Undiagnosed Stroke Leads to Record-Breaking Verdict

This month we look at a case that recently made headlines after a jury awarded the injured plaintiff almost 40 million dollars. 

Facts of the Case

Mr A was a 37-year-old landscaper who was married with two young children. He had been suffering from a cough with mucous and went to a pharmacy clinic for advice on what to take. At the pharmacy, his blood pressure reading was 132/82, and the clinic advised him to follow up with his primary care physician to rule out hypertension.

Mr A did not currently have a primary care physician, so he contacted his HMO who assigned Dr X as his primary care physician who would then be responsible for directing Mr A’s health care needs. Mr A made an appointment with the physician for the end of January.

At the appointment, Mr A complained of a persistent cough “for a couple of months” and difficulty breathing during the coughing fits. Mr A’s blood pressure reading was 190/102. Dr X examined the patient and noted in the chart that Mr A’s differential diagnosis included acute bronchitis, elevated blood pressure, tachycardia, and morbid obesity.

The doctor expressed concern about the patient’s blood pressure and noted in the chart that both the patient’s parents suffered from hypertension. The patient agreed to monitor his blood pressure at home using a home device for the next 2 weeks. Ultimately, the physician prescribed azithromycin, benzonatate perles, codeine/guaifenesin cough syrup, and a budesonide inhaler to treat the acute bronchitis. The physician did not order any medication to treat the hypertension.

At the end of day, in a follow-up call to the patient, Dr X expressed some concern that Mr A was possibly suffering from a pulmonary embolism and offered Mr A a referral for a CT scan. Mr A declined at that point, and the physician agreed with him. The physician documented this conversation in the patient’s chart.

A little over a week later, in early February, Mr A called the physician’s office and spoke to a nurse. Mr A complained of a sore throat, earache, and runny nose. In response, Dr X refilled Mr A’s antibiotic, but did not reevaluate him or ask him to return for a follow-up appointment.

About a month later, in early March, Mr A’s co-workers found him in his car in respiratory distress and called for an ambulance. First responders found Mr A sitting in his car, unable to speak, trying to move his right arm with his left. He was rushed to the hospital. On the way, his systolic blood pressure was as high as 290.

At the hospital, the stroke team sprung into action. Mr A was unable to speak or provide any medical history. An EKG revealed sinus tachycardia among other things. The emergency department team assessed Mr A as having had an acute intracerebral hemorrhage, likely secondary to hypertension. He was sent for a CT scan which confirmed that Mr A had suffered a devastating hemorrhagic stroke.

Ultimately, Mr A spent over a year in rehab undergoing physical, occupational, and speech therapy. He was left with hemiparesis, and is unable to walk long distances, drive, dress, bathe, or eat without assistance. His right hand is nonfunctional, and he suffers speech issues due to brain damage suffered from the stroke. He can no longer work and will require care for the rest of his life.

Mr A’s wife contacted a plaintiff’s attorney who hired a medical expert to review the records. The expert concluded that Dr X had been negligent in his treatment of the patient. Specifically, he faulted Dr X for failing to order blood or urine tests or any other diagnostic tests, failing to appreciate the significance of the patient’s hypertension, failing to send the patient to the emergency department or a cardiologist, and failing to appreciate the patient’s risk factors for stroke such as obesity, hypertension, and shortness of breath. 

The attorney filed a medical malpractice lawsuit against the HMO based on the negligence of Dr X, its employee.

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Legal Background

It took almost 9 years for the case to make its way to a jury trial. The trial lasted 2 weeks and included the testimony of numerous medical experts. 

Mr A, who now suffers from aphasia, was unable to testify. According to his family, Mr A now must carry a card with him reading “I have aphasia, a loss for words not intelligence.”

The HMO defendant, rather than try to defend Dr X’s treatment of the patient, tried to defend itself by disassociating itself from the physician and denying that the physician was acting as the agent of the HMO, despite the fact that it was the one who assigned him. After the medical expert testimony, it was pretty much a given that Dr X was negligent, so the legal basis of the rest of the trial centered on whether he was acting as an agent of the HMO when he treated Mr A.

After 4 hours of deliberation, the jury determined that the HMO was responsible for the actions of its physician, and they awarded $39.9 million in damages to Mr A, a record-breaking verdict for a stroke victim.

Protecting Yourself

Why didn’t Dr X send the patient to the hospital, order diagnostic tests, or prescribe blood pressure medication? Without being in his head, we cannot know what was behind Dr X’s decisions, however, it is likely that the patient’s relatively young age played a role. It’s tempting to assume the best rather than the worst, and in most cases a 37-year-old with a cough might very well be someone with bronchitis. But as a medical professional it is essential to always consider the worst-case scenario in order to best prevent it. 

When the physician later called the patient to offer a CT scan because he had concerns about a potential pulmonary embolism, it is unclear if he advised the patient of the dangers of an embolism, or the urgency of the situation. Instead, he noted in the patient’s file that Mr A declined the referral and “I agreed with him.” The plaintiff’s medical expert rightly faulted Dr X for not instructing Mr A to call 911 or go to the emergency department for diagnostic testing. According to the medical expert, Dr X thoughtlessly assessed Mr A with acute bronchitis, but pulmonary embolism was in the differential diagnosis. “A doctor’s first duty is to protect his patient against serious and life-threatening disease,” concluded the medical expert.

While in most cases it will be the more common, less serious, diagnosis, it is remiss to not explore and rule out the most dangerous possibility.