Serious symptoms and history fail to prompt stroke workup
A MAN WITH DIABETES AND HYPERTENSION went to his primary care physician’s office complaining of right-sided headache, dizziness, some weakness and tingling on his left side, and difficulty picking up his left foot. The 56-year-old patient was seen by a nurse practitioner. The nurse consulted the physician twice during the visit, but the physician didn’t examine the patient personally.
An electrocardiogram was performed. The nurse found no neurologic indications of a transient ischemic attack. The patient was sent home with prescriptions for aspirin and atenolol and instructions to return in a week.
The patient’s condition deteriorated, and he went to the emergency department, where he was treated for a stroke. The symptoms progressed, however, leading to significant physical and cognitive disabilities.
PLAINTIFF’S CLAIM The physician and nurse practitioner failed to appreciate the patient’s risk of a stroke and recognize that his symptoms suggested a serious neurologic event. Immediate referral to an ED for a stroke work-up and treatment would have prevented progression of the stroke and the resulting disabilities. The physician should have evaluated the patient personally. The patient had not received proper treatment for hypertension, diabetes, and high cholesterol for many years before the stroke.
THE DEFENSE The treatment given was proper; earlier admission wouldn’t have made a difference.
VERDICT $750,000 Massachusetts settlement.
COMMENT Supervision of midlevel employees carries its own risks. When in doubt, see the patient!