In May 2011, an Illinois medical malpractice jury returned its verdict in favor of the medical malpractice plaintiff in the amount of $3,767,792. However, the trial judge granted the defendants’ post-trial motion and vacated the jury’s verdict in September 2011. The second trial commenced on March 20, 2012, and resulted in a defense verdict. The unsuccessful plaintiff appealed.
The Underlying Factual Allegations
On May 15, 2001, a man was at work in Chicago Heights, Illinois when he began to experience severe pain (the parties fiercely disputed whether the pain was initially in the man’s chest or abdomen). A co-worker observed the man pacing back and forth in the loading dock area, sweating profusely, pounding his chest, and stating that he was dizzy and nauseous. The man complained of a sharp, stabbing pain that he had never felt before, moving between his chest, back and abdomen.
An ambulance was called and the paramedics noted that the man was complaining of stomach pain, that he was sweating, and that his skin was pale and cold to the touch. The paramedics hooked him up to a cardiac monitor and the readings were reported as normal; the man’s blood pressure was also reported as normal. He was transported to a local hospital emergency room, where he described his pain as an 11 on a scale of 1 to 10. An emergency room physician (one of the medical malpractice defendants) examined him and described the man’s complaint as abdominal pain over the epigastric area, without nausea, chest pain, or vomiting.
The emergency room triage nurse wrote in her notes that the man told her that he began having abdominal pain and cramping after he had eaten chicken for lunch, that he did not mention chest pain or shortness of breath, that his vital signs were normal, and that he was alert and oriented. She also noted that the man’s skin color was normal and his skin temperature was warm.
Another emergency room nurse noted that the man was given a “GI cocktail” for complaints of abdominal pain, after which he vomited a small amount and then felt better.
Within a few hours, the man’s pain subsided and he was discharged from the emergency room, with instructions to follow up with his primary care physician the following day.
On May 21, 2001, the man was found dead in his mother’s apartment. An autopsy found an aortic dissection that caused pericardial tamponade (when the blood goes into the pericardium and occupies space in the lining around the heart), which was determined to be the cause of death.
The man’s mother filed a medical malpractice lawsuit on behalf of her son’s estate, alleging that the emergency room physician and his employer were negligent in failing to diagnose the man’s aortic dissection in the emergency room, which led to the man’s death.
The Man’s Aortic Dissection
The man had a type A aortic dissection (involving the ascending aorta). The aorta is made up of three layers. An aortic dissection generally begins as a small tear in the inner layer of the aorta that may be repaired in some cases to prevent the blood from entering the pericardium; however, in cases where blood enters through the tear and advances through the second layer, the aorta can be dissected. Pericardial tamponade is the most common cause of death following an aortic dissection, where the pressure around the heart prevents the heart from beating (the condition is usually fatal).
Symptoms of an aortic dissection typically include a sharp stabbing or ripping pain in the chest with the pain then migrating to the back or abdomen. Other symptoms may include dizziness, nausea, and profuse sweating. In type A dissections, the symptoms can stabilize and abate completely for a period of time, according to the plaintiff’s experts.
Aortic dissection is a rare condition that is most commonly seen in people over 60, or in people over 50 who have chronic hypertension; it is seen in younger people typically only if they have a connective tissue disorder or a specific risk factor for the disease. The man in this case was only 35; however, an x-ray taken in the emergency room showed that he had cardiomegaly (an enlarged heart), which is typically caused by chronic high blood pressure.
The defense experts provided testimony that the man’s aortic dissection was not present during the emergency room visit and that the emergency room physician had met the standard of care in treating the man.
The second medical malpractice jury found in favor of the defendants, which was appealed by the medical malpractice plaintiff but affirmed by a split-decision of the appellate court on April 16, 2014.
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