Medhaps

Matters of the Heart

Posted on 17. Sep, 2009 in Case Reports

Case Synopsis

Early Symptoms

On January 24, 1996, Stacy started feeling ill and checked herself in at a local emergency room. She was suffering from pains in the upper stomach area on and off for the past day. These pains would radiate to her back and shoulders and it felt like it was burning with some pressure. She felt bloated, nauseated, and had vomited a small amount.

At the emergency room, she had her blood pressure, temperature, and pulse checked, which were all normal. She was 59 years old at the time.

The Workup

Dr. Edwards was the doctor working in the emergency room that day. He saw Stacy and ordered a bunch of tests: a chest x-ray, an EKG, and an array of labs. The labs, including tests to detect a possible heart attack, came back all normal. The chest x-ray was also normal. The EKG however showed possible left heart atrial enlargement and myocardial ischemia.

Not completely sure on the diagnosis, Dr. Edwards gave Stacy some Nitroglycerine, which usually alleviates pain caused by a heart attack. In this particular case, it had no effect on the pain. So Stacy was given a GI cocktail. A GI cocktail is a concoction taken orally containing antacids such as Maalox, lidocaine for stomach pain relief, and other drugs to help relieve stomach pain. After taking the GI cocktail, Stacy began to feel better. Stacy was also given Demerol soon after. Her pain nearly dissipated.

Double Checking?

In a little while, a repeat EKG was taken which showed further evolution of a possible heart attack. Another set of labs were drawn as well. This time the results showed elevation of Stacy’s cardiac enzyme, which would suggest a heart attack. When Dr. Edwards reviewed the labs, he felt that the elevations in the enzymes were likely due to Stacy getting Demerol. His rationale was that because the Demerol is injected into the muscle (arm, buttock, or other muscles), this could cause a temporary rise is the muscle breakdown enzymes – mimicking the lab results as a seen in the event of a heart attack.

View Actual Case File

The next day on January 25 at 2:00 am in the morning, Stacy woke up with pain again. She was given another shot of Demerol by the nurse and like before, her pain was relieved.

Going Home!

That same day at 5:40 am, Stacy was discharged from the emergency room. The final diagnosis was “acute abdominal pain.” She was given two instructions: 1) return to the emergency room if the symptoms worsened; 2) follow-up today with your primary doctor.

Case Outcome

Later that evening at home, Stacy had a full on heart attack, became unconscious and was rushed to the hospital. CPR and other efforts to resuscitate Stacy ensued. She was pronounced dead at 6:20 pm from cardiopulmonary arrest.

A year later, Dr. Edwards also prescribed an antibiotic to a patient who was allergic to it. That patient suffered 14 hours of severe pain and fevers of 104 degrees.

Although the medical board sought to revoke his license, Dr. Edwards entered a form of plea bargaining with them. The case was negotiated and Dr. Edwards was only given a public reprimand.

Analysis by Florence

Oh my! This story is so shocking and worrisome. There was nothing poor Stacy could have done! Something so basic as a heart attack was missed by the doctor, it’s hard to understand how this could happen at all. They performed all these tests, and yet still did not catch it.

There’s really not much to say as an analysis, except the punishment received by the doctor just doesn’t sit well with me. Somehow it feels that he got off too easily, although I’m not sure making a medical oversight (well, actually, two) should result in a revoked license. Regarding the antibiotic prescription, I’ve had a doctor prescribe a medication for me that, luckily after I talked to the pharmacist, I found out I was allergic to. Unfortunately, I believe this happens much more than we realize, and too many doctors get away with it.

I think the easiest reaction here is to start mistrusting our physicians, but I’m not sure that’s the best route to go, either. It sure puts us in a bind without a clear way out.

Florence's DAISE Score - What is this?

Score
7

Damage	Anger	Ineptitude	Shock	Ethics
10	6	8	6	5

The DAISE Score

The DAISE (Day-see) Score is comprised of 5 metrics. Each component measures different aspects of the case to determine it's severity. This is done so different cases can be compared and contrasted, along with bringing attention to the many aspects of the stories.

