Woman died after delay in identifying brain aneurysm — $900,000 settlement

Type of action: Medical malpractice

Injuries alleged: Wrongful death

Verdict or settlement: Settlement

Amount: $900,000

Attorney for plaintiff (and city): William E. Artz and Thomas M. Wochok, McLean

Description of case: Plaintiff’s decedent was a 39-year-old mother of two who presented to her primary care physician with a complaint of headache at the back of her head down her neck for approximately one week. She noted also pain in her eye. She reported night sweats that woke her up. Her blood pressure was elevated. She was prescribed medication and released. An MRI was ordered for her. She was told to return if symptoms persisted or go to the emergency department.

The next day, the decedent called her family practice group stating that she had been in the office yesterday and the medication was not helping her. She was instructed to go to the ED. She presented with sharp, squeezing bilateral headache, nausea, vomiting and back pain. She also reported that she had seen her PMD yesterday and was given medication which did not alleviate her headache. She also reported that she was scheduled for an MRI. In triage her BP was elevated. While in the ED they administered morphine, decadron, Benadryl, labetalol and metoclopramide. Lab work was ordered. She was discharged home with the diagnosis of tension headache and essential hypertension and instructed to follow up with her PCP in two days and if symptoms worsened to follow up with the ED.

The decedent called her PCP practice a few days later with complaints of nausea and vomiting. She was instructed to get the MRI done and follow up. The MRI was performed and was read to be normal. She followed up with her PCP.

Later that evening, she presented to the ED with headache, nausea and vomiting. It was also noted that she had been in the ED several days before with the same complaints. A 10 was recorded on the pain assessment scale and she reported photophobia. She was discharged with prescriptions for several medications. Diagnoses were nonintractable migraine, unspecified migraine type.

A few days later, she returned to her PCP due to continuing headache. She reported having nausea prior to the headache and the headache had been persistent the past two days. She was experiencing nausea and vomiting which kept her from taking any of her medications. Her PCP noted that her recent MRI was normal. The impression was migraine or migraine equivalent. She was started on Fioricet as needed. She was given Toradol and a phenergan injection while in the clinic. She was counseled on lifestyle changes to help avoid headaches. She was advised to call if symptoms worsened or were not better.

The decedent was subsequently brought to the ED by rescue squad after she collapsed at home. On arrival she was described as alert but not responsive to commands. She was moving all four extremities without difficulty and withdrew to painful stimuli. She continued to have multiple episodes of emesis and was intubated to protect her airway. A head CT was performed. The imaging showed an acute subarachnoid hemorrhage. There was also an acute right subdural hematoma. The bleeds resulted from an aneurysm which had ruptured. Both led to the development of vasospasm and the death of the patient.

Breaches were alleged against both the PCP and ED doctors on grounds that the standard of care required a prompt CT and, if negative, a lumbar puncture and/or a CTA to assess the vascular structures as a potential cause of headache. A CTA would have disclosed an aneurysm which would have been treated by coiling or clipping thereby preventing a massive rupture and death. The defense argued that the MRI was an adequate study and was read to be normal. The defense maintained that there was no sentinel or small bleed seen on the MRI. Therefore, there was no standard of care requirement to look for an aneurysm. Eleven days after the MRI was read, the aneurysm, suddenly and without warning, ruptured. The defense contended there was no negligence on the part of the providers.

The surviving spouse remarried 10 months later to preserve the family structure for his two minor children. The defense contended that the effect of the remarriage dissipated the surviving spouse’s claim for solace.

The case was submitted to mediation which was unsuccessful but the case settled close to the trial date.

Thomas Wochok, counsel for the plaintiff, provided case information.