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ARTICLE ID 195808

$________ – MEDICAL MALPRACTICE NEGLIGENCE – EMERGENCY DEPARTMENT NEGLIGENCE – FAILURE OF EMERGENCY ROOM PHYSICIAN TO CALL "STROKE CODE" WHEN PLAINTIFF PRESENTS WITH SIGNS AND SYMPTOMS – DEFENDANT EMERGENCY ROOM PHYSICIAN, FURTHER COMPROMISING PATIENT CONSISTENT WITH POSTERIOR CIRCULATION STROKE.

Hudson County, NJ

This was a medical malpractice action involving a plaintiff, then approximately 50 years old, in which the plaintiff contended that when he was brought to the ER approximately one hour after awaking in the early morning hours with tingling in one arm and one side of the face, as well as the very recent onset of nausea, vomiting, and headache – the defendant ER physician negligently failed to consider the possibility of a stroke, and call a stroke code. The stroke code would have set in motion procedures directed at rapidly diagnosing a stroke, such as emergent CT scanning, lab work, and consultation with neurology before the institution of TPA – which must be administered within three hours of the onset of signs and symptoms of a stroke. The plaintiff also contended that the defendant ER physician – who attempted to intubate the patient shortly after first examining him when respiratory compromise set in – did so in a negligent manner, resulting in the plaintiff’s oxygen levels being compromised for some 16 minutes, heightening the permanent neurological deficits. The plaintiff maintained that he has sustained cognitive injuries, and has essentially lost the use of his right arm and leg. The plaintiff, who had been employed the machinery field by G.E., in a position in which he traveled extensively setting up systems, contended that he has been rendered permanently unemployable. The plaintiff had initially named the triage nurse, contending that he should have immediately recognized the need to set the stroke procedures in motion. The triage nurse saw the patient seven to eight minutes before the physician who had the patient for the balance of the emergency room treatment thereafter. The plaintiff withdrew his claim against the triage nurse at the time of trial. The defendant denied that the ER physician should have reasonably considered that the plaintiff was suffering a stroke, establishing that he did not exhibit the classic signs of a stroke, such as arm weakness, a facial droop, or slurred speech. The plaintiff countered that such signs are typical with the more common anterior circulation infarctions, and that the signs and symptoms with which the plaintiff presented, could well be indicative of a posterior cerebral stroke, which the plaintiff maintained accounts for approximately 25% of strokes.

The plaintiff introduced evidence that he had awoken with his symptoms at approximately 3:00 a.m., after going to sleep on his boat around 2:00 a.m. He arrived at the ER at approximately 3:45 a.m. The plaintiff became unresponsive in triage shortly after arriving at the hospital, and was then seen by the defendant ER physician who identified respiratory compromise and attempted to intubate the patient. The plaintiff maintained that the defendant had great difficulties, failed to implement proper intubation techniques, and should have asked anesthesia residents to assist him. The intubation procedure took some 16 minutes to complete, during which time the plaintiff was not properly oxygenated. The plaintiff established that during this period, the oxygen saturation levels dropped from a normal level in the mid-90s to critically low levels in the 20s. The plaintiff maintained that this deprivation significantly heightened his ultimate deficit. The plaintiff argued that, even if the defendant’s position that TPA had a significantly less than a 30% chance of being effective was accepted, it was clear that the added factor of the compromise of the airway deprived the plaintiff of at least a 30% chance of either a full or near full recovery that he would have had if proper care had been provided. The stroke was diagnosed later in the morning; several hours after the plaintiff arrived at the hospital and long after the opportunity for treatment with TPA had passed. The plaintiff contended that his extensive deficits are permanent. He sustained a permanent visual impairment, a moderate cognitive deficit and difficulties ambulating, including limited use of his right arm and hand. The plaintiff, who now resides with his sister, contended that he cannot live alone and will incur extensive future costs. He will require therapies, medication, physician visits, as well as home care and modifications of the home. The plaintiff introduced evidence of economic loss, including income loss and costs of care, of $________. The case settled prior to trial for the defendant ER physician’s policy limit of $________.

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