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Plaintiff claims emergency physicians failed to diagnose stroke – Defense Verdict

The plaintiff was a 31-year-old female who presented to the emergency department via EMS with complaints of severe headache, visual loss, dizziness and nausea/vomiting. She reported to the EMS personnel and the ED providers that she had experienced similar symptoms the week prior, consistent with a history of migraine headaches. The treating nurse practitioner in the ED reviewed the electronic medical record and determined that the patient had been seen two weeks prior with complaints of vision loss. During the previous visit, her head CT was read as normal and she was instructed to follow up with a neurologist (which she failed to do).

The nurse practitioner evaluated the patient and ordered anti-nausea medication and pain medicine. The patient’s headache and nausea/vomiting quickly improved, although her dizziness persisted. Given the continuing symptoms, the nurse practitioner consulted with the attending ED physician and the decision was made to consult with neurology. The on-call neurologist was paged and the nurse practitioner inquired as to whether any further imaging was needed in light of the patient’s complaints and her recent history, including the negative CT. The neurologist reviewed the patient’s chart and imaging, and indicated that he felt the patient was able to be discharged for outpatient follow-up in his office. Prior to discharge the patient’s dizziness and visual problems continued to improve.

The following day, the patient presented to a different facility with complaints of headache, nausea/vomiting and dizziness. She was given a CT, which showed that she had suffered numerous acute strokes due to a spontaneous vertebral artery dissection.

Plaintiff’s neurology expert testified that the plaintiff was a candidate for tissue plasminogen activator (tPA) in the ED, and that if she had been given tPA timely, she would have recovered to her pre-stroke abilities. The examination by plaintiff’s physical medicine and rehab expert found her to have significant gait issues as well as some memory deficits. Plaintiff’s ED physician expert testified that the defendants should have made the neurologist examine the patient in person or obtained an in-person consult from another neurologist. Plaintiff’s standard of care physician and nurse practitioner testified that the examination in the ED by the defendants was lacking in that it did not include gait analysis and/or visual examination.

The defendants’ ED physician experts testified that the examination performed in the ED was appropriate and that the defendants appropriately relied on the advice of the consulting specialist. The plaintiff had atypical stroke symptoms and improved during the course of her stay. The defendants’ nurse practitioner expert explained that the examination done was appropriate and that the plaintiff was not a stroke alert patient. The defense experts also opined that she was not a candidate for tPA at any time, and that even if she had been administered tPA, her outcome would not have been any better. Physical therapy records indicated that the plaintiff had greatly improved post-discharge from the hospital, but failed to continue with physical therapy, which caused a decline in her condition.

After a five-day jury trial, the jury returned a verdict for the defendants and their practice.


Type of action: Medical malpractice
Injuries alleged: Failure to treat an acute stroke in the emergency department
Name of case: Wilson v. Emergency Physicians of Tidewater, et al.
Court: Suffolk Circuit Court
Case no.: CL13-658
Tried before: Jury
Judge: Carl Eason Jr.
Date resolved: Aug. 8, 2014
Demand: $6,000,000 (complaint)
Offer: None
Verdict or settlement: Defense verdict
Attorneys for defendant: A. William Charters and Lindsy M. Roberts, Norfolk
Attorney for plaintiff: Ken Wills, Norfolk
Defendant’s experts: Todd J. Crocco, M.D., emergency medicine; William Brady, M.D., emergency medicine; Colleen Andreoni, PhD, NP-C, nurse practitioner; Owen Samuels, M.D., neurology
Plaintiff’s experts: Richard Serra, M.D., emergency medicine; Derek Riebau, M.D., neurology; Thomas Watanabe, M.D., physical medicine and rehabilitation); Constance Gilman, NP-C, nurse practitioner
Insurance carrier: MAG Mutual


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