Heart Failure Malpractice?

[AkersTile]

What is the name of your state (only U.S. law)? MO

This question is for my Mother-In-Law.

My Father-In-Law passed away on Friday. He had congestive heart failure and evidently had been in heart failure for 6-8 weeks prior to seeing his cardiologist on May 27th. He saw his primary care physician twice in that 6-8 week period because he was having trouble breathing and was getting very swollen. He was told both times that he was fine and needed to cut down on sodium. When he went to the cardiologist, the nurse there had him immediately admitted to the hospital where they ran a bunch of tests and gave him different medications. His heart was so enlarged it was pressing against his lungs (why he was having so much trouble breathing). There was also over 90% blockage in most of his heart and his aortic valve wasn't working properly. All told, his heart was working at 15%. His cardiologist tried to do a triple bypass, valve repair, and put an RVAD pump in. Unfortunately nothing worked and we lost him the day following the surgery.

My Mother-In-Law would like to sue his primary care physician. She does not want to sue for any money. She simply does not want this woman in practice any longer.

Is this something that would be possible or would it not even be considered malpractice?

Thank You in advance for any and all advice.

 

[Proserpina]

Your FIL was already under the care of a cardiologist during this 6-8 week period when he was seeing his PCP?

 

[AkersTile]

Your FIL was already under the care of a cardiologist during this 6-8 week period when he was seeing his PCP?

Yes. He had been under the care of the cardiologist for a few years already. MIL made him an appt with cardiologist after PCP told them 2x that he needed to cut down on sodium and he kept swelling.

 

[tranquility]

Medicine is an inexact science. When the end result is known, it is always obvious what course one should take. This is a very fact sensitive issue. See a malpractice attorney and bring the medical files. If he takes it on contingency, you have a case. If not, you don't.

You can see as many attorneys as that will convince you to their opinion.

 

[justalayman]

Yes. He had been under the care of the cardiologist for a few years already. MIL made him an appt with cardiologist after PCP told them 2x that he needed to cut down on sodium and he kept swelling.

You do realize the PCP is not a cardiologist and the cardiologist is a cardiologist?

Yet you expect the PCP to have the same skills concerning the heart as the cardiologist.

. She does not want to sue for any money

well, that is your only option.

She simply does not want this woman in practice any longer.

then she might want to file a complaint with the state licensing board and and oversight association she belongs to (such as AMA)

 

[AkersTile]

You do realize the PCP is not a cardiologist and the cardiologist is a cardiologist?

Yet you expect the PCP to have the same skills concerning the heart as the cardiologist.

It was obvious to anyone around him that something was not right. The PCP did not once tell him he should see the cardiologist or send him for any tests. MIL made the appt with the cardiologist because PCP was doing nothing and MIL knew something wasn't right.

then she might want to file a complaint with the state licensing board and and oversight association she belongs to (such as AMA)

OK. I will let her know to do that. Thanks

 

[AkersTile]

Medicine is an inexact science. When the end result is known, it is always obvious what course one should take. This is a very fact sensitive issue. See a malpractice attorney and bring the medical files. If he takes it on contingency, you have a case. If not, you don't.

You can see as many attorneys as that will convince you to their opinion.

Ummm yeah. Ok. You're reply kind of confused me. I posted here to see if she had a possible malpractice case. I figured with as much good advice as I have gotten from this board previously, this would be a good place to start before her finding an attorney.

 

[Proserpina]

It was obvious to anyone around him that something was not right. The PCP did not once tell him he should see the cardiologist or send him for any tests. MIL made the appt with the cardiologist because PCP was doing nothing and MIL knew something wasn't right.



OK. I will let her know to do that. Thanks

The thing is, we have here a patient with a significant history of heart disease and whenever symptoms such as SOB and swelling occur, I'd hazard the most common first line of advice from a PCP would be "cut your sodium intake".


I think there is also a reasonable expectation that a cardiac patient has been at least somewhat educated as to their condition and should be able to recognize a change in symptoms - so if there's something not quite right, the first call should really have been to the treating cardiologist or, if severe enough, 911.

I honestly cannot see the PCP being held responsible in this instance. I cannot see any malpractice suit.

 

[tranquility]

Sorry to confuse you, but, there are few experts on such medical care here.

While there may be malpractice, there may not be.

You need to see an expert who can review the particular medical records. Only then can a determination be made. This is not a "case" until people who know medicine review specific medical facts (Which are not summaries, but are how much of this given at what time and under what objective criteria and in what way, etc..) of the treatment.

Do you have a case? I don't think so. But, I've never studied medicine and have little knowledge of how people in medicine behave day by day.

You need to interview many attorneys who are knowledgeable in medical malpractice. If they want any money up front or through the case, let it go.

If they are willing to front the money required and will work on contingency, give it a try.

Personal and uneducated opinion? Sorry. Sometimes people get sick and die. I'm sorry for your loss.

 

[AkersTile]

Thanks everyone for your advice. I will let MIL know what her options are when I speak with her tomorrow. What she will choose to do at that point, I don't know.

