According to the Centers for Disease Control and Prevention (CDC), every year approximately 715,000 Americans have a heart attack. Because there is no definitive test, the rate of misdiagnosis of heart attacks can be high, with about 1 in 50 heart attack victims sent home from the emergency room with a mistaken diagnosis. With such high rates of misdiagnosis, medical malpractice claims involving heart attack misdiagnosis are among the most common malpractice claims made.
What Makes a Woman’s Heart Attack Diagnosis So Different From That of a Man?
Dr. David A. Meyerson, MD, JD, Director of Cardiology Consultation Services, Johns Hopkins, tells us that “…with regard to heart attack and heart disease women do present differently from men … Men will often feel that terrible essential chest pain or pressure, with pressure and pain going through to the jaw, perhaps to the back, perhaps to the left arm, shortness of breath, dizziness, a whole constellation of things. Women sometimes have less warning. Their symptoms are not quite as dramatic…[They] may complain about profound fatigue or weakness… chest pressure…or shortness of breath.” Because of these differences heart attacks in women can go undiagnosed, resulting in serious injury or death.
Demonstrating Malpractice for Injuries to Female Heart Attack Patients
Not every failure to diagnose is malpractice. Proving a heart attack malpractice injury case for a female patient requires:
- Expert testimony on the applicable standard of care the physician owed the patient
- Expert testimony on the physician’s deviation from that standard of care
- Expert testimony stating there is a causal link between the physician’s deviation and the patient’s heart attack injury
An emergency room physician’s failure to conduct a second troponin enzyme test six hours after the female patient began experiencing heart pain was a proximate cause of the patient’s increased injuries from a delay in diagnosis and treatment for the heart attack in Browne v. Portland Adventist Medical Center, 254 Or.App. 73, 295 P.3d 69 (Or.App. Dec 12, 2012). Expert testimony presented by the plaintiffs indicated that the second test would have shown that the patient was suffering a heart attack and that the delay in diagnosis caused by the failure to conduct the second test created a risk that heart tissue was likely to be lost. According to the expert, the applicable standard of care for an emergency room physician required the physician to conduct a repeat test, because it would mitigate the extent of any permanent injury to the plaintiff’s heart. The court also determined that the expert testimony was sufficient for the jury to conclude that, if the diagnosis of heart attack had been timely made, the cardiologist would have ordered the patient to the cardiac catheterization laboratory for additional treatment or performed other curative treatment, and that the physician’s breach of the standard of care was thus the proximate cause of the patient’s injury.
Use the following checklist as a guide to proving your malpractice case for misdiagnosing a woman’s heart attack
Patient Medical History:
 Past history of cardiovascular disorders
 Past history of risk factors for heart attack, such as family history, obesity, or cigarette smoking
 List of medications the patient is currently taking for hypertension or other cardiovascular issues, if any
 All symptoms experienced by the woman, such as general fatigue, shortness of breath, pain, weakness, etc.
Proof of Physician’s Duty of Care:
 Proof of physician-patient relationship
 Physician duty to exercise independent medical judgment on behalf of the patient
 Expert testimony establishing the physician’s standard of care
Treatment by Physician:
 Date of the patient’s first visit or consultation with the physician
 Diagnostic tests and procedures performed
 Physician’s diagnosis and treatment regimen proposed
 Specific treatment procedures performed
 Specific medications prescribed or administered
 Date(s) of subsequent visits to the physician, if any
 Patient’s symptoms of illness or injury after treatment by the physician
 Date of hospital admission
 Treating physician’s diagnosis and treatment
 Specific procedures performed
 Prior cardiovascular treatment, if any
Proof of Breach of Standard of Care:
 Facts showing a breach of the standard of care
 Expert testimony demonstrating a deviation from the standard of care
 Physician’s failure to disclose risks of treatment proposed or recommended
 Physician’s failure to discuss alternatives
 Physician’s failure to obtain informed written consent
Physician’s Breach of Standard of Care Caused Patient’s Injury:
 Specific act alleged to have caused or contributed to the patient’s heart attack injury
 Expert testimony showing proximate causation between the physician’s negligent acts and the patient’s injury
 Expert testimony ruling out other causes of the patient’s injury
 Absence of negligent conduct by the patient that contributed to injury
 Absence of intervening causes that resulted in the patient’s injury
 Lost wages or business profits
 Present medical expenses
 Future medical expenses
 Other economic losses
Proving a malpractice action for the failure to diagnose a woman’s heart attack involves different symptom evidence than the symptoms a man experiences. Counsel must be aware of these differences and use practice aids, such as the checklist above, to carefully prove their case.
Medical Law Perspectives presents 50-page detailed reports on medical litigation in the news for attorneys, physicians, insurers, and employers. The January 2013 report on vaccine litigation contains additional expert comments and detailed medical and law information. Monique C.M. Leahy, JD, Publisher can be reached at email@example.com; 212.213.0222; www.medicallawperspectives.com.
The writers’ opinions are those of the writers and not ALM. This material is intended for general information purposes only and does not constitute legal advice.