Confidential

Facts

On July 28, 1996, patient, a 55-year-old engineer, was fixing a light fixture when he was stricken with chest pain,
dizziness, a burning pain in the upper abdomen and difficulty swallowing. Paramedics transported him to the
ER at defendant medical group where he was evaluated and a portable chest X-ray was taken at 8:46 p.m. The
X-ray revealed a markedly widened mediastinum. There was clinical evidence of aortic regurgitation on
auscultation of the chest. EKG showed inferior ST depression.
The ER physician testified that the presentation was very suspicious for, but not diagnostic of an aortic
dissection. According to the plaintiff, defendant medical group was not capable of the surgical management of
an aortic dissection. The patient was taken to CT scan at 9:15 p.m. That study was completed at 10 p.m., and
the radiologist interpreted the study as showing no intimal flap and no conclusive evidence for an aortic
dissection. Marked dilation of the aortic root to 6 centimeters was noted. At 10:40 p.m., a transthoracic
echocardiogram was begun. The study was completed at 11 p.m. and showed moderate to severe aortic
insufficiency. The study was all but diagnostic for an aortic dissection. Arterial blood gasses were drawn at 11
p.m., revealing severe acidosis. Arrangements were then made for transport to Scripps Memorial Hospital,
following intubation.
The patient was taken to surgery at approximately 12:15 a.m. on July 29. A large dissection ascending aortic
aneurysm was found with intussusception of the aortic arch. Repair was undertaken, but bleeding was
encountered from all needle holes and through the grafts. During surgery, patient became more hypotensive,
acidotic and did not respond to Dopamine.
The patient was pronounced dead at 7:34 on July 29, while still in the OR. An intraoperative transesophageal
echocardiogram was performed, revealing a 6-7 centimeter aneurysm of ascending aorta.

TThe plaintiffs contended that given decedentÆs clinical presentation, most notably the aortic regurgitation, coupled
with findings on chest X-ray, those at defendant medical group should have arranged for the immediate
transfer to another hospital beginning at approximately 9 p.m. in view of the fact that they were not equipped to
manage an aortic dissection surgically.
The plaintiffs further contended that the CT scan which was completed at 10 p.m. did show evidence of an
intimal flap; that the levels imaged on the CT scan were improper in that the aortic root was not well imaged.
The plaintiffs claimed that, had decedent been taken to surgery 2+ hours earlier, it is more likely than not that
he would have survived.
DEFENDANT CONTENTIONS:
The defendant contended that, although decedentÆs presentation at the ER was
consistent with an aortic dissection, it was not diagnostic of. DecedentÆs EKG and CPK enzymes were
suggestive of a cardiac ischemic event. In the absence of a relatively firm diagnostic of an aortic dissection, it
would have been inappropriate to transfer the patient earlier. Further, CT scan was properly read. No hard
evidence of an intimal flap was seen.
The defendant maintained that any delay did not contribute substantially to the end result. Decedent made it to
surgery and was placed on the heart-lung machine and his blood gases stabilized.

Injuries

Death of a husband and father of two adult children.

Other Information

<a>An arbitration was held before Kenneth Sigelman, for claimant, Robert Cosgrove, for respondent and Judge Arthur Jones, retired, as neutral arbitrator. </a>