Emergency room physicians hold a critical responsibility to make sound medical judgments when treating patients. Very often the decisions they make will directly impact the ongoing health of a patient. Legally, physicians and emergency rooms can be held liable if they fail to adhere to the accepted standard of care. This is particularly true when that failure leads to “preventable harm”. In this medical malpractice case, a woman in her early 40s claimed that an emergency room physician failed to hospitalize her after visiting a New Jersey emergency room complaining of chest pain.
Further, while at the emergency room she had abnormal electrocardiogram (EKG) results. After being turned away, she suffered a heart attack that caused the death of 30% of her heart muscle. The case illustrates the serious legal consequences that can arise when physicians fail to make appropriate judgments in emergency and urgent care settings.
Medical Malpractice in the Emergency Room Due to Poor Medical Judgement
In this case of medical malpractice in the emergency room, the central issue revolved around whether the emergency room physician’s decision to diagnose the plaintiff with gastritis, rather than recognizing the EKG results was reasonable. The plaintiff argued that the doctor failed to meet his legal obligation to provide appropriate care by not hospitalizing her, if only to further monitor her in the event she needed additional treatment. According to the plaintiff, the emergency room physician’s failure to recognize the severity of her condition led directly to a myocardial infarction (heart attack) the following day.
The plaintiff called an expert witness, a cardiologist, who testified that the defendant’s failure to take a complete patient history and to consider her risk factors—such as cigarette smoking and the cold sweats she’d been experiencing—was a significant deviation from what would have been considered the accepted emergency room standard of care. These factors, along with her complaints of chest pain and her abnormal EKG results, should certainly have caused the doctor to admit her for additional evaluation. The plaintiff argued that if the doctor used the type of sound medical judgment that is consistent with emergency room standards of care, diagnostic tests like cardiac catheterization could have revealed the blocked arteries. Ultimately, these tests would have provided medical professionals a strong opportunity to prevent the heart attack.
Legal Standard of Care in Emergency Medicine
In medical malpractice cases, particularly those involving emergency room physicians, the legal standard of care is a key factor in determining liability. The emergency room standard of care for recognizing and treating myocardial infarctions refers to the level of care and skill that a reasonably competent physician would provide under the same or similar circumstances. In an emergency room setting it is incredibly important for doctors to take potential medical issues seriously. This is especially true when dealing with patients who may be presenting with life-threatening conditions.
The plaintiff’s skilled personal injury attorney argued that the emergency room physician failed to meet this standard by not fully investigating her symptoms or considering the possibility of a heart attack. While the defendant contended that the symptoms did not fit the classic presentation of ischemic chest pain, the plaintiff’s cardiologist disagreed, suggesting that the ongoing nature of her pain, combined with the abnormal EKG should have raised serious concerns. If not indicating an imminent heart attack, it certainly should have warranted additional tests. In this way, the failure to hospitalize the plaintiff was a critical lapse in judgment, the expert cardiologist argued, that ultimately led to serious harm.
The Defendant’s Defense: Exercising Medical Judgment
The defendant physician countered that his was a reasonable medical judgment based on the information that he had available at the time. He argued that the plaintiff’s chest pain did not present as the type of intermittent and severe pain that is generally associated with ischemic heart disease. What’s more, he argued that the EKG results were only mildly abnormal. Finally, the doctor pointed out that there were no recorded findings of cold sweats or other symptoms and, in that the patient did not provide that information, there were no additional red flags raised that suggested an impending heart attack.
The defense emphasized that emergency room physicians often face challenging diagnostic situations. They further offered that is very common patients to present with chest pain that us unrelated to cardiac issues. In this case, the defendant maintained that he felt confident he had ruled out the most likely life-threatening conditions before discharging the plaintiff.
Legal Responsibility and Timing of the Infarct
A significant point of contention in the case was the timing of the heart attack and whether earlier intervention could have prevented it. The plaintiff argued that the infarct occurred the day after her initial emergency room visit. Had she been admitted for additional monitoring, the doctors would have been able to perform diagnostic tests. They could have engaged in potentially life-saving procedures, such as coronary bypass surgery, before the heart attack occurred.
