Facts

On the morning of Jan. 10, 2004, claimant Mahvash Laghai, who was then 52 years old,
presented to the Kaiser clinic a complaint of "palpitations since last night." Claimant had no
complaints of chest pain, shortness of breath or dizziness, but was complaining of weakness.
She had a history of palpitations in the past, and of mitral stenosis. Her blood pressure when she
presented her complaint was 80/50. The clinic doctor, based on an EKG, made a diagnosis of
atrial fibrillation and sent the claimant to the Kaiser emergency room. The ER doctor consulted
with a Kaiser cardiologist who ordered that the claimant be given a medication called Flecainide
to convert her heart back to normal rhythm. She was given the Flecainide, and after her heart
converted back to normal rhythm she was discharged from the ER. The following day, the
claimant suffered a massive stroke for which she required long hospitalizations. The claimant
was left with substantial permanent residual disability, including left-sided weakness.

PLAINTIFFÆS CONTENTIONS:
The claimant contended that her atrial fibrillation was of unknown duration,
and that in such situations the standard of care requires that the patient be anticoagulated for three to four
weeks before being cardioverted to protect from the risk of stroke. This is because when a patient is in atrial
fibrillation, blood stagnates in the atrium, which could clot and therefore create the risk of stroke, particularly
when the heart is converted to normal rhythm.
The claimant contended that using the patientÆs history of onset of symptoms to determine when the atrial
fibrillation began was below the standard of care because atrial fibrillation can be symptomatic or
asymptomatic in the same patient in the same event of atrial fibrillation. Therefore, the claimant contended,
cardioverting her without first anticoagulating her for three to four weeks was below the standard of care and
caused the massive stroke the next day.

DEFENDANTSÆ CONTENTIONS:
The respondents contended that using the history of onset of symptoms to
determine when the atrial fibrillation began was a recognized method of diagnosing how long the patient had
been in atrial fibrillation, and that therefore the claimantÆs atrial fibrillation was not of unknown duration, but
rather had lasted less than 24 to 48 hours, and that it was therefore within the standard of care to cardiovert her
without first anticoagulating her.

Injuries

Massive stroke resulting in substantial permanent residual disability and left-sided weakness.

Result

$1,538,164.

Other Information

The arbitrator, retired Judge Bruce J. Sottile, of ARC, expressly rejected the respondents' contention that use of patient history of symptoms to determine onset of atrial fibrillation was a recognized method of diagnosing when the atrial fibrillation began. The award has been paid in full.