9175 Case Study: Failure to Diagnose Pulmonary Embolism | Harry S. Cohen & Associates

Failure to Diagnose Pulmonary Embolism

Filed under Misdiagnosis

The Shuman Case

This case is based on the Defendants’ collective failure to diagnose a pulmonary embolism (“PE”) during a patient’s 4-day admission in a hospital. Although the patient was seen by multiple specialists, each specialist ordered tests, negligently interpreted them, and thereafter, operated in a vacuum.

The Facts:

On January 9th, Rodger Shuman, a healthy, active, married, 46-year old employed by the Pennsylvania State Police as a Motor Carrier Enforcement Officer, went to the Hospital Emergency Room with complaints of shortness of breath on exertion (a sign of a PE) and chest pain (a sign of a PE). He was admitted under the care of an internist who ordered some testing and consulted a cardiologist and pulmonologist.

The following tests were done: A non-stress test (Mr. Shuman fainted during this test – fainting is a sign of a PE); a CT scan without contrast (since it was without contrast it is undisputed that it was useless in determining whether a PE existed); a D-dimer blood test (it was abnormal and elevated – a sign of a PE); a V/Q perfusion lung scan (it was equivocal as to whether a PE existed and also done improperly as part of the lungs were hidden by the patient’s arms); and an echocardiogram (which revealed a massive enlargement of the right ventricle and right atrium, pulmonary hypertension, and moderate tricuspid regurgitation - all signs of a PE). At no time did any of the Defendants order a CT scan with contrast, a Dopler venous ultrasound, or a pulmonary angiogram (i.e. the proper tests used to diagnose a PE and/or deep venous thrombosis (“DVT”)).

Nonetheless, despite these test results likely indicating a possible PE and despite Mr. Shuman having most every clinical sign of a PE, Mr. Shuman was diagnosed with asthma and possible obstructive sleep apnea.

At the family’s request, just prior to his discharge to home on January 12th, Mr. Shuman was transferred to UPMC-Presbyterian. At UPMC-Presbyterian, Mr. Shuman was first seen by an intern. Based on Mr. Shuman’s symptoms, the intern quickly diagnosed Mr. Shuman as likely having a PE and ordered a CT with contrast and a Dopler venous ultrasound. A PE and blood clot were made apparent after the CT with contrast and ultrasound were performed. As a result, Mr. Shuman had to have an interior vena cava filter (“IVC Filter” or “Greenfield filter”) implanted to prevent a fatal PE (this would not have been necessary had the PE and blood clot been timely diagnosed at the original Hospital because anticoagulation treatment would have been initiated earlier).

Since the time of these events, Mr. Shuman has been required to continuously treat with various doctors who continue to monitor his health and pulmonary issues. Mr. Shuman continued to experience shortness of breath, especially on exertion, would get short-winded even in his house, has coughing spells, left chest discomfort/pressure that lasts up to hours, and intermittent swelling of the legs.

Additionally, Mr. Shuman tried to return to work with the Pennsylvania State Police; however, after 3-weeks, he was unable to perform his duties because he is constantly short of breath and fatigue (all noted in his medical and employment records). As part of his duties as a Motor Enforcement Officer and inspecting trucks on the highway, Mr. Shuman was required to do lots of walking, climbing on trucks, carrying 50-pound scales, etc. It is also noted by his treating physicians that Mr. Shuman was “markedly impaired such that he could not perform his duties …” and that his “massive pulmonary embolism and resultant pulmonary changes have decreased his functional abilities …” etc.

