Facts

On June 8, 2002, at approximately 3:45 p.m., the plaintiff, Maria Martinez, was brought to the emergency room. The defendant is Midway Hospital where the plaintiff was taken. The plaintiff did not speak English. The plaintiff's sister acted as her interpreter. The emergency room physician and the triage nurse do not remember seeing the plaintiff. They had to rely on the emergency room record created for the plaintiff at the time of her visit. The record showed that the plaintiff complained about anxiety and difficulty sleeping for the last month. The plaintiff had also failed to take her high blood pressure and diabetes medications for the last 15 days. Her blood pressure was 200/85. After a physical examination, the emergency room doctor diagnosed the plaintiff with anxiety, insomnia and poorly controlled diabetes and hypertension. The plaintiff was given Ativan. She slept for approximately one hour in the emergency room. When she woke up, her blood pressure was down to 165/100. The plaintiff was then released. She was given instructions to resume her medications, take Ativan as needed for anxiety and to see her family doctor.
The plaintiff had a stroke on June 9, 2002.

PLAINTIFF'S CONTENTIONS:
The plaintiff and her sister contended that, that morning, the plaintiff fell onto her bed and had right-sided weakness. The incident lasted approximately 20 minutes. The plaintiff did not remember what happened until she opened her eyes in the waiting area of the emergency room, and then later when waking up in the emergency room. The plaintiff's sister contended there were two more such episodes, one in the car going to the emergency room, and one in the emergency waiting room. Each episode lasted 15-20 minutes with right-sided weakness.

DEFENDANT'S CONTENTIONS:
The defendant doctor argued that she took an adequate history from the plaintiff. Neither the plaintiff nor her sister gave her a history of transient ischemic attacks. The history was whole-body weakness, not one-sided weakness.
The plaintiff's emergency room expert was critical of the emergency room doctor's care and treatment of the plaintiff. He was critical of the anxiety diagnosis. Further, he was critical of the failure of the emergency room doctor, possibly because of the language barrier, to get a more thorough history. Such an inquiry from the plaintiff and her sister would have revealed the three transient ischemic attacks and the possibility of a stroke. A neurologist should have been called in for consultation. This would probably have resulted in the plaintiff being hospitalized.

The plaintiff's expert neurologist alleged that the three transient ischemic episodes were precursors of stroke. More could have been done for the plaintiff if she had been hospitalized. The experts opined that if she had been hospitalized, she could have been given aspirin and Plavix to better control her blood pressure. This may have prevented the stroke. Further, if she had been in the hospital and the beginning of the stroke was caught, TPA could have been given to try to minimize the effects of the stroke.
The defendants' emergency room expert testified that the care and treatment met the standard of care. The defendant doctor and the defendants' emergency room expert testified that even if the doctor had been notified of the episode, there was nothing that could have been done differently to prevent the stroke. The plaintiff had already been instructed to resume her medications, which included aspirin. Further, Plavix takes days to start working. The plaintiff's blood pressure was brought under reasonable control in the emergency room before her release. She was told to resume her hypertension medication. Even if the plaintiff had been in the hospital where TPA could be considered, there was a small chance it would have improved her condition. Even if the selective criteria for its use were met, only approximately 18 percent of patients demonstrate an improvement through TPA, while six percent are made worse and 82 percent are unaffected.

Specials in Evidence

$26,000 (paid by Medi-Cal)

Damages

The life care plan called for between four hours and 16 hours per day at a present value cost of a low of $440,000 to a high of $1,600,000.

Injuries

The plaintiff had weakness in the entire right side of her body. She was unable to take care of her normal activities of daily living. The plaintiff's husband stopped working to assist her. He spent approximately eight hours a day assisting her with daily living activities.

Result

Judgment was for the defense.

Deliberation

half day

Length

six days