Facts

John Doe, 52, was earning $120,000 as a commercial drilling supervisor. His cardiac risk factors included a 20-year smoking history, rheumatoid arthritis, hypertension, and elevated lipids.

In early August 2013, he developed a new onset of chest pain related to exertion. He reported this to his rheumatologist at a routine visit on Aug. 14, 2013. He was referred for a treadmill stress test on Aug. 23, 2013. He was seen that day by a cardiac nurse but not by a physician. The nature of his chest pain, its onset, provoking, and relieving factors were not charted. He developed chest pain at 7 minutes 30 seconds of exercise in a 12-minute Bruce protocol. He did reach his target heart rate but the nurse stated that the test was discontinued at 9 minutes 36 seconds "due to chest pain." There were no associated ST segment changes.

John Doe was discharged without having seen a physician. A physician did review the EKG data from the treadmill test, saw no ST segment changes, and determined that John Doe was at "low risk" for cardiovascular disease.

On Aug. 28, 2013, John Doe collapsed at work. Resuscitative efforts were unsuccessful. An autopsy revealed a 90-95 percent blockage of his left anterior descending coronary artery and a fresh thrombus.

Plaintiffs were the decedent's spouse and two adult financially emancipated daughters.

PLAINTIFF'S CONTENTIONS:
Plaintiffs contended accepted standards of care required that somebody at Roe Clinic take a detailed cardiac history before placing him on the treadmill. The rheumatologist did not, nor did the cardiac nurse that ran the treadmill study. Had a detailed history been taken, it would have been concluded that decedent suffered from unstable angina.

They would not have placed him on the treadmill, but would have taken him to the cath lab where angiography would have revealed a 90-95 percent lesion in the LAD, which would have been stented at that time. Plaintiffs also argued that, in the alternative that the standard of care required that the cardiac nurse appreciate that the chest pain, which decedent experienced during the treadmill stress test was likely anginal in nature, and she should have summoned the cardiologist to see decedent. Had she done so, plaintiffs contended the cardiologist would have appreciated this to represent unstable angina, which would have prompted an angiogram and stenting.

Plaintiffs contended that, had decedent been stented, his life expectancy would have been into his late 70s.

DEFENDANT'S CONTENTIONS:
Defense contended that his pre-test chest pain was likely not angina, that an adequate history was taken, that the chest pain that he experienced on the treadmill was likely pleuritic versus angina, since it increased with deep breathing. That, coupled with the fact that the EKG was entirely normal made it reasonable for those at Roe Clinic to believe that decedent was at low risk.

Roe Clinic argued that, given his risk factors and comorbidities, even had he been stented, his life expectancy was on the order of 5-7 years.

Result

Arbitrator found in favor of the plaintiffs and returned an award in the amount of $1.1 million.

Other Information

The case was arbitrated over the course of three days before Joseph E. Thielen, as the sole neutral arbitrator.