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Delayed treatment of heart attack

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danrmn

Member
What is the name of your state (only U.S. law)? Ks
Early morning on March 4, 2011, my father presented to Medical Center with severe chest pains. ER Doctor did EKG and other lab work and felt my dad was experiencing esophagus erosion. ER Doctor suggested my dad be admitted to the hospital and checked by a cardiologist in the morning, however stated he was 99% sure it had nothing to do with his heart. My father signed himself out of the ER AMA, opting to see his personal physician the first thing in the morning. My dad was seen by his primary doctor that morning. Primary doctor diagnosed him with esophagus erosion, gave him RX for Prilosec and Lortab 5. My dad continued to feel weak and began experiencing pain in his neck. The chiropractor told my father that something was out of place in his neck and he was working on getting it back in place. The pain in my father's neck moved from side to side and the chiropractor claimed that whatever he was moving back to place wasn't staying in place. The chiropractor gave my dad another RX for Lortab 5, told him to use a neck massager, and told him to keep coming back. Approximately March 6, 2011, my father returned to his primary doctor with continued pain. At this time the doctor gave my father a lidocainesolution to drink that was to numb his throat and help with the pain he was experiencing. My dad continued to see his chiropractor almost every other day until March 18th. On March 18th, my dad went again to his primary doctor for a recheck of his esophagus, he was continuing to experience pain in his neck and chest and shortness of air. The primary doctor immediately sent him to hospital via ambulance and his heart was found to be in A-Fib rhythm. A cardiologist there shocked his heart back to regular rhythm and admitted him to the hospital for observation. On March 21st, a hear cath was performed and my father was found to have a hole, tear, and aneurysm in his heart. Cardiologist reported this was from a massive heart attack. The afternoon of March 21st, the heart surgeon advised my father that his heart was too weak to withstand surgery at that time, so they were going to wait approximately 6 weeks. After receiving this news I debated sending my father to a heart specialty hospital. The director of the Cardiology department encouraged me to not transfer my father as they had a very capable heart surgeon there. On the morning of March 22, 2011, a nephrologist came to my dad's room and advised us that his kidneys and liver were not working properly and he would get them "in tip-top shape prior to surgery". Approximately 2 hours after the nephrologist left, my father coded at the hospital. They did manage to regain a pulse on my dad and they immediately transferred him to heart specialty hospital. On the morning of March 22nd, we seen the heart surgeon who advised us he must perform surgery immediately because of the kidneys and liver failing due to a lack of blood supply. Surgeon stated the first 72 hours would be critical after surgery. Surgery was performed and my father was on respirator and dialysis following surgery. On March 23rd, my father appeared to be regaing consiousness slightly, gagging on his ventilator, moving his lips and legs, and turning his head to look at people. On March 24, my father showed no signs of alertness and we were told his liver was failing and the dialysis was doing the work of his kidneys. On March 25, 2011, we learned that my father's liver appeared to be improving. On March 26, surgeon reported that liver function again worsening. My dad continued to deteriorate until on March 30, 2011 when were told his pupils were fixed and dilated and organs were not going to improve. ICU director advised we should make a decision on whether to stop meds, stop dialysis, or stop vent; any of which would lead to his passing. We decided to extubate him and he passed approx 20 minutes following. The heart surgeon advised that my dad's heart surgery had repaired the heart, however due to the liver not working the heart could not survive in that polluted environment. I am very concerned as to:
1. my father's primary doctor continued to diagnose him with esophaeal corrosion from March 4th to March 18th
2. Chiropractor continued to treat my dad from March 4th to March 18th telling him something "was popped out".
3. Nephrologist at first hospital told my father we had to get his kidneys and liver in tip top shape prior to surgery when the heart was what was causing the organ failure.
4. That the cardiologist at first hospital waited from March 18th until March 21st to do the heart cath.
5. The cardiology dept. director in at first hospital advised me that their heart surgeon was competent to take care of my father's condition and then they end up sending him to specialty hospital the next morning.
6. The cardiologist at first hospital was going to wait 6 weeks to perform my dad's heart surgery, while his organs were not getting adequate blood supply from the heart and were failing.

Would this not be malpractice?
 


justalayman

Senior Member
you need to go way back to this:

ER Doctor suggested my dad be admitted to the hospital and checked by a cardiologist in the morning, however stated he was 99% sure it had nothing to do with his heart. My father signed himself out of the ER AMA, opting to see his personal physician the first thing in the morning. My dad was seen by his primary doctor that morning.
Your father signed himself out AMA. If he had stuck around, it would have been possible (maybe even likely) the cardiologist would have seen the heart problem and it could have been dealt with at that time.

after that, I don't really see anything necessarily wrong with what was done. Your fathers PCP is not a cardiologist and your father had been at the ER the night before where a heart condition was not diagnosed but obviously suspected enough to recommend staying overnight and seeing a cardiologist. If the ER docs didn't see it, why would you expect your PCP to see it. Your father chose to not go to a cardiologist and that appears to be why things ended up the way they did.
 

