4874 Case Study: Failure to Diagnose Heart Attack in ER | Harry S. Cohen & Associates

Failure to Diagnose Heart Attack in ER

Filed under Emergency Room

The McAvoy Case

Case Summary

Scott McAvoy, a 59-year-old father of three, suffered a massive heart attack shortly after being improperly discharged from the emergency room. Unfortunately, because his heart was in ventricular fibrillation for so long as a result of the heart attack, he was not able to be revived, and died.

Case Details

Scott McAvoy was a 59-year-old father of three, who worked as a machine operator at a local manufacturing plant. In early June, he began to feel chest pain, and after two weeks, he decided that he had enough, and before his evening shift for work was to begin, he drove himself to the emergency room.

Scott got to the emergency room around 3 o’clock in the afternoon, and was immediately taken to the triage unit. Because he had active chest pain, he was then taken to the back to the emergency department where he saw Dr. Vactor. Dr. Vactor questioned Scott, took a history of the symptoms and complaints, examined him and then ordered blood work, an EKG, and a chest x-ray. These tests all came back as negative (meaning that they did not show any reason for Scott’s heart complaints). Dr. Vactor was still unsure as to what was causing Scott’s complaints, so he ordered Scott to undergo a test called a CT angiogram, also known as a CTA.

A CTA is a CT of the heart. It is a series of x-rays that are taken quickly to help see what is going on with a heart, and to help determine whether or not there is any heart problems, such as if any of the arteries are blocked by plaque.

The CTA test takes some time to complete, because a patient must be given medication to lower the heart rate, and Scott was given the medication, however, unfortunately, Dr. Vactor was going off shift at 4 o’clock, and the CTA would not be done for at least an hour or two.

Since Dr. Vactor knew he was going off shift, he met with Dr. Foreman, explained to her Scott’s condition, and told her that Scott was going to undergo the CTA. Dr. Vactor also said that he told Dr. Foreman that when the CTA test was done, if it was negative, Scott could be discharged.

Dr. Foreman did not examine Scott, but waited for the CTA to be completed. Around 5 o’clock, Scott was taken to the radiology department, and the CTA was done. Radiology images were then sent electronically to Dr. Johnson, a radiologist who was in a satellite Hospital, with a computer, ready to read the images. Around 6:30 p.m., Dr. Johnson reviewed the images, and at 6:40 p.m., he called Dr. Foreman to discuss the results.

Dr. Johnson told Dr. Foreman that Scott’s results were compromised because the images were not that clear since Scott had moved a little bit during the procedure, and some of the images could not fully see inside the heart. As to the images that could be seen, Dr. Johnson told Dr. Foreman that there was plaque in some of the arteries, and concluded that it was mildly to moderately compromised.

Dr. Foreman, on the other hand, testified that she spoke with Dr. Johnson, and she said that he had told her that the images were good, that Scott only had mild disease, and that Scott could be discharged to home for follow-up with his PCP. Dr. Foreman was adamant that Dr. Johnson told her that Scott could be discharged.

Dr. Foreman then went in to meet Scott, and told him that based upon the results of the CTA, he was being discharged, and to follow up with his PCP as needed.

Scott went home and called his PCP for the next available appointment, which was on Monday morning. Scott then went to work on Friday night for the late shift, and as he was preparing for work, he collapsed from a massive heart attack, and went into ventricular fibrillation. His fellow employees tried to perform CPR, an ambulance was called, and Scott was taken back to the same emergency department he was in a few days before. Unfortunately, because his heart was in ventricular fibrillation for so long, he was not able to be revived, and died.

A lawsuit was brought on behalf of Scott’s estate against Dr. Foreman for improperly discharging Scott. During her deposition, she implied that she was not responsible because Dr. Vactor gave her wrong information about Scott, and also implied that Dr. Johnson was responsible because he allegedly told her to discharge Scott.

A second lawsuit was then brought against Dr. Vactor and Dr. Johnson because of what Dr. Foreman had said. At their depositions, Dr. Vactor and Dr. Johnson denied that they had told Dr. Foreman to discharge Scott based upon mild results on the CTA.

The doctors and the Hospital defended the case vigorously, arguing that based upon Scott’s presentation, and the results of the CTA, his risk stratification was such that he could be discharged to home.

However during jury selection, the Dr. Foreman and her employer, the Hospital, agreed to settle the case for a multimillion dollar settlement.

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