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Tag: Cardiology

Delay Between Clearance and Surgery

Posted on by Burton Bentley II, M.D FAAEM

FOCUS

Did the 9-month delay between the stress test for clearance prior to elective knee surgery constitute negligence?

BACKGROUND

Patients undergoing elective joint replacement often require cardiology consultation for preoperative clearance. Although cardiology expert witnesses opine in a variety of areas, only a cardiology expert witness who routinely performs preoperative evaluations can opine on the applicable standard of care.

CASE

A 66-year-old woman was scheduled to undergo elective bilateral total knee arthroplasty. As part of her preoperative clearance, she saw a cardiologist who performed a nuclear stress test. For various reasons, nearly nine months lapsed prior to her actual surgery. The patient was cleared for the operation, but during surgery she suffered a cardiac arrest. She was eventually resuscitated though the anesthesiologist had difficulty establishing an airway. She survived with an anoxic brain injury. The plaintiff law firm contacted Elite Medical Experts to secure a leading cardiology expert witness to determine what occurred. Elite also recommended an anesthesiology expert since the anesthesiologist had an independent duty to assure that the patient was stable for surgery. Consequently, the firm required an anesthesiology expert witness to evaluate the patient’s intraoperative anesthesia care and resuscitation.

ELITE’S ROLE

Our free physician-level case consultation identified the need for both a cardiology expert witness and an anesthesiology expert witness. Elite refined the case strategy and worked with the firm throughout discovery.

THE MEDICAL EXPERTS

Elite quickly secured a hand-vetted Professor of Cardiology from a major medical university. The cardiology expert witness was specifically chosen due to extensive experience with preoperative clearance. Elite also secured a leading Professor of Anesthesiology from a different US university. Between the two, the experts had 133 publications, book chapters, and presentations.

OUTCOME

The cardiology medical expert determined that the preoperative clearance was adequate and that is was incumbent upon the anesthesiologist to realize that the interval between evaluation and surgery had been too long. The anesthesiology expert witness agreed. Reports were written by both the cardiology expert witness and the anesthesiology expert witness. The case settled for an undisclosed amount.

Looking for the right team of experts for your case? Contact Elite Medical Experts today and speak to a physician or nurse case strategist to discuss your case.

E-Case Studies are brief clinical vignettes based upon actual cases handled by Elite medical Experts. Identifying information has been redacted or altered to protect case confidentiality.

Did an Inmate’s Care Constitute Negligence and Contribute to his Premature Death?

Posted on by Burton Bentley II, M.D FAAEM

Focus

Did the lack of monitoring and treatment of an inmate’s pacemaker and hypertension constitute negligence and contribute to his premature death?

Background

Hypertension is a leading cause of heart disease, but heart disease can occur for a variety of reasons. Only a skilled cardiology expert witness can distinguish between various causes. This case was also complicated by the alleged medical negligence occurring in a correctional medicine facility. The client needed an experienced correctional medicine expert witness to opine upon the applicable standard of correctional medicine care.

Case

A 62-year-old correctional inmate had a history of diabetes, congestive heart failure, pacemaker placement, and coronary artery disease. While incarcerated, he died of hypertensive heart disease. The family of the decedent alleged that the inmate was not under appropriate medical observation and that there was a failure to monitor his pacemaker and to treat his hypertension. They were also concerned regarding the development of progressive renal failure noted on a lab test prior to his death. A defense law firm contacted elite medical experts on behalf of the correctional system. The defense firm was in need of a cardiology expert witness to determine whether any alleged breach of the applicable standard of care actually caused or contributed to the man’s death. The defense firm also required a correctional medicine expert witness to opine on the standard of care for the correctional medicine aspect of the case.

Elite’s Role

Our complimentary case consultation distilled the need for two experts: a cardiology expert witness and a correctional medicine expert witness. Elite’s physician-led team immediately secured a cardiology expert witness with expertise and publications in hypertensive heart disease. Elite also secured an expert witness who was an experienced professor of internal medicine (the same specialty as the defendant physician) with current practice in correctional medicine.

