, and the ER
> Plaintiff's experts will testify that :
> 1. the heart condition could have been diagnosed by a simple
> 2.the heart was enlarged on x-ray.
> 3. the cardiologist should have advised patient to do echo and follow up
> studies since he only did part of the workup in the hospital.
> 4. The ER docs should have called in a cardiologist in September and
> Mr. S could have been saved if treated with medicines.
> 5. The Medical examiner at autopsy found the heart to be enlarged.
> CT-scan showed
> that the heart wall muscles are enlarged. This was confirmed by
> defense's experts will say:
> 1. The radiologists state that the heart is not enlarged. (see
> point # 5)
> A CT-scan can't accurately determine muscle size and therefore the doctor
> not fall below the standard of care.
> The way you measure a heart on x-ray is by using a simple formula. If the
> heart size is greater than 50% of the chest cavity it considered enlarged.
> expert opines that it is about 55%. Their experts state that it greater
> however argue that you also have to look at the overall heart size not
> the width and therefore it is not enlarged.
> 2. The defendant's cardiologist argues that all the cardiologist was
> to do in the hospital was rule out whether the patient was having a heart
> attack at the time. He is not required to do all testing in an emergency
> Had anyone told him that he was having continuing symptoms he would have
> more tests. This doctor had not instructed him to return if he had
> symptoms and did not schedule any follow up appointments. The discharge
> printed form given by the hospital tells him to follow up with the
> cardiologist but
> the cardiologist specifically told him not to follow up with him. this is
> disputed by the cardiologist. The cardiologist will by inference argue
> the other medical providers should have alerted him to the continued
> 3. The ER physicians will argue that since the x-ray came back normal in
> September they had no reason to believe there was a cardiac problem. Also
> problem also resolved during the visits. In September they thought his
> were neurological since he also complained of loss of balance. In
> ER docs did nothing to figure out his reason for shortness of breath which
> a major cardiac symptom. Also they called the primary care physician and
> of his symptoms and it was the PCPs job to make the appropriate
> main argument for the ER physicians is that the patients condition was not
> threatening and they didn't see reason to admit. They also feel that his
> abdominal complaints were most likely related to his acid reflex and
> The PCP says he made multiple referrals to initially the cardiologist and
> then to a gastroenterolgist then neurologist and he acted appropriately.
> [Non-text portions of this message have been removed]
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