Thursday, April 11, 2013
I answered the questions below, which were submitted to me online during the months of March and April 2013.
$1.2 Million Dollar Settlement on Behalf of Estate of Bergen County Man Who Died When Multiple Defendants Failed to Diagnose Subacute Bacterial Endocarditis.
On May 27, 2007, the plaintiff died as a result of complications related to subacute bacterial endocarditis (SBE). Plaintiff’s spouse/executrix brought this action for negligence and wrongful death, which was settled on March 22, 2013 for $1.2 million.
The plaintiff presented to his primary care physician’s office with symptoms consistent with SBE throughout the month of March 2007. On March 15, 2007, a nurse practitioner at that office referred Greenberg for an echocardiogram at his cardiologist’s office to rule out a diagnosis of SBE after discovering a new heart murmur. Telephone records revealed that the nurse’s suspicion of endocarditis was conveyed to staff working at Cardiologist’s office, but this clinical suspicion was never conveyed to the cardiologist interpreting the echocardiogram or to the plaintiff’s primary cardiologist. As a result, the clinical indication for the echocardiogram was merely listed as “dizziness,” and no additional diagnostic studies or workup were performed when the March 20, 2007 transthoracic echocardiogram was reported within normal limits.
The nurse practitioner and the plaintiff’s primary care physician never obtained the report from the March 20, 2007 echocardiogram, but merely relied on conversation with the plaintiff to conclude that this study was negative. These medical providers were therefore unaware that the test was performed for the wrong clinical indications.
Although the plaintiff’s primary care physician referred him to an infectious disease specialist to rule out endocarditis, without examining the reports from the plaintiff’s blood cultures, that physician concluded that the plaintiff was not suffering from an infectious process. Discovery revealed that the infectious disease doctor was unaware of key facts related to the plaintiff’s presentation, however, including: (a) the identity of the specific organism found in the blood culture, (b) the fact that the nurse practitioner recently discovered a new heart murmur, or (c) that the plaintiff previously suffered a splenic infarct. Finally, the infectious disease specialist relied on the fact that the echocardiogram was “negative” without looking at the report from that study. He suggested that the plaintiff’s problems where rheumatologic in nature. As a result, a rheumatologist assumed the care of the plaintiff.
The cardiologist who interpreted the March 20, 2007 echocardiogram was initially named as a defendant, but subsequently dropped from the lawsuit. He testified that if he was aware that the March 20, 2007 echocardiogram he interpreted was performed to rule out endocarditis, he would have recommended further diagnostic workup in the form of a transesophageal echocardiogram, because that test is more apt to diagnose early stage endocarditis.
It was not until Greenberg developed a significant aortic insufficiency with large aortic vegetation, a myocardial and aortic root abscess with first degree heart block and mitral valve involvement, that some of the defendants revisited the issue of endocarditis. By that time, the plaintiff’s disease progressed to the point where even open heart surgery with appropriate antibiotic therapy could no longer save his life.
The settlement reached with defense counsel, consisted of $500,000 paid on behalf of the plaintiff’s primary care physicians, $500,000 paid on behalf of the defendant cardiologist and $200,000 paid on behalf of the infectious disease expert.
The case settled the week of March 25, 2012 after a court-held settlement conference and continuing negotiations thereafter.