Woman had bad headache, later suffered aneurysm and died – Defense Verdict

Decedent presented to Lynchburg General Hospital’s emergency department on July 19, 2013, complaining of “one of the worst headaches” she had ever experienced. Decedent’s symptoms in­cluded a week-long head­ache unaffected by over-the-counter medication, dizziness upon standing, nausea, and vomiting. Decedent’s treating ER physician diagnosed tension headache and instructed decedent to follow-up with her pri­mary care physician. Two days later on Sunday July 21, decedent visited an immediate care clinic operated by defendant family practice group and was examined by defendant physician’s assistant. Decedent reported that her head­ache pain had initially improved following her prior visit to the emergency room but that it had returned on the morning of July 21. She described her pain as an 8 or 9 out of 10 as opposed to a 10/10 during her prior emergency room visit.

The defendant PA utilized differential di­agnosis and considered a number of causes for her headache, including the possibility of an intracranial bleed, and treated the dece­dent with an intramuscular injection of stan­dard headache medications. By the end of her visit, decedent reported her pain level had im­proved to a 5/10. Based on decedent’s improve­ment and presenting symptoms which includ­ed the patient’s report that it was “consistent with a tension headache” as documented in the treatment record, the defendant did not order a CT scan or MRI, instructed decedent to return home and rest, and instructed dece­dent to return to the emergency department if her headache worsened.

On July 29, eight days after her visit to the immediate care clinic, decedent’s family found her unresponsive and had her transported to the hospital by ambulance. A CT scan re­vealed blood in the lateral ventricle and an intraparenchymal hemorrhage in the middle deep left frontal lobe with some edema, and a midline shift of decedent’s brain. A sub­sequent CT scan revealed a cerebral artery aneurysm. Decedent was transferred to the University of Virginia Medical Center where she died on Aug. 3, 2013.

Plaintiff contended that the defendant failed to appreciate the significance of decedent’s negative history of tension or migraine headaches, and that decedent’s symptoms were indicative of a “thun­derclap” headache that was unrelenting. Plaintiff contended decedent’s symptoms required the defendant to order imaging studies and refer her for additional treat­ment and evaluation. Defendant countered that the symptoms were not indicative of an unrelenting “thunderclap” headache given decedent’s self-reported improvement, that it was not of immediate and rapid onset, and that it was not the worst headache of her life. Defendant also contended that plain­tiff failed to follow medical instructions when she did not go to the emergency room after her headaches worsened in the days after her treatment by defendant. Further, the evidence showed that decedent attempted to self-med­icate with Lortab, over-the-counter Sudafed (an amphetamine), and marijuana in the days after her treatment by the defendant PA which was admissible as evidence on her failure to mitigate damages when she did not return to the emergency room or seek any medical care if her headache worsened which had been clearly noted in the PA’s treatment note. The trial court agreed that the evidence was admissible on the mitiga­tion of damages defense and supported the jury instruction offered on that doctrine.

Plaintiff settled with the defendant hospi­tal before trial. After a five-day trial and af­ter deliberating for approximately two and a half hours, the jury returned a defense verdict for the defendant PA and his family practice group. Plaintiff has noted an appeal.

[16-T-087]

Type of action: Medical Malpractice
Injuries alleged: Plaintiff sustained malignant cerebral edema secondary to a brain aneurysm rupture resulting in death.
Name of case: Confidential
Court: Lynchburg City Circuit Court
Tried before: Jury
Name of judge: Hon. F. Patrick Yeatts
Date resolved: Feb. 26, 2016
Special damages: $222,763.78 in medical and funeral expenses and approximately $934,000 for future loss of services.
Demand: $5,000,000.00
Verdict or settlement: Defense Verdict
Amount: $0
Attorneys for defendant: Walter Peake III and Matthew Kelley, Roanoke
Defendant’s experts: John R. Merten, MD; Nicole V. Rice, MPA, PA-C
Plaintiff’s experts: David Shulmister, MD; Craig A. Baumgartner, PA-C
Insurance carrier: The Doctors Company