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ARTICLE ID 29036

- MEDICAL MALPRACTICE - FAMILY PRACTITIONER NEGLIGENTLY PRESCRIBES ALLEGEDLY CONTRAINDICATED ALLEGRA-D TO PATIENT WITH HISTORY OF HYPERTENSION - ALLEGEDLY CAUSALLY RELATED MYOCARDIAL INFARCT - FURTHER MEDICAL MALPRACTICE ALLEGED AGAINST DEFENDANT FOR FAILING TO TIMELY DIAGNOSE MYOCARDIAL INFARCT.

San Diego County, California

The plaintiff in this action was a 47-year-old male site manager for a car dealership who suffered a myocardial infarction as an alleged result of the negligent medical treatment received by the plaintiff at the hands of the defendant family practitioner. The plaintiff contended that the defendant family practitioner was negligent in several respects relative to his care and treatment of the plaintiff. Specifically, the plaintiff contended that the defendant family practitioner prescribed allergy medication which was contraindicated for the plaintiff due to his medical history, and that the defendant’s negligence in this regard caused or contributed substantially to the plaintiff suffering the myocardial infarct. The plaintiff additionally alleged that the defendant negligently failed to timely diagnose and treat the plaintiff’s cardiac emergency, causing the plaintiff to sustain greater damage to his heart. The defendant physician denied negligence in his care of the plaintiff. The defendant asserted that Allegra-D was not contraindicated for this patient and that he acted appropriately in subsequently prescribing beta-blockers when the plaintiff presented with the sole complaint of a rapid heart rate.

The plaintiff was seen for the first time by the defendant family practitioner on October 25, ________, when he presented with complaints of chronic back pain. A prescription for hypertension medication was refilled at the plaintiff’s request, at the same time the defendant prescribed medication for the plaintiff’s low back problem. The refilling of the hypertension medication was not noted in the chart. The plaintiff returned on December 15, ________, complaining of ear and nose congestion and general discomfort. The plaintiff also had a history of chronic ear and sinus problems and was diagnosed on December 15, ________, with bilateral otitis media and rhinitis. The plaintiff was prescribed an antibiotic, given an injection of Kelog and was also given samples of Allegra-D. The Allegra-D dosage was ________ mg., one every 12 hours.

The plaintiff’s evidence established that he had telephoned the defendant physician’s office at about 9:00 a.m. on the morning of December 16th, and advised the defendant’s on-duty staff that he was experiencing a "Charlie Horse" type sensation in his chest and numbness in his arm. The plaintiff alleged that in response, he was advised only to stop taking the Allegra-D and to drink lots of water. He was not told to come in for an examination.

On December 17th, the plaintiff placed another telephone call to the HMO’s office and talked to someone from the defendant’s staff. The plaintiff claimed that he again related that he p 7 3 experiencing radiating numbness, feelings of a "Charlie Horse" type sensation in his chest and palpitations. The plaintiff contended that he was advised to take a beta-blocker at that time and was not told to come into the office or report to a local emergency room.

The medical records as well as other evidence indicated that the plaintiff suffered the myocardial infarction on the morning of December 16th, somewhere between 6:30 a.m. and 7:30 a.m. The plaintiff contended that the myocardial infarction was directly attributable to the negligence of the defendant HMO’s medical caregiver in prescribing allegedly contraindicated Allegra-D. The plaintiff further alleged that the defendant’s staff failed to timely and properly respond to his telephone calls on the 16th and 17th of December, and that further damage was caused by the instruction to the plaintiff on the 17th to take a beta blocker to address his ongoing complaints of rapid heart rate.

The plaintiff presented expert testimony on the standard of care from a board certified family practitioner. The plaintiff’s expert maintained that Allegra-D was contraindicated for this patient due to his history of hypertension and that it was the defendant’s prescribing of this medication that proximately caused the plaintiff’s myocardial infarction The plaintiff’s expert additionally opined that assuming the facts as related by the plaintiff regarding the symptoms expressed to the triage person manning the defendant’s phone on the 16th and 17th of December, the defendants deviated from the standard of care in failing to properly respond to classic symptoms of a myocardial infarction in a timely manner.

The plaintiff’s expert further maintained that the plaintiff’s physical damages would have been considerably reduced had he received timely treatment within the optimal several hour period following a heart attack (this expert specifically noted that the optimal time for minimizing heart-muscle injury requires a patient to obtain treatment within three to six hours post- infarct). Assuming the myocardial infarction occurred on December 16th, the plaintiff was deprived of valuable time within which necessary treatment could well have made a difference in the heart muscle damage sustained, according to the plaintiff’s experts.

The defendant denied that Allegra-D was contraindicated for this patient. In fact, the Allegra-D at ________ mg. per capsule would have given the plaintiff a total of ________ mg. in a 24-hour period, which is the same exact amount that the plaintiff would have received had he bought over-the-counter Sudafed. On the plaintiff’s initial patient history form, which he filled out on October 25th, he failed to note any history of hypertension and failed to list any hypertension medications. He stated on this patient history form that over-the-counter Sudafed was the only medication he had ingested in the recent past. Sudafed is equivalent to the D component in Allegra-D.

Further, the defendant maintained that the plaintiff’s hypertension was under control and that the Sudafed component in Allegra-D was not contraindicated. The defense noted that there has been no reported incident of Sudafed causing a myocardial infarction, only a rapid heart rate. p 7 3 The defendant asserted that the plaintiff telephoned the defendant’s office in the afternoon of December 16th, not in the morning as the plaintiff alleged. The defense further maintained that during that call, the plaintiff advised only that he was experiencing symptoms of rapid heart rate. The defendant maintained that the symptoms of "Charlie Horse" sensation in the chest and numbness of the arm were never mentioned on either December 16th or 17th. The defendant on-call physician reported that he took the call from the plaintiff on December 17th, during which conversation the plaintiff again complained solely of suffering the sensation of a rapid heart rate. This physician prescribed the beta-blocker, which the defense expert alleged was appropriate for this patient’s described symptoms.

The plaintiff claimed that as a result of the defendant’s negligent failure to timely address his symptoms of heart attack, the plaintiff suffered more significant damage to his heart muscle than otherwise would have occurred with timely treatment.

The plaintiff claimed economic damages of $________ out-of-pocket past medicals, future medicals of approximately $________ and past and future lost earnings of $________. The plaintiff claimed pain and suffering of $________ (California statutory cap on non- economic damages in medical mal cases). The plaintiff wife claimed damages for loss of consortium in the amount of $________.

The plaintiff made no settlement demand and the defendant tendered an offer to waive costs in return for plaintiff dismissing the case. Counsel for plaintiff asked the jury to award $________. The jury found for the defendant.

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