Virginia Lawyers Weekly//October 21, 2019
Virginia Lawyers Weekly//October 21, 2019//
The patient presented to the emergency department with a two-day history of bilateral frontal headache and described the pain as a “10” with throbbing and ever presence. She stated that it felt like her head was in a vice. She had vomited three times. She reported milder headaches in the past and had prior ED visits, including a CT scan which was negative. Her current headache was worse than in the past. Her blood pressure was 211/87 and later 199/84. She was administered Reglan, Benadryl and Ativan. She was diagnosed with acute headache and vomiting. She was discharged with the primary impression of tension headache. She was prescribed Motrin, Fioricet and Phenergen.
She returned four days later to the ED due to persistence of headache. A different ED doctor saw her and was prepared to discharge her a second time with instructions to follow up with her primary care doctor for ongoing headaches and hypertension. Prior to discharge, the patient fell to the floor. CT imaging revealed an acute intracerebral bleed with subarachnoid and intraventricular bleeding. Arrangements were made to transfer her to a better equipped facility. A CT/CTA of the head revealed a rupture of an aneurysm of the anterior communicating artery. There was concern for significant vasospasm. Subsequently, the patient underwent a coil embolization of the ruptured aneurysm. Imaging in the form of an MRI was performed which revealed a large area of acute infarction within the bilateral parasagittal frontal lobes in the distribution of the anterior cerebral arteries. Despite extensive treatment, the patient was assessed with some cognitive disabilities due to stroke as well as left spastic hemiparesis.
Plaintiff’s experts contended that the ED defendants breached the standard of care during the patient’s first visit to the ED by failing to order appropriate imaging in the form of a CT or CT angiogram following the patient’s complaint of severe pain (10), her feeling that her head was in a vice and a worse headache than in the past. They further breached the standard of care by failing to order a neurological or neurosurgical consult for the patient.
The defense contended that there was an insufficient clinical basis to justify the ordering of CT imaging or a referral to a neurological specialist as complaints of headache in this patient were common and more was needed to justify further investigation than that presented by the patient. There was also a causation defense to the effect that earlier intervention would not have made a difference since the damage here was caused by vasospasm and vasospasm can and does occur despite earlier intervention.
The patient had some previous alcohol abuse issues and some co-morbidities in addition to her previous history of headaches.
A negotiated settlement was reached in the amount of $700,000 shortly before the trial date.
Type of action: Medical Malpractice
Injuries alleged: Failure to order appropriate imaging and failure to seek neurological consult in response to patient’s complaints of severe headache resulting in a patient suffering ruptured aneurysm, cognitive deficits and permanent physically-disabling sequelae.
Verdict or settlement: Settlement
Attorneys for plaintiff: William E. Artz and Thomas M. Wochok, Tysons Corner