Tranquility~
Thanks for explaining your last post. I really helped out a lot. Lack of sleep combined with 6 kiddos makes my brain not function all that well.

Hope you all have a good night.

 

[Proserpina]

Thanks everyone for your advice. I will let MIL know what her options are when I speak with her tomorrow. What she will choose to do at that point, I don't know.

Tranquility~
Thanks for explaining your last post. I really helped out a lot. Lack of sleep combined with 6 kiddos makes my brain not function all that well.

Hope you all have a good night.

MIL needs to focus on grieving. This is the very first step in a long journey.

Check your PMs....

 

[ecmst12]

Unless mom was in the doctor's office with dad, she doesn't know what was actually said, only the second-hand account. Dad may have been advised to see the cardiologist, but didn't want to do it.

 

[lya]

I see three 'things' in the Original Poster's (OP's) description of events.

First: A known heart patient with a treating cardiologist begins to swell more than usual, sees his PCP, is advised to reduce sodium intake, and does so without ever contacting his cardiologist. The swelling continues--he returns to his PCP, again bypassing his cardiologist. Somehow or other, he ends up seeing the nurse at his cardiologist's and is admitted to the hospital with exacerbation of his longterm cardiac conditions.

Secondly: The PCP stated the patient "was fine", which he probably was for a man somewhere between 50 and 90 who has multiple longterm cardiac conditions and cardiac insufficiency. His admitting diagnosis/findings are those of longterm cardiac problems and resulting cardiac insufficiency: overall function of the heart blocked 90%, aortic valve insufficiency, cardiac output 15% of normal. His cardiologist chose to operate vs medical management--maybe that was the only option left and maybe the patient knew his heart was in such poor condition that surgery was his last option and that's why he didn't go to his cardiologist in the beginning of his problems with swelling.

Thirdly: Once again we see family members who cannot accept that the patient's condition was not one of survivability, that he made the conscious and willful decision to bypass his cardiologist and see his PCP, which for maintenance care of such conditions is OK, even in the presence of swelling, and is seeking to destroy another human being because the loved one died from one or more conditions that do not support life.

My opinion: There is no valid claim of malpractice or negligence and I doubt an honorable attorney would take the time, effort, and expense to investigate a medmal claim on a patient whose longterm medical condition rules out any potential for damages due solely to an act(s) of medical malpractice or negligence.

Run it by a medmal attorney and then let it go. Get on with learning to accept that death is the normal progression of life--none of us are getting out of here alive (barring intervention from God or aliens from another world). It hurts to lose a loved one; it makes (you) angry to have lost that loved one--for a while; then, it gets better and (you) can accept that here you are and here they aren't.

 

[xylene]

He was already dead

PCP gives a dying man some sensible diet advice

Cardiologist orders multiple costly surgeries that have the net effect of hastening death.

And yet you want to sue the PCP for not having sent the patient in for surgery sooner.

The patients terminal condition of advanced primary heart disease did not present in 6 weeks.

 

[LAWMED]

PCP gives a dying man some sensible diet advice

Cardiologist orders multiple costly surgeries that have the net effect of hastening death.

And yet you want to sue the PCP for not having sent the patient in for surgery sooner.

The patients terminal condition of advanced primary heart disease did not present in 6 weeks.

I have a slightly different take on a portion of what you said:

PCP gives useless diet advice either because she is stupid and a poor diagnostician, or a liar who spouts nonsense when at a loss for telling the truth. 'I am swelling and cannot breath' can be diagnosed with 99% accuracy as congestive heart failure by a blind first year resident. 'Cut back on your sodium' is equal to 'rub a magic rock every morning' as far as therapy goes.

See Lya's comments for some very good analysis.

Cardiologist likely presented the patient with his only hope of survival with aortic insufficiency and an apparent ejection fraction of 15% and (we assume?) some coronary artery blockage of 90%. The enlarged heart pressing on the lungs did not cause the shortness of breath. The inability of the heart to pump oxygenated blood in an effective manner caused the shortness of breath along with likely pulmonary edema.

The patient was certainly informed of the risk of this major surgery, which included a Right Ventricular Assist Device (indicating some additional dysfunction we have no info on, like a rt ventricular infarct or pulmonary hypertension, since I would expect a left assist device). Ultimately it sounds as if he needed a heart transplant but without this surgery would not survive to receive it. His death was not hastened by surgery since based on the info provided he should have been dead any minute...or after one ride on a roller coaster.

None of this developed in 6 weeks. It would seem the patient had to know he was a heart failure patient if he had been seeing a cardiologist, had to have been on meds for it, his PCP had to have known, and unless an idiot there is no explanation for her salt comment as a medical professional. The patient's choosing to see the the PCP rather than the cardiologist is something I can see my elderly parents doing since they are from the 'old school' where doctors, no matter their training, know best.

Lastly, no offense but we need to hear from a more reliable (closer "in the know" so to speak) source than a daughter in law regarding the events.