Illinois cardiologist not held responsible for patient's death while waiting for angiogram
A judge in the Illinois 5th District Court of Appeals upheld a previous trial victory that cleared central Illinois cardiologist Amit Dande, MD, and Prairie Cardiovascular Consults LLP of alleged misdiagnosis of the severity of a patient's heart condition that led to his death prior to a scheduled angiogram.
In the opinion issued Feb. 20, Judge Mark Bovard upheld the lower court's decision in favor of the defendants.
The plaintiff, Cheryl Wilson, brought a wrongful death action claiming her husband Leslie Wilson died as a result of the cardiologist being negligent in his evaluation. The claim alleged Dande did not understand the severity of Wilson's heart condition and failed to intervene in a timely manner. But the jury in the case decided he was not negligent and followed the normal standard of care for a patient with stable ischemia.
On appeal, the plaintiff claimed that the trial court erred in allowing the defendants’ medical expert to testify about possible causes of the patient's death. There was debate among the medical experts in the trial because no one knew the actual cause of death, since no autopsy was performed. The plaintiff also said the court refused to admit into evidence Wilson's complete death certificate with the cause of death, and denied the plaintiff’s motion for a directed verdict on the allegation that the defendants failed to properly instruct the patient to restrict his physical activities while awaiting the heart catheterization procedure.
After reviewing the trial results, Bovard opted to let the lower court decision stand.
Details from the malpractice trial
On July 29, 2015, Dande met with the patient, reviewed the results of the stress test, and recommended an elective cardiac catheterization scheduled Aug. 11, 2015. On Aug. 3, Wilson went out to mow his family farm. His wife found him dead, slumped over the steering wheel of his tractor, which had run into a fence.
She later sued the defendants, claiming her husband's death was due to negligence. She claimed the defendants deviated from the standard of care in failing to appreciate the seriousness of the patient's cardiac condition, failed to timely and adequately perform appropriate diagnostic tests to assess and treat his condition, and failed to provide adequate instructions regarding restricting his physical activities.
During the trial, the defendants’ expert argued there were multiple possible causes of death. This focused on the patient's family history of heart disease, hypertension, high cholesterol and obesity. In September 2010 he suffered a stroke, and a scooter accident in December 2010 caused an intercranial hemorrhage and fractured fibula requiring surgical repair. A surgical related deep vein thrombosis (DVT) developed in February 2011. The patient also had the heterozygous factor V Leiden genetic mutation, which can cause abnormal clotting. He was diagnosed with chronic venous insufficiency in August 2011 and told it was possible he could develop blood clots in the future due to the condition. He was later diagnosed with chronic DVT in September 2011 and underwent a successful thrombectomy.
In July 2015, the patient was assessed because of shortness of breath upon exertion. He reported that he had a couple episodes of some visual field defects and occasionally slurred speech that lasted multiple days each time in between 2022 and 2015. A carotid ultrasound showed he had less than a 50% blockage of the right and left internal carotid arteries.
An exercise stress test was suggestive of myocardial ischemia. In testimony during the trial, Wilson did not report chest discomfort and demonstrated fairly good exercise tolerance for his age. The test was stopped because of shortness of breath and the horizontal ST depressions on the ECG, typical of ischemia. The patient scored a minus 4.7 on the Duke Treadmill Score, and a future cardiac events assessment indicated that his five-year life expectancy was 94%.
Wilson was referred to Dande for a cardiology consultation. Dande testified after considering the symptoms, family and medical history, and results of the stress test. He concluded Wilson needed a cardiac catheterization to determine whether there was a blockage of the coronary arteries. His staff scheduled the nonurgent procedure according to the next available opening on his schedule. Dande also recommended that Wilson have an echocardiogram prior to the procedure to make sure he did not have an enlarged heart, fluid around the organ, or a leaky valve.
There was no autopsy performed so no clear cause of death was known. During the trial, experts opined that death could have been caused by a heart attack, stroke, pulmonary embolism, aortic dissection or aortic aneurysm. The court found that the death certificate listed a cause of death being "sudden cardiac death." There was no information as to the qualifications of the coroner to offer such an opinion, so the court would not allow the document to be entered as evidence.
The plaintiff's medical expert was Jeffrey Breall, MD, PhD, a board-certified interventional cardiologist with Indiana University Health Cardiovascular. He reviewed the medical records and the depositions in the case. Breall opined that the results of the stress test suggested a severe blockage of the coronary arteries that required urgent attention. He testified that the progressive worsening of shortness of breath with everyday activities, together with known risk factors and the abnormal stress test, indicated the patient had unstable angina. He said it would have been reasonably prudent to perform a heart catheterization within 48 hours after the office visit, or refer the patient to another facility. Dande should have placed the patient on medication and instructed him to limit his usual activities until the procedure was done, he added.
But Edgar Carell, MD, a board-certified interventional cardiologist with UChicago Medicine AdventHealth Medical Group Heart and Vascular in the Chicago suburbs, who was the defendants’ medical expert, argued differently. He said there was no chest pain or indication that the patient required an urgent catheterization. A careful cardiologist would instruct a patient to be reasonable, to refrain from activities that made him feel poorly and, if the patient was feeling well, generally they could do what they wanted. In the end, the jury agreed with this assessment.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com