Nurse Case Study: Failure to timely diagnose and treat stroke.

Failure to timely diagnose and treat stroke – partial paralysis of arm, aphasia, mild cognitive impairment and foot drop – $4 million settlement.

The plaintiff, age 52, went to the emergency department of the hospital in March 2005. He had experienced transient episodes of blurred vision and also had a numb right hand. He was examined by a doctor and nurse “A”. The plaintiff’s symptoms quickly resolved and a CT scan did not reveal abnormalities.
The doctor diagnosed a transient ischemic attack and contacted the plaintiff’s treating physician. The plaintiff’s treating physician arranged transfer to the hospital’s telemetric monitoring area and requested neurological evaluation. Before the transfer occurred, the doctor and nurse “A” reassessed the plaintiff and detected no neurological abnormalities.
About twenty minutes later the plaintiff was examined by another nurse, “B”, who noted slurred speech, confusion and weakness on the right side. The symptoms were reported to the emergency department and Nurse “B” was told that these symptoms had not been present in the examinations by the doctor and nurse “A”.
Nurse “B” then contacted the doctor who then requested an immediate neurological consultation by a neurologist. The neurologist examined the plaintiff over an hour later. The neurologist considered the use of tPA, but the plaintiff had been at the hospital for over six hours at that time and the neurologist determined that the three-hour time for administration of tPA had passed. Further observation was recommended.
The plaintiff’s symptoms worsened. By the next day it was determined that the plaintiff had suffered a full stroke. The plaintiff was transferred to another hospital and was hospitalized for several weeks. He achieved significant recovery, but continued to have partial paralysis of his right arm, aphasia, mild impairment of cognitive functions, and foot drop of the right foot. He requires a cane, but can independently perform most of his everyday activities.
The plaintiff alleged negligence in the failure to timely diagnose and treat the stroke. The plaintiff claimed that the stroke was caused by a clot which traveled to the brain and could have been treated with tPA.
The defendants claimed that tPA would not have provided any benefit to the plaintiff. Additionally, the neurologist claimed that Nurse “B” could not accurately determine the time of the onset of the symptoms and that the first two examinations by the doctor had been concluded more than four hours earlier.
Nurse “B”, however, claimed that she reported to the neurologist that the symptoms had begun less than three hours prior to the examination.
The doctor claimed that her order for an immediate neurological evaluation was all she was required to do. The defendants also claimed that the stroke was due to circulatory obstruction caused by a dissection of the left internal carotid artery, which was confirmed by angiography.
A $4 million settlement was reached at the end of the plaintiff’s presentation of evidence at trial.
With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 800-298-6288.

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