Cardiology Expert Advises on Anticoagulant That Caused Fatal Brain Bleed


Cardiology expert - blood clotA cardiology expert advises on a case involving a man in his 60’s was admitted to the hospital after complaining of dyspnea on exertion and bilateral lower extremity edema. He was diagnosed with congestive heart failure with unknown function. Infectious pneumonia was considered a possible etiology.

According to the plaintiff, the man’s wife, the next morning, the man complained to the nursing staff of a headache, and he received acetaminophen. A cardiology consult was performed that day by the defendant cardiologist’s physician assistant. The plan was to start the man on Coumadin and Warfarin. The man told the cardiology PA that he had a headache and had recently fallen.

Later in the afternoon, the man complained to his attending physician that he had a throbbing headache that radiated around to his eye. The physician said he was going to obtain a CT scan before starting Heparin. That night, a nurse, per the attending physician’s order, administered Heparin via IV drip. No CT scan was performed. The pain intensified overnight, and an emergency CT scan was ordered. Before it could be performed, the man become unresponsive.  He was transferred to another hospital, where he was diagnosed with a large hyperacute subdural hematoma. He died three days later.

The plaintiff sued the hospital, cardiologist, physician’s assistant and attending physician for medical malpractice.

Question(s) For Expert Witness

  • 1. What was required of the defendants?
  • 2. Did they breach the standard of care?

Expert Witness Response

It is my opinion that the cardiologist breached the standard of care and skill by failing to order and obtain the results of a CT scan of the patient’s head prior to initiating anti-coagulation therapy or by failing to have direct verbal communication with his attending physician to ensure that he was aware of the history of fall and headache and to ensure that a CT scan would be performed prior to the initiation of anti-coagulation therapy. A physician under the same conditions and similar circumstances, when made aware of the history of the patient having fallen and striking his head a week prior to admission and experiencing a headache must first obtain a CT of the head to rule out an intracranial bleed prior to initiating anti-coagulation therapy, in order to protect the life and safety of the patient. Anti-coagulation therapy can exacerbate an intracranial bleed, causing brain damage and death.

The failure of defendant to either order the CT scan or ensure that the attending physician did constituted a breach of the standard of care exercised by cardiologists generally under similar conditions and like surrounding circumstances.

Similarly, it is my opinion that the physician’s assistant breached the standard of care and skill by failing to order and obtain the results of a CT scan prior to initiating anti-coagulation therapy or by failing to have direct verbal communication with the attending physician.

It is my opinion, that, to a reasonable medical probability, the negligent acts and omissions on the part of the cardiologist and physician’s assistant caused or contributed to the devastating left subdural bleed, brain damage, and death of the patient.

The expert is board-certified by the American Board of Cardiology and by the American Board of Internal Medicine and has been specializing in the practice of cardiology for more than 30 years. The expert is responsible for supervising and instructing physician assistants in hospitals with respect to the provision of cardiac care.

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