The State of Michigan Court of Appeals (“Michigan Appellate Court”), in an unpublished opinion dated October 22, 2019, reversed summary judgment that had been granted by the trial court to the defendant cardiologist in a Michigan medical malpractice wrongful death lawsuit involving a 57-year-old man.
The Underlying Facts
On July 21, 2013, 57-year-old Edward suffered a heart attack and the next day he had an implantable cardioverter defibrillator (ICD) implanted with a lead placed in the right ventricle of his heart to help his heart to function properly. There is no allegation of any negligence regarding the implantation procedure itself. ICD installment carries a known risk that the wire lead inserted in the ventricle may migrate and cause perforation of tissue and effusion of fluid which may collect in the pericardial sac surrounding the heart.
The hospital admitted Edward on August 2, 2013, when he presented complaining of chest pain and shortness of breath. Defendant Dr. Akhtar served as the consulting cardiologist during his hospital stay from August 2 through August 4, 2013. About a week after his discharge from the hospital, Edward went to his primary physician’s office because of shortness of breath, chest pain, and pain while breathing. He received treatment from defendant physician assistant Radewahn. A few days later Radewahn called Edward to follow up and noted in his medical records that he was “doing well.”
Edward continued to have problems but he did not seek further treatment. Edward died on August 18, 2013. An autopsy revealed that he died from cardiac tamponade, the compression of the heart from an accumulation of fluid within the pericardial sac.
The plaintiff estate alleged that the defendants failed to take appropriate medical actions despite Edward’s complaints of chest pain and shortness of breath, and despite the fact that a computed tomography angiogram (CTA) performed on Edward during a hospital stay the first week of August 2013 showed mild pericardial effusion, or fluid around the heart. The plaintiff alleged that an ICD lead moved causing symptoms, and his treaters should have detected and repositioned the lead before it led to Edward’s death.
The trial court concluded that the plaintiff failed to present sufficient evidence that the defendants could have detected the issue and taken appropriate preventive actions before Edward’s death on August 18. The trial court opined that the evidence conclusively established that the perforation and the bleeding around Edward’s heart occurred shortly before his death, not on or before the dates of the pertinent treatments by the defendants which commenced on August 2, 2013.
Michigan Appellate Court Opinion
The plaintiff’s cardiology expert testified that Edward had symptoms of an ICD lead perforation including pleuritic chest pain, shortness of breath, and a pericardial effusion as shown by the CTA performed during his August hospital stay. He opined that a lead had, at that point, begun the process of perforating out of Edward’s right ventricle and that when “more lead came out at the end . . . that was associated with sufficient acute bleeding to cause the hemodynamic catastrophe of tamponade.” He pointed out that the images from the CTA that Edward underwent had areas of brightness that prevented one from seeing whether any perforation had occurred.
The plaintiff’s expert further testified: “It is my opinion that according to the standard of care, [Dr. Akhtar] would have needed to get an [echocardiogram] and interrogated the [ICD]. And further, it is my opinion that had those things been done, the diagnosis of ICD lead perforation, a known complication of this type of surgery, would have been made when the patient had a small pericardial effusion, another operation would have been done, the lead would have been moved back and repositioned, and the progressive pericardial effusion that ultimately led to tamponade would not have happened.”
The Michigan Appellate Court held: “Given the expert testimony presented, plaintiff adequately raised a genuine issue of material fact regarding whether Dr. Akhtar violated the applicable standard of care and whether this violation resulted in Edward’s death … We conclude that, when viewed in the light most favorable to plaintiff, the evidence presented by plaintiff in this case established a genuine issue of material fact regarding medical malpractice by Dr. Akhtar. The record establishes that Dr. Schneller [plaintiff’s expert] based his expert opinions on record evidence and the conflict between the parties’ experts regarding the facts underpinning their opinions should have been left to the fact-finder to decide. Accordingly, the trial court erred by granting Dr. Akhtar summary disposition.”
Source Estate of Edward Szekely v. Nikolai Kinachtchouk, M.D., COA 344377.
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