OHRoadwarrior

Senior Member
From my wife, based on her experience with my father...

I don't think anything constitutes malpractice. Everything seems based on their advising the best outcome possible. Many doctors tend to say things in a manner most patients view as positive as they don't want to discourage families from being optimistic, as they don't know who will survive and who will not. Negative vibes from family can affect a patients outcome.
My father was in and out of Cleveland Clinic, one of the top five hospitals nationwide for the last 18 months of his life. He experienced a heart attack, had pacemaker installed and kidney failure complicated by diabetes and COPD.

Even there, with a team of 5 doctors, the head of cardiology, a thoracic doctor and a kidney specialist, many times the doctors could not agree what exactly was causing his problems. This resulted in at least one change of the five doctor team seeing him regularly. Unfortunately once certain damage is done to the body, problems mimic each other. What you experienced was a group of well qualified doctors constantly reevaluating and altering treatments to try and balance body systems that refuse to stabilize. One time, in our situation, it took over 6 weeks to fine tune it for surgery.

We hope your father passed in accord with his wishes, as ours did.
We are sorry for your loss.
 

gr8rn

Senior Member
What is the name of your state (only U.S. law)? Ks
Early morning on March 4, 2011, my father presented to Medical Center with severe chest pains. ER Doctor did EKG and other lab work and felt my dad was experiencing esophagus erosion. ER Doctor suggested my dad be admitted to the hospital and checked by a cardiologist in the morning, however stated he was 99% sure it had nothing to do with his heart. My father signed himself out of the ER AMA, opting to see his personal physician the first thing in the morning. My dad was seen by his primary doctor that morning. Primary doctor diagnosed him with esophagus erosion, gave him RX for Prilosec and Lortab 5. My dad continued to feel weak and began experiencing pain in his neck. The chiropractor told my father that something was out of place in his neck and he was working on getting it back in place. The pain in my father's neck moved from side to side and the chiropractor claimed that whatever he was moving back to place wasn't staying in place. The chiropractor gave my dad another RX for Lortab 5, told him to use a neck massager, and told him to keep coming back. Approximately March 6, 2011, my father returned to his primary doctor with continued pain. At this time the doctor gave my father a lidocainesolution to drink that was to numb his throat and help with the pain he was experiencing. My dad continued to see his chiropractor almost every other day until March 18th. On March 18th, my dad went again to his primary doctor for a recheck of his esophagus, he was continuing to experience pain in his neck and chest and shortness of air. The primary doctor immediately sent him to hospital via ambulance and his heart was found to be in A-Fib rhythm. A cardiologist there shocked his heart back to regular rhythm and admitted him to the hospital for observation. On March 21st, a hear cath was performed and my father was found to have a hole, tear, and aneurysm in his heart. Cardiologist reported this was from a massive heart attack. The afternoon of March 21st, the heart surgeon advised my father that his heart was too weak to withstand surgery at that time, so they were going to wait approximately 6 weeks. After receiving this news I debated sending my father to a heart specialty hospital. The director of the Cardiology department encouraged me to not transfer my father as they had a very capable heart surgeon there. On the morning of March 22, 2011, a nephrologist came to my dad's room and advised us that his kidneys and liver were not working properly and he would get them "in tip-top shape prior to surgery". Approximately 2 hours after the nephrologist left, my father coded at the hospital. They did manage to regain a pulse on my dad and they immediately transferred him to heart specialty hospital. On the morning of March 22nd, we seen the heart surgeon who advised us he must perform surgery immediately because of the kidneys and liver failing due to a lack of blood supply. Surgeon stated the first 72 hours would be critical after surgery. Surgery was performed and my father was on respirator and dialysis following surgery. On March 23rd, my father appeared to be regaing consiousness slightly, gagging on his ventilator, moving his lips and legs, and turning his head to look at people. On March 24, my father showed no signs of alertness and we were told his liver was failing and the dialysis was doing the work of his kidneys. On March 25, 2011, we learned that my father's liver appeared to be improving. On March 26, surgeon reported that liver function again worsening. My dad continued to deteriorate until on March 30, 2011 when were told his pupils were fixed and dilated and organs were not going to improve. ICU director advised we should make a decision on whether to stop meds, stop dialysis, or stop vent; any of which would lead to his passing. We decided to extubate him and he passed approx 20 minutes following. The heart surgeon advised that my dad's heart surgery had repaired the heart, however due to the liver not working the heart could not survive in that polluted environment. I am very concerned as to:
1. my father's primary doctor continued to diagnose him with esophaeal corrosion from March 4th to March 18th
2. Chiropractor continued to treat my dad from March 4th to March 18th telling him something "was popped out".
3. Nephrologist at first hospital told my father we had to get his kidneys and liver in tip top shape prior to surgery when the heart was what was causing the organ failure.
4. That the cardiologist at first hospital waited from March 18th until March 21st to do the heart cath.
5. The cardiology dept. director in at first hospital advised me that their heart surgeon was competent to take care of my father's condition and then they end up sending him to specialty hospital the next morning.
6. The cardiologist at first hospital was going to wait 6 weeks to perform my dad's heart surgery, while his organs were not getting adequate blood supply from the heart and were failing.