Damage	The amount of damage caused by the perpetrator(s) in the story. This typically will include the patient and family, but sometimes it may include other factors as well, such as the environment, society, etc.	0 = No actual damage 10 = Heaviest damage
Anger	The amount of anger and animosity you feel toward the doctor(s) while reading the story.	0 = Cool serenity 10 = Seething, white anger
Ineptitude	How much of this medhap was caused by the doctor's incompetency and negligence?	0 = Not really the doctor's fault 10 = Should never be a doctor
Shock	How shocked/surprised were you after reading this story?	0 = Hear about it all the time 10 = O..M..G...
Ethics	Or rather, the lack thereof - How much did the doctor breach the code of ethics?	0 = No breach in ethics 10 = Criminal

The final Score is an average of the 5 metrics. The higher the score, the worse the case.

Response by Lyssa

I’d have to agree with Flo on this one. It’s entirely shocking for a doctor to miss a heart attack, and I’m also not very happy with the punishment that resulted. I’d probably go a step further than Flo by saying that this doctor should have lost his license, or at least have it suspended. It seems that he is either rather shoddy in his work, or he doesn’t know what he’s doing. There’s very little else to comment about this story, except that I hope Dr. Edwards doesn’t mess up again.

Lyssa's DAISE Score - What is this?

Score
8

Damage	Anger	Ineptitude	Shock	Ethics
10	8	8	7	7

The DAISE Score

The DAISE (Day-see) Score is comprised of 5 metrics. Each component measures different aspects of the case to determine it's severity. This is done so different cases can be compared and contrasted, along with bringing attention to the many aspects of the stories.

Damage	The amount of damage caused by the perpetrator(s) in the story. This typically will include the patient and family, but sometimes it may include other factors as well, such as the environment, society, etc.	0 = No actual damage 10 = Heaviest damage
Anger	The amount of anger and animosity you feel toward the doctor(s) while reading the story.	0 = Cool serenity 10 = Seething, white anger
Ineptitude	How much of this medhap was caused by the doctor's incompetency and negligence?	0 = Not really the doctor's fault 10 = Should never be a doctor
Shock	How shocked/surprised were you after reading this story?	0 = Hear about it all the time 10 = O..M..G...
Ethics	Or rather, the lack thereof - How much did the doctor breach the code of ethics?	0 = No breach in ethics 10 = Criminal

The final Score is an average of the 5 metrics. The higher the score, the worse the case.

Response by Marc

Although this sounds like an honest mistake to me, I’d have to agree that when it comes to a possible heart attack, a bit more vigilance needs to be taken. I did a quick look-up of GI cocktail since I wasn’t quite sure what was in it and right there it says, “cardiac pain may sometimes be relieved with a GI Cocktail, and this may give a false sense of security to the treating clinician.” Given the lab results and EKG findings, Dr. Edwards shouldn’t have missed this one. Not much more to say other than “be more careful.” Oh, and don’t leave the hospital until you are satisfied with all the workup if you think you may have a heart attack and the doctor says all you have is the stomach flu.

Marc's DAISE Score - What is this?

Score
6

Damage	Anger	Ineptitude	Shock	Ethics
10	4	8	5	3

The DAISE Score

The DAISE (Day-see) Score is comprised of 5 metrics. Each component measures different aspects of the case to determine it's severity. This is done so different cases can be compared and contrasted, along with bringing attention to the many aspects of the stories.

Damage	The amount of damage caused by the perpetrator(s) in the story. This typically will include the patient and family, but sometimes it may include other factors as well, such as the environment, society, etc.	0 = No actual damage 10 = Heaviest damage
Anger	The amount of anger and animosity you feel toward the doctor(s) while reading the story.	0 = Cool serenity 10 = Seething, white anger
Ineptitude	How much of this medhap was caused by the doctor's incompetency and negligence?	0 = Not really the doctor's fault 10 = Should never be a doctor
Shock	How shocked/surprised were you after reading this story?	0 = Hear about it all the time 10 = O..M..G...
Ethics	Or rather, the lack thereof - How much did the doctor breach the code of ethics?	0 = No breach in ethics 10 = Criminal

The final Score is an average of the 5 metrics. The higher the score, the worse the case.

Tags: Featured, Public Reprimand