The Medical Experts

A top cardiology medical expert was hand-vetted to the specific needs of this case. The cardiology medical expert was a full-time professor of cardiology at a major Texas medical university and the author of numerous publications and clinical trials. The correctional medicine medical expert was also a top-tier professor who oversaw the correctional medicine program at three correctional facilities.

Outcome

The cardiology medical expert witness was able to quickly determine that the inmate’s hypertension was chronic and that short-term intervention would not have altered the course of the disease. The correctional medicine expert witness supported the care administered by the correctional medicine team. Although the inmate’s blood pressure was not optimally controlled, it was adequately controlled and appropriately monitored. The defense prevailed on both standard of care and causation.

Looking for the right team of experts for your case? Contact Elite Medical Experts today and speak to a physician or nurse case strategist to discuss your case.

E-Case Studies are brief clinical vignettes based upon actual cases handled by Elite Medical Experts. Identifying information has been redacted or altered to protect case confidentiality.

 

Did a Failure to Prescribe Anticoagulation Result in a Stroke?

Posted on by Burton Bentley II, M.D FAAEM

Focus

Did a failure to prescribe Anticoagulation result in a stroke?  A case requiring review by a Cardiology Expert Witness.

Background

Atrial fibrillation is a common medical condition with complex treatment options. Medical malpractice cases regarding atrial fibrillation frequently require cardiology medical expert witnesses.  A leading cardiology medical expert is the key to success in these difficult cases.

Case

A 32-year-old man with atrial fibrillation was under the care of a cardiologist who referred him to a cardiac electrophysiologist for permanent pacemaker placement.  While under the care of the cardiac electrophysiologist (“EP specialist”), he was never instructed to take aspirin or any other anticoagulant therapy.  Several months later, while awaiting pacemaker placement, he suffered a debilitating stroke resulting in left-sided hemiparesis. The client contacted Elite Medical Experts to secure a leading cardiology medical expert witness.

Elite’s Role

As a part of our case consultation, our internal physician-led team realized that the scope of this case fell outside of the realm of a general practicing cardiology medical expert. The client required a clinical cardiac electrophysiology medical expert to independently review the medical records in order to determine what occurred as only an electrophysiology medical expert could analyze the requisite standard of care.  The role of the electrophysiology medical expert would be able to determine whether the actions of the treating electrophysiologist deviated from the applicable standard of care.

The Medical Expert

A top electrophysiology medical expert was hand-vetted to the specific needs of this case.  The electrophysiology medical expert was a professor of clinical cardiac electrophysiology (“ep specialist”) from a major California medical university. The expert had 74 major publications and had authored 16 textbooks chapters.

Outcome

The electrophysiology medical expert was able to quickly distill the relevant clinical issues though it was ultimately determined that the patient did not require anticoagulation due to a low CHADS-2 Score, an anticoagulation risk stratification tool for patients with non-valvular atrial fibrillation.  The CHADS2 score and its updated version, the CHA2DS2-VASc score, are clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF), a common and serious heart arrhythmia associated with thromboembolic stroke. Such a score is used to determine whether or not treatment is required with anticoagulation therapy or antiplatelet therapy.  The CHADS2 score is simple and has been validated by many studies.

The expert contacted the client to provide an oral opinion on the merit of the claim.  The claim was subsequently dropped and the client was satisfied with the knowledge that his stroke did not occur as the result of negligence.

 

Looking for the right team of experts for your case? Contact Elite Medical Experts today and speak to a physician or nurse case strategist to discuss your case.

E-Case Studies are brief clinical vignettes based upon actual cases handled by Elite Medical Experts. Identifying information has been redacted or altered to protect case confidentiality.

Interventional Cardiology: Essentials for Attorneys

Posted on by Burton Bentley II, M.D FAAEM

Given the widespread prevalence of heart disease in the US population, issues related to cardiology occur in countless medical negligence cases. Consequently, in the realm of medical expert witnesses, the Interventional Cardiology expert witness is King.

