A neurology expert witness opines on a stroke victim’s claims that delayed treatment caused further damage. The plaintiff was a sixty-two-year-old Caucasian male who had a history of diabetes, sleep apnea, hypertension, obesity and diabetic ketoacidosis from his Invokana medication. He suffered a stroke upon waking up in the morning. The plaintiff’s wife witnessed her husband’s stroke and called an ambulance for transportation to the defendant hospital in Delaware. He arrived at the hospital approximately 90-minutes after awakening, and the hospital’s use of stroke telemedicine made obtaining a diagnosis of the patient’s cranial scan a time-consuming affair.
Question(s) For Expert Witness
- 1. What was the standard of care?
- 2. Was it violated?
- 3. What impact did this have on the patient?
Expert Witness Response
Plaintiff was a proper candidate for intravenous recombinant tissue plasminogen activator (t-PA), and the failure to offer t-PA therapy increased the risk of debilitating short-term and permanent sequelae from the patient’s ischemic stroke.
A CT scan showed a left middle cerebral dense artery sign and subtle early ischemic changes in the posterior insular cortex and temporal lobe. The plaintiff returned from the CT clearly within the FDA-approved 3-hour treatment window for intravenous t-PA. Then there was an unexplained delay before the doctor consulted a neurologist. The plaintiff was transferred to another hospital, and his scores worsened.
The plaintiff’s last “normal” was when he awoke and verbally communicated with his wife. Based on his acute stroke presentation shortly thereafter in which he was significantly hemiparetic and aphasic, it is my opinion that he would not have suffered his stroke prior to 6:30 a.m. and still be able to make purposeful movements and communicate. Failure to take and record a detailed and accurate history to determine when the patient was last “normal” is a deviation from the standard of care committed by the triage nurses and the emergency room physician.
Critical elements of the patient’s history must include information on the time of stroke symptom onset: when the patient was at his previous baseline or symptom-free state. The departure from standard of care exhibited by these health care providers also includes a failure to timely speak with and question the plaintiff’s wife for several hours, after the window of opportunity to administer t-PA had been lost. A neurological consultation was not requested until even later, another departure from the standard of care.
The available data prior to and subsequent to the date of the event clearly support the fact that the plaintiff would have had a better chance had he been treated with t-PA than without t-PA for obtaining clinically meaningful improvement.
The expert is a board-certified neurologist and emergency department educator.