Medical Malpractice: This doctor made a mistake, do you think he is guilty?

This is the review of an interesting medico-legal case from New Brunswick and my personal take-away.

GG was a middle-aged diabetic man who also smoked. In his personal life, he was a nice and hard working man. In November 2012, he had a severe bout of chest pain that he described as burning going up his chest and down his left arm. It happened a few times, waxing and waning over 4 days. He consulted an emergency room in New Brunswick where he met Dr. S. GG had normal vital signs, Dr. S had an EKG done that was normal. He also had blood test done–everything was normal including his troponins. He got a diagnosis of gastritis and got prescribed some Zantac. Dr. S told him that if it ever happened again, he should go see his family doctor. Surprise surprise, it happened again. He went to see his family doctor who asked for an outpatient cardiology consult and changed the zantac to something stronger. It happened a few more times with GG thinking it was gastritis. 28 days after his emergency room visit, he suddenly died of a heart attack.

GG’s girlfriend contented that the doctor was negligent and he missed a heart attack and by telling the patient to go to his family doctor if it recurred, he did not consult the emergency room again when it did recur. In retrospect, he was clearly having unstable angina that cumulated to a heart attack. Reading the court documents about this case is interesting because the lawyer spent so much time debating whether if he had a second troponin on his initial consultation, the outcome would have been different. Reading back, spending all their time discussing this seems like a wasted opportunity from the plaintiff’s lawyer’s point of view. I doubt repeating a normal test after 4 days of pain is going to reveal all of a sudden an underlying disease hitherto hidden. Anyhow, you do not expect positive troponins in unstable angina and that does not make it any less of a dangerous disease. The doctor won his case in the end because the plaintiff just couldn’t prove the second troponin would have made a difference.

My personal take ways: First, be really really scared that your diabetic, smoker patient may have heart disease, as he probably does… The second take away, when someone leaves, you told him to go back to the Emerge if things do not work out. You do not tell them that he does not have heart disease and to do a follow-up with their family doctor, because if they do, his life may be on the line…

The decision in its entirety is available on CanLii if you wish to peruse it. As always, this is not medical or legal advice, please see your doctor/lawyer for those.

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