The Defendants/Negligence:

  • Internist #1: The attending physician was negligent for failing to order the proper tests to diagnose a PE on a patient that had most every clinical sign of a PE. Notably, he testified in his deposition that he did not order a CT with contrast because the dye would have been too hard on Mr. Shuman’s kidneys since he had an EKG and V/Q scan (not only is this incorrect, it is even disputed by the Defendant cardiologist in his deposition and the experts, including defense experts). The internist was still able to find an “expert” to defend his care.
  • Radiologist: A radiologist read the January 11 V/Q lung scan and negligently concluded: “low probability of pulmonary embolism.” Not only did the radiologist misread the V/Q lung scan, he negligently performed the study and/or failed to re-take it, as he even noted that the patient’s arms blocked part of the imaging. Notably, a radiologist defense expert even opined that the radiologist’s interpretation was negligent, yet the Defendant radiologist was still able to secure a local radiologist “expert” that wrote an expert report defending him.
  • Cardiologist: A cardiologist did consults on January 11 and January 12. His impression was obstructive sleep apnea. He testified that the results of the V/Q scan were all he needed to rule out a PE despite the results of the D-dimer test suggesting a PE, an echocardiogram (which was markedly different from the echo that he performed on this patient just 11- months earlier) suggesting a PE, and despite the patient having most every clinical sign of a PE. Note that the Defendant pulmonologist testified in his deposition that had he seen the results of the echo, like the cardiologist did, he would have known that the diagnosis of obstructive sleep apnea was incorrect. Despite filing a formal Answer denying that he was negligent at the beginning of the case, the cardiologist could not find an expert to defend his case. Instead, his experts blamed the other Defendants.
  • Pulmonologist: A pulmonologist did a consult on January 11. His diagnosis was asthma and obstructive sleep apnea. He testified that the results of the V/Q scan were sufficient for him to rule out a PE despite the results of the other tests and despite the patient having most every clinical sign of a PE. Like the cardiologist, despite filing a formal Answer denying that he was negligent at the beginning of the case, the pulmonologist could not find an expert to defend him on negligence.
  • Internist #2: This physician was internist #1’s partner. He was going to discharge Mr. Shuman to home before Mr. Shuman’s family asked for a transfer to UPMC-Presby. Like internist #1, he was negligent for failing to order the proper tests to diagnose a PE on a patient that had most every clinical sign of a PE. Notably, like his partner (represented by the same lawyer), he testified that he did not order a CT with contrast because the dye would have been too hard on Mr. Shuman’s kidneys since he had an EKG and V/Q scan (not only is this incorrect, it is even disputed by the cardiologist in his deposition and the experts, including defense experts).
  • The Hospital: All of the Defendants were “ostensible agents” of the Hospital as Mr. Shuman sought treatment directly from the hospital; therefore, the Hospital was vicariously liable for their negligence.

Our Experts:

To provide opinions relating to the Defendants’ negligence and how our client was damaged by the negligence, we secured expert opinions from a cardiologist/internal medicine physician, a pulmonologist from Harvard Medical School, and an expert radiologist.

We also secured the expert opinion of a forensic economist who provided an opinion commenting on the economic value of Mr. Shuman’s wage loss.

The Defenses:

In addition to the “it was him, not me” defenses, the defense in this case was that Mr. Shuman’s current breathing problems related to anything other than the PE, even though Mr. Shuman never had any breathing problems prior to the PE. For example, the defense experts opine that Mr. Shuman’s breathing problems were the result of: (1) some newly diagnosed unspecified asthma at age 46 (which coincidentally Mr. Shuman never had before the PE); (2) obesity and deconditioning (as noted in his deposition and in the records, prior to this event, he exercised regularly and ran 30-40 minutes per day on the treadmill even though he weighed more than his current weight); and even (3) a diastolic left ventricular dysfunction.

In addition to the comments above, Plaintiffs’ pulmonology expert and Plaintiffs’ cardiologist expert were extremely dismissive of these defenses (e.g. the pulmonologist clearly stated in his report that Mr. Shuman‘s test results were not consistent with asthma in any way).

Furthermore, there was a clear and undisputable filling defect in Mr. Shuman’s proximal left upper lobe segmental pulmonary artery with more distal webbing (which the defense recognized but attempted to minimize). Our experts agreed that this finding was consistent with chronic thromboembolic disease which is a complication of acute pulmonary emboli which was caused by the delay in diagnosis and treatment.

The Result:

After years of litigation and prior to the scheduled jury trial, at a Court ordered Mediation conducted by a private attorney specializing in Mediations, the case settled for a substantial amount.

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Publisher: Harry S. Cohen and Associates, P.C.