Interventional Cardiology is a subspecialty of cardiology relying upon highly specialized cardiac procedures to diagnose and treat coronary artery disease. Cardiologists who employ these techniques to intervene in the course of coronary artery disease are known as Interventional Cardiologists. Since Interventional Cardiologists have expertise in both the diagnosis and interventional treatment of cardiac disease, issues addressed by Interventional Cardiology expert witnesses may focus on standard of care, breach, and/or harm. Interventional Cardiology experts also opine upon standard practices involving billing, compliance, resource utilization, and observation v. admission status.

Standards of care relate to the principles, practice, and procedures of Interventional Cardiology. The most frequent Interventional Cardiology procedure is angioplasty, also known as Percutaneous Coronary Intervention, or PCI. During PCI, an Interventional Cardiologist inserts a catheter into an artery and then threads the catheter to the level of the heart. The target artery is one or more coronary arteries perfusing the heart. The Interventional Cardiologist monitors the location of the catheter by injecting dye and viewing real-time images during the procedure. When a coronary artery is determined to have significant narrowing due to atherosclerosis (plaque), the Interventional Cardiologist will perform an “angioplasty”, literally reshaping the interior of the blood vessel. The angioplasty catheter uses a tiny balloon to press plaque against the luminal walls of the artery, effectively opening the internal diameter and improving blood flow. In 70% of angioplasty procedures, the Interventional Cardiologist will also deploy a stent. Stents are tiny metal tubes that remain in place to permanently reinforce the artery wall.

The same PCI techniques of vascular entry and guidewire insertion form the foundation for nearly all Interventional Cardiology procedures. Other procedures include:

Atherectomy: The use of tiny devices such as burrs or lasers to physically remove plaque from coronary arteries.
Balloon Valvuloplasty: The use of balloon catheters to physically open narrow heart valves (e.g. aortic stenosis).
Percutaneous Valve Repair: The use of specially equipped catheters to repair abnormal heart valves.
Transcatheter Aortic Valve Replacement (TAVR): TAVR is a revolutionary non-surgical treatment for aortic stenosis. During TAVR, the Interventional Cardiologist deploys a prosthetic aortic valve that is instantly deployed over the patient’s native valve. The native valve is entirely displaced while the new valve functions in its place.

The most common standard of care allegations include procedural delays, particularly during the treatment of acute myocardial infarction. Other allegations may involve procedural complications such as hemorrhage (e.g. hematoma or retroperitoneal hemorrhage), vessel rupture, nerve injury, device malfunction, embolism, and stroke. Given the complexity of interventional cardiology procedures, only a Board-Certified, full-time practicing Interventional Cardiology expert witness can opine upon the applicable standard of care.

In additional to opining on standard of care, an Interventional Cardiology expert witness is often required to address causation. Causation arguments may arise when an Interventional Cardiologist is alleged to have acted negligently. In other words, did the alleged malpractice result in harm? Interventional Cardiology experts also evaluate causation when a patient suffers a deprivation of care by not being referred to an Interventional Cardiologist in a timely manner. For example, allegations may arise when a primary care provider fails to refer a patient with chest pain, or when an Emergency Medicine specialist delays admission to the cardiac catheterization lab. Such situations mandate meticulous analysis, and only a credible and independent Interventional Cardiology expert witness can connect the dots.

Since Interventional Cardiology experts are also Cardiologists, IC experts are also called upon to determine the existence, nature, extent, and prognosis of cardiac harm. For example, when a patient suffers a myocardial infarction (i.e. heart attack), what is the extent of the injury and how will it impact the patient’s health? Investigating the status and degree of cardiac harm is an essential strategic element is many cases. Once again, a skilled and impartial Interventional Cardiology expert witness will be the key to your case’s success.

In countless areas of medical litigation, from billing and compliance to percutaneous coronary angioplasty, the Interventional Cardiology expert witness plays a pivotal and irreplaceable role. To succeed in your next cardiac case, contact Elite to find the right Interventional Cardiology expert witness today.