Virginia Lawyers Weekly//January 11, 2021
Virginia Lawyers Weekly//January 11, 2021//
Injuries alleged: Stroke
Tried before: Mediation
Name of judge or mediator: Hon. Michael Allen (Ret.)
Date resolved: 5/29/2020
Special damages: Past medical expenses – $85,000; life care plan – $748,000
Verdict or settlement: Settlement
Attorney(s) for plaintiff (and city): Charles J. Zauzig III and Melissa G. Ray, Woodbridge
Description of Case: Plaintiff was a patient of the defendant primary care physician for approximately 20 years. By 2014, plaintiff, who was now in his 60s, consistently had elevated blood pressure. Plaintiff’s hypertension went untreated for 3+ years as the defendant never diagnosed plaintiff with hypertension and never treated him for hypertension.
On Jan, 25, 2017, plaintiff was seen by a gastroenterologist for a consult. During that visit the gastroenterologist noted plaintiff had a critical blood pressure elevation of 203/87. The gastroenterologist’s office placed a call to defendants’ office alerting them to plaintiff’s high blood pressure and advised them she had instructed the patient to proceed to their office for evaluation.
Upon departing the gastroenterologist’s office, plaintiff proceeded, as instructed, to the office of the defendant which was in the same building. A nurse in the defendant’s office recorded plaintiff’s blood pressure at that time as 198/84. The nurse documented in the chart that she notified the defendant of the plaintiff’s blood pressure and that the defendant recommend the plaintiff go home, “take his blood pressure at home daily and then follow-up in one week for a nurse visit and bring his blood pressure readings and cuff with him.” The defendant did not evaluate the plaintiff prior to sending him home.
Plaintiff’s medical history and risk factors for both coronary artery disease and cerebrovascular disease, included obesity, obstructive sleep apnea, uncontrolled hypertension, and hyperlipidemia, sedentary lifestyle, poor diet and chronic stress.
Plaintiff monitored his blood pressure at home as instructed and the systolic readings remained in the 190s-200s. Plaintiff was not instructed by the defendant to contact his office or go to the hospital if his blood pressure remained elevated at home. On the afternoon of Feb. 4, 2017, plaintiff was transported to the emergency room and was discovered to be neurologically impaired and code stroke was initiated. Initial vital signs demonstrated a blood pressure of 206/92. Neurology diagnosed plaintiff with an acute ischemic stroke resulting in right hemiparesis and near mute aphasia of less than three hours and ordered administration of tPA. Plaintiff was admitted to CCU for acute CVA and post-tPA care. A brain MRI performed on Feb. 5, 2017, confirmed left thalamic infarct involving the left midbrain and left thalamus. Plaintiff gradually improved for discharge to a rehabilitation hospital for eight days of intensive inpatient rehabilitation.
Plaintiff continues to suffer from permanent neurologic impairment as a result of the stroke he suffered due to uncontrolled hypertension. He experiences dizziness, lightheadedness, numbness, loss of sensation, slurred speech, diminution in memory, and impaired strength, gait and coordination.
Plaintiff’s experts alleged two violations of the standard of care. The first is that in patients over 60 with systolic pressures persistently at or above 150 mm Hg, medical management which includes blood pressure medication is mandated and the defendant failed to order medication management for plaintiff. The second is that on Jan. 25, 2017, plaintiff’s acute extremely high blood pressure required immediate treatment with medication and the defendant instead sent plaintiff home.
The defendants argued that plaintiff did not meet the definition of persistent hypertension and did not require medical management, and instead that his elevated blood pressures at office visits were related to “white coat syndrome.” Defendants also argued plaintiff’s stroke was caused by his co-morbidities and not by hypertension.