Amount of Settlement: 2,500,000.00
CASE SUMMARY:
Plaintiff's decedent, a 54 year old married mother of adult children, began experiencing difficulty breathing and chest pain while at work. She was taken by ambulance to the local emergency department where she had been seen on more than 19 occasions for episodes of asthma and asthma exacerbation. The symptoms of shortness of breath and chest pain she complained of were a common presentation for her asthma episodes. By the time she arrived at the emergency department, she was noted to be pain free. Serial enzymes were all negative. Auscultation of her lungs noted decreased breath sounds with expiratory wheezing. The emergency room physician noted that she was having another "acute asthma exacerbation." She received a nebulizer treatment with Albuterol while in the ED. The nurse practitioner attending to plaintiff's decedent in the ED ordered a cardiology consult and an exercise tolerance test (ETT) and the patient was admitted to the hospital. Overnight, she requested and received further Albuterol treatment for her asthma, and at 6:45 a.m., auscultation confirmed that she still had diminished breath sounds in all four lobes of her lungs and was experiencing expiratory wheezing. She had no other symptoms. A few hours later, she was seen by a cardiology nurse practitioner who noted her significant past history of asthma. However, this nurse practitioner (Defendant 1) changed the earlier order for an ETT to a pharmacological stress test using Adenosine, which was contraindicated in asthma patients such as the plaintiff's decedent. At her deposition, Defendant 1 testified that she had conferred with her supervising physician (Defendant 2), who concurred with her plan for the Adenosine test. Defendant 2 testified at his deposition that he had no memory of examining or evaluating plaintiff's decedent prior to her stress test, nor is there any indication in the medical record that he did so. Defendant 2 testified that if Defendant 1 testified that she had consulted with him prior to changing the stress test order, then he must have spoken with her and concurred with the change of the order. No request was made for a pulmonology consult, despite the fact that plaintiff's decedent's long-standing pulmonologist was on staff at the same hospital and there was no urgency to perform the stress test, given that her cardiac enzymes and EKG were normal and she had been without chest pain since the day before.
Several hours later, the Adenosine stress test was commenced. Immediately after the administration of the Adenosine, plaintiff's decedent became short of breath and suffered a respiratory/PEA arrest. A code was called for "respiratory failure," and Defendant 2 finally appeared to participate in plaintiff's decedent's care. As a result of the respiratory/PEA arrest, plaintiff's decedent suffered irreversible anoxic brain damage and subsequently died.
Plaintiff was prepared to present expert testimony at trial from a board certified cardiologist and a board certified pulmonologist who were expected to testify unequivocally that the ordering and administration of Adenosine for plaintiff's decedent, given her long history of severe asthma, her acute asthma exacerbation the day before, as well as her diminished breath sounds and expiratory wheezing noted only a few hours before the Adenosine infusion, constituted a grave and substantial departure from applicable standards of care by both defendants. Plaintiff's pulmonology expert was expected to testify that plaintiff's decedent was experiencing "active" asthma up until the time of the Adenosine infusion and, therefore, such infusion was clearly contraindicated. Defendants named both a cardiologist and a pulmonologist in the Pre-Trial Memorandum with expectations that they would testify in diametrical opposition to plaintiff's experts.
The case settled for $2,500,000.00 30 days before trial.
