Alcohol Withdrawal: Individualized Care and Pharmacologic Treatment

from May/June Issue of Clinical Advisor

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follow-up consultation. The plan was electronically signed by both Mr A and his supervising physician, Dr S.

Mr A told the patient that he had scheduled the cardiopulmonary stress test (in 3 weeks), after which they would meet again for a follow-up visit. The day before the stress test was scheduled, Mr P suffered a cardiac arrest and died in his home.

Mr P’s widow sought the advice of a plaintiff’s attorney. After reviewing Mr P’s medical records with medical experts, the attorney called Mrs P back and said she had a case. The lawsuit was filed against the medical practice.

Legal Background

The medical practice, including Mr A and Dr S, received notice of the lawsuit and consulted their defense attorney. The defense attorney, like the plaintiff’s attorney, sent the medical records out to be reviewed by experts.

The plaintiff’s experts alleged that Mr A, his supervising physician, and the practice had failed to meet the standard of care required in this case by failing to recognize and appreciate Mr P’s risk for sudden cardiac arrest. They noted that the PA had failed to recognize or understand that a single electrocardiogram is not reassuring for the lack of significant cardiac disease and risk for heart attack.

The defense experts also were critical after reviewing the medical records. They criticized the PA (and by extension his supervising physician and the practice) for not immediately referring Mr P to a cardiologist and/or the emergency department for further monitoring, evaluation, and treatment. They noted that the patient should have had immediate stress echocardiography, serial cardiac enzyme tests, and serial electrocardiograms, considering his presenting symptoms.

Mr A admitted that he was concerned it was a cardiac issue, which is why he ordered a stress test and a follow-up visit, but that he didn’t appreciate the urgent nature of the complaint.

After numerous discussions, the parties settled the case before trial for $3.5 million.

Protecting Yourself

One of the most challenging jobs of a clinician is recognizing when something should be treated as an emergency. Sometimes it is obvious — trauma, loss of consciousness, broken bones, or a heart attack in progress. Sometimes, however, it is less obvious.

When it comes to cardiac issues, it is better to err on the side of caution. In the case of an overweight, middleaged man with a history of hypertension and dyslipidemia who is complaining of shortness of breath, epigastric pain, and jaw pain, it would have been appropriate to refer the patient to a cardiologist or hospital for further testing and monitoring; however, Mr A relied solely on a single office electrocardiogram and auscultation. Had Mr A referred his patient immediately to a cardiologist or to the emergency department for further screening, the patient may have experienced a different outcome.

It is far better to be overly cautious in the case of possible cardiac issues and order further testing immediately than to take a wait-and-see attitude and risk something happening before the next appointment. ■

Mr P’s medical history included hypertension, dyslipidemia, situational anxiety, and seasonal allergies.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.

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