The defendant, however, argued that the heart attack did not happen until several days later, and that it would have occurred regardless of whether the plaintiff had been admitted to the hospital earlier. The defendant’s expert witnesses pointed to the “peaking” of cardiac enzyme levels, which they argued indicated that the infarct occurred at a later time. The defense maintained that the plaintiff suffered the heart attack despite receiving proper care at the second hospital and that the defendant’s actions did not cause the ultimate damage to her heart.
However, the plaintiff’s expert witness refuted this claim, explaining that elevated cardiac enzymes often take time to appear in venous blood tests, particularly in cases of severe coronary blockage. The expert argued that even if the heart attack occurred later, the failure to admit the plaintiff on her initial visit precluded the timely interventions that could have prevented the infarct or mitigated its severity. The expert’s testimony emphasized that the doctor’s failure to exercise appropriate clinical judgment at the initial presentation set in motion a chain of events that led to the heart attack.
Legal and Financial Consequences of Poor Medical Judgment
The jury ultimately found in favor of the plaintiff, concluding that the defendant physician’s failure to hospitalize her represented a breach of the standard of care. The court awarded $1,200,000 to the plaintiff for her physical and emotional suffering, and an additional $500,000 to her husband for his per quod claim, which reflected the impact of her condition on their marital relationship.
The jury’s verdict serves as a stark reminder of the legal consequences physicians face when they fail to use sound judgment in emergency situations. Emergency room doctors are expected to be especially cautious when treating patients with chest pain and abnormal test results, as the consequences of a missed or delayed diagnosis can be life-threatening. In this case, the physician’s decision not to admit the plaintiff for further observation and treatment was seen as a critical error that led to severe and irreversible damage to her heart.
Key Legal Lessons
This case highlights several important legal principles that govern the responsibilities of emergency room physicians:
- The Standard of Care in Emergency Medicine: Emergency physicians have a heightened responsibility to rule out life-threatening conditions when patients present with symptoms such as chest pain. A failure to adequately investigate or consider all potential diagnoses can constitute a breach of the standard of care.
- Medical Judgment and Liability: While physicians are often required to make quick decisions, those decisions must still fall within the accepted standard of care. If a doctor’s judgment is found to be unreasonable or negligent, they can be held legally liable for the resulting harm.
- Timely Intervention: This case underscores the importance of timely intervention in preventing serious outcomes like heart attacks. Even if a condition does not appear life-threatening initially, emergency room physicians must consider the potential risks and err on the side of caution when discharging patients with concerning symptoms.
- Legal and Financial Consequences: Physicians who fail to meet their legal responsibilities can face substantial financial penalties, as seen in this case. A skilled personal injury attorney who has experience litigating this type of complex case was foundational to the outcome. In addition to compensating the patient for their physical suffering, the legal team secured an award for additional damages to family members impacted by the patient’s condition.
Wrapping Up
In this case of medical malpractice in the emergency room, the failure of an emergency room physician to make sound medical decisions resulted in significant harm to the plaintiff and led to a substantial legal judgment against the defendant. The case illustrates the critical legal responsibilities that physicians bear in emergency situations and the serious consequences that can arise when those responsibilities are not met. This serves as a reminder to medical professionals of the importance of exercising caution, conducting thorough evaluations, and considering all potential risks when making clinical decisions in the emergency room.
Additional Resources
American Heart Association – Guidelines on the management of patients with chest pain and the standard of care in emergency medicine, which could provide insight into the accepted protocols for handling such cases.
National Institute for Health and Care Excellence (NICE) – Standards for diagnosing and treating myocardial infarctions, which can offer readers more on the typical steps to prevent heart attacks.
New Jersey Medical Malpractice Law – A comprehensive resource on how medical malpractice cases are handled in New Jersey courts, which could provide legal context to the case.
National Institutes of Health (NIH) – Research articles on the risks of delayed diagnosis of cardiovascular diseases, including how missed EKG readings can result in heart damage.