Failure to Diagnose Heart Attack Lawsuit in Baltimore

Barnett v. Franklin Square Hospital Center

This is a survival action and wrongful death emergency room malpractice medical malpractice filed on behalf of a woman in Baltimore City who died at Franklin Square Hospital of a heart attack about ten hours after she was admitted with significant chest pain.

This malpractice lawsuit was filed on January 9, 2017, in Maryland Health Claims Arbitration, and is the ninth medical malpractice case filed in Maryland in 2017.

Summary of Plaintiff's Allegations

The decedent, a 52-year-old woman, goes to the ER at Franklin Square Hospital with right-sided chest pain for about a week, which began to spread to her arm and shoulder. She tells the triage nurse that her pain is sharp, that she vomited that morning, and that she took aspirin before going to the ER. The nurse believed she was suffering from acute coronary syndrome. In other words, she having a heart attack or a heart attack was imminent.

Her EKG is abnormal. Defendant physician assistant and defendant doctors assess the decedent, whose chief complaint is right sided chest pain for more than one week. Defendant physician assistant knows that the woman's pain was 10/10 before she arrived at the hospital and that the pain was relieved with aspirin somewhat. She also knows that the patient has a family history of heart disease and that the woman has high cholesterol and hypertension.

The doctors place the woman on continuous cardiac monitoring in the emergency room and order labs to be done. Her troponin level is noted to be high. Defendant doctor requests another reading of her troponin level, but does not start her on anti-thrombolytic medication or beta blockers, and does not order a cardiology consultation.

Defendant internal medicine hospitalist assesses her, and says to hold off on medications until the second set of troponin level labs came back. These results come back, and are even more elevated than the first round of labs. She gets orders for Nitroglycerin, Heparin, Lovenox, Lisinopril, and an EKG, in addition to a cardiology consult. However, none of the medications are administered to the patient except for Heparin and Nitroglycerin.

Defendant cardiologist evaluates the decedent and notes that her troponin level are borderline elevated and that her EKG showed some inversions. He places her in the telemetry unit, and plans on transferring her to Union Memorial Hospital the next morning for cardiac catheterization. After this consult, defendants do not continuously monitor her.

The woman tells a nurse that afternoon that she needs to use the bathroom. The nurse allows her to walk to the bathroom, instead of making her use a bedpan. Thirty minutes later, the nurse finds that the woman had not returned from the bathroom. The nurse goes to check on her, but the woman does not answer the door. The nurse calls security to open the door. Once the door is open, the decedent is found without a pulse and not breathing on the floor, covered in vomit. The attempts to resuscitate her fail.

Additional Comments
  • Plaintiff's malpractice lawyer filed a Certificate of Merit, but we did not see an expert report with the filing. So we do not know exactly where plaintiffs' expert will place her emphasis. We also do not have access to the medical records so where do not know what the doctors were thinking. Did they recognize that acute coronary syndrome is a potentially life-threatening event which requires immediate medical intervention to avert or reduce damage to the heart muscle?
  • What was the negligent act that caused the death? The standard of care would be to order aspirin medications, including thrombolytic agents, anticogoaulatant agents to reduce infarct size (i.e., beta blockers and nitrate), antiarrhythmics and diuretics and appropriate dosages and combinations. A lot of this was done. Will plaintiff's malpractice lawyer contend that had the patient gotten Lovenox and Lisinopril that she would have survived? What would have serial EKGs or better monitoring of troponin levels change the outcome?
  • It is hard to argue that a cardiologist should not have been consulted. But the question is would it have made a difference.
  • The question is also raised why the patient was not transferred to another facility to get an immediate cardiac catheterization. Why wasn't that done immediately? Why did the doctors at FSH think they should delay a transfer until the next day? It certainly stands to reason that if she had received a cardiac catheterization, the doctors could have restored proper blood flow and oxygen supply to her heart, probably limiting any ischemic injury and cardiac muscle death and saving her life. So why wait?
  • This lawsuit was filed in Baltimore City even though Franklin Square is in the county. If the plaintiffs' attorney can keep the case in Baltimore City, the settlement value of the claim will increase.
  • The simplest version of plaintiffs' claim is that a 52 year-p;d patient ordinarily should not die of a heart attack after being in the hospital for 10 hours.
Jurisdiction
  • Baltimore City
Defendants
  • Three ER doctors
  • Internal medicine doctor
  • A physician's assistant
  • Franklin Square Hospital Center, Inc.
Hospitals Where Patient was Treated
  • Franklin Square Hospital Center
Negligence
  • Failed to recognize the plaintiff was suffering from acute coronary syndrome that was life threatening upon arrival to the hospital
  • Failed to timely call a hospitalist/cardiology consult
  • Failed to timely initiate medications for acute coronary syndrome
  • Failed to timely order labs and perform serial EKG's
  • Failed to appropriately monitor plaintiff in the emergency department
  • Failed to act appropriately upon the initial troponin results
  • Failed to timely call a cardiology consult
  • Failed to have the plaintiff transferred for cardiac catheterization
  • Inappropriately allowing plaintiff to walk to the bathroom off of a monitor
Specific Counts Pled
  • Wrongful Death
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