This case takes place in South Carolina and involves a male patient with permanent limitations to his movement following an ischemic stroke. One day, the patient experienced the sudden onset of severe headache, slurred speech, weakness, and an unequal and uneven smile and facial features. He presented to the ER and was initially diagnosed with a migraine by the defendant physicians. The patient was prescribed Topamax and was sent home. Some time later, the patient returned to the ER and a CT was performed which showed no evidence of hemorrhage. The patient was not administered tPA until later that night, at which point significant neurological damage had occurred. It is alleged that by delaying the administration of tPA, the treatment fell outside of the window of opportunity to prevent permanent injury.
Question(s) For Expert Witness
- 1. Do you have specific knowledge of strokes and the impact early administration of tPA has on long term outcomes?
- 2. What are you opinions regarding the potential for tPA to minimize long term complications when administered early?
- 3. Do you think in this case there was potential to prevent permanent disability if tPA had been administered once the patient was cleared for therapy by CT exam? 4. Please explain your experience reviewing similar cases?
Expert Witness Response E-027369
I am a board certified neurologist with 25 years experience. I am well versed in the management of strokes and the use of tPA. tPA has been proven to minimize the long-term complications of strokes in several clinical trials. In this case there was likely potential to prevent permanent disability if tPA had been administered earlier but I would need to review the relevant medical records in more detail to be sure. It seems that the initial decision to release the patient from the ER was shortsighted, and some sort of imaging study should have been performed. I have done 2-5 expert witness cases involving stroke over the past 25 years.
Expert Witness Response E-000818
I have 30 years experience in clinical and research aspects of stroke. Much of my recent work has been in the area of healthcare delivery research that is applicable to this case. I was one of the investigators in the development of tPA for use in stroke. tPA has significant benefit in improving clinical outcome in ischemic stroke cases. The benefit of treatment is related to how early the drug is administered and delay can lead to poor outcome for the patient. From the information provided it seems this would have been an appropriate case for tPA administration.