Would this not be malpractice?
I am sorry for your loss. It sounds like your father had a history of liver problems that predated the heart problems, is that correct? Did he have cirrhosis?
I agree, if he had stuck around that first ER visit they would have drawn a set of cardiac enzymes which would have clued them into the heart issue.
 

danrmn

Member
no prior liver problems

My dad had no liver problems prior to the heart attack. He had hardly ever been ill and had never been in the hospital before. Granted, my dad should have let them admit him to hospital from ER, but he did go to his primary doctor at 8 am that morning. Why did primary doctor not refer him to a cardiologist, that was the doctor my dad trusted. Primary doctor knew ER had suggested dad see a cardiologist, however primary doctor said he felt no need for cardiologist since this was issue with esophagus that would take about 6 weeks to heal.
The cardiac surgeon at specialty hospital advised us that my dad's liver and kidneys failed due to a lack of oxygenated blood from the heart prior to his surgery.
 
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tranquility

Senior Member
Signing out AMA only protects things before the document and would not protect later doctors.

I'd certainly see an attorney to review the facts. There are enough decisions here and such an unfortunate result that it would be silly to not make sure all of the doctors' actions rose to the level demanded.
 

danrmn

Member
Thanks Tranquility,
I think that was what I was believing. I am only looking at the facts after my dad signed out of ER and had already seen other doctors.
 

lya

Senior Member
I don't see any obvious area of malpractice. The only question I really have is when was the very first EKG done and by whom. (primary MD, chiropractor, ER staff)

I see a patient's very complicated presentation of the effects of heart damage, with and without an acute cardiac condition.

I see nothing to disprove that esophageal erosion existed and or to prove that only cardiac conditions were present. Sometimes, the two go hand in hand, especially if the liver has problems.

A cardiac cath can't be done on a patient whose creatinine level is not perfectly normal; otherwise, the dye cannot be eliminated via the kidneys and the patient would be damaged.

Nephrologist work in close coordination with cardiac surgeons. Never underestimate the importance of a nephrologist when a cardiac condition exists.

It would have been best if the nephrologist had been able to reverse and stablize the kidneys' status.

Cardiac surgery done on a patient whose kidneys and liver are not up to pre-op criteria is done as a last-best-chance option.

Without an acute event, liver problems and kidney problems from cardiac function abnormalities would not have been detected unless a routine exam revealed it.

The patient made an "OOPS" when he checked out of the hospital rather than be admitted and being seen by a cardiologist the next morning. Obviously, the patient was in denial, which is the first most common response to a heart attack, or the patient did not understand that a cardiologist can hear more with his/her stethescope than most MDs can see on a 12-lead EKG--a cardiologist is not just a doc with a fancy name and higher billing rates.

Chances are, the patient didn't tell the primary doc or the chiropractor that the ER doc thought he should be checked by a cardiologist; otherwise, the primary doc and the chiropractor would have supported the ER doc and tried to persuade the patient to actually be evaluated by a cardiologist.

So--what I see is a patient who did as many do and denied he was experiencing a cardiac event, delayed treatment by seeing a primary doc and a chiropractor, allowing the heart to continue to fail, the liver and the kidneys to fail because of the heart's failing, and died as a result of the on-going cardiac condition.

Would he have lived if he had stayed in the ER/hospital and been evaluated by a cardiologist? I have no idea. His heart was not in good health; he was a hard-headed patient; and nobody knows the extent of chronic damage that existed in any of his organs.

For your own peace of mind, you can run this by a medmal attorney; but, I don't believe there is cause for a lawsuit or to spend money obtaining records and opinons.
 
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danrmn

Member
The first EKG was done by the ER doctor. And yes, my dad's doctor knew that he had signed himself out of ER without seeing cardiologist. My dad told the doctor I thought I was having a heart attack. The doctor said esophagus problems often mimic heart attack. Up until my dad was admitted to the hospital, his primary doctor never once mentioned seeing cardiologist.
 
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lya

Senior Member
The first EKG was done by the ER doctor. And yes, my dad's doctor knew that he had signed himself out of ER without seeing cardiologist. My dad told the doctor I thought I was having a heart attack. The doctor said esophagus problems often mimic heart attack. Up until my dad was admitted to the hospital, his primary doctor never once mentioned seeing cardiologist.
Esophageal problems often mimic heart attacks. Sometimes, it takes a full evaluation and some trial and error to rule one out and the other one in.
 

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