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Strokes And Medical Malpractice

This article is based on a presentation given by Michael to the American Board of Professional Liability Attorneys in May 2019.

Michael Kaplen discusses the facts surrounding strokes in the USA, the present and future of stroke treatment, and the serious issue of medical malpractice in the care of stroke victims.

Strokes are frequently caused by preventable physician errors and malpractice in hospital emergency departments. Many strokes are easily diagnosable and easily preventable. In some cases, prompt medical intervention can prevent a stroke. These injuries and their causes should be on the radar screen of every medical malpractice attorney and warrant careful investigation.

Strokes have reached epidemic levels in the United States Here are the latest frightening statistics from the American Heart Association and the American Stoke Association

  • There are approximately 800,000 new strokes annually
  • There are approximately 100,000 deaths each year caused by strokes
  • By the year 2030, one in every twenty five adults will suffer a stroke, which translates into 3.4 million individuals

Source

What Is A Stroke?

The brain requires oxygen to survive. This oxygen is supplied to the brain through blood that flows to the brain through blood vessels and then circulates within the brain. When there is a blockage in the flow of blood, a clot develops that prevents the delivery of oxygen. This blockage and disruption in the delivery of oxygen causes rapid death of brain tissue resulting in what is known a stroke.

Source: National Institutes of Health: National, Heart, Lung and Blood Institute

Major Categories of Strokes

There are two major classifications of stokes. The most prevalent type of stroke as an “ischemic stroke” which is caused by a blood clot within a blood vessel in the brain. This accounts for approximately 85% of all strokes.

The second type of stroke is known as a “hemorrhagic stroke” which occurs when a blood vessel in the brain bursts or ruptures restricting the flow of blood within the brain. This event accounts for approximately 15% of strokes.

Typically, medical malpractice actions are focused on ischemic strokes.

Source: National Institutes of Health: National, Heart, Lung and Blood Institute

Strokes may be caused by the failure to diagnose and timely treat medical disorders.
One these disorders is a vertebral or cervical artery dissection. This condition, frequently caused by chiropractic manipulation or neck trauma can lead to a tear in a artery in the neck. The blood will leak from the artery, stagnate and pool causing a clot to form. The clot if not properly treated with the use of blood thinning agents will then break away and travel through the artery to the brain where it will cause a blockage and a stroke.

Common symptoms include severe headaches, neck and face pain , vision disturbances , sensitivity to light. The history of neck trauma is very important information that cannot be ignored by the doctor.

When cerebral or vertebral artery dissection is suspected, a computed tomography angiography (CTA) of the neck must be taken to rule our this condition.

Our New York based medical malpractice law firm has successfully prosecuted a case where the misdiagnose of a vertebral cervical artery dissection lead to a stroke and permanent disability.

Source: Cleveland Clinic ; Neurology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898434/

Another leading cause of strokes in pregnant women is a condition knowns as cerebral venous sinus thrombosis. In this condition, blood fails to circulate properly in the venous system of the brain. The blood will stagnate forming a clot leading to a stroke. Again, blood thinners is the treatment of choice to prevent a stroke. Our New York based medical malpractice law firm has successfully prosecuted a case of a misdiagnosed cerebral venous thrombosis leading to a stroke and permanent disability.

In a pregnant woman with symptoms of severe headaches, or abnormal vision this condition must be considered as part of a differential diagnosis and ruled out.

When cerebral venous sinus thrombosis is suspected, a computed tomography angiography (CTA) of the brain or MRI angiography, (MRA) of the brain must be taken to rule our this condition.

Our New York based medical malpractice law firm has successfully prosecuted a case where emergency department physicians ignored our pregnant client’s complaints and failed rule in or out this condition by taking a CTA or MRA study of her brain. Had her condition been timely diagnosed and treated, a stroke and blindness would have been averted.

Source: Johns Hopkins University

The failure to treat a cardiac condition known as atrial fibrillation can also lead to a stroke. In this condition, the heart is not beating properly causing the pooling of blood in one of the heart chambers. When the blood then clots, the clot may then travel to the brain through one of the artery’s causing as blockage and a stroke.

Timely treatment of this condition through the use of blood thinners can prevent a stroke from developing.

Our New York based medical malpractice law firm has successfully prosecuted a case where our client’s cardiologist failed to prescribe a blood thinner for our client who was diagnosed with atrial fibrillation leading to a stroke and permanent disability.

Source: American Heart Association

When a stroke happens, every minute counts for successful treatment. The American Heart Association and the American Stroke Association have developed a saying, “Time is Brain” to emphasize the need for prompt treatment of strokes to reduce the risk of permanent disability.

Our New York based medical malpractice law firm has successfully prosecuted cases here our clients failed to receive timely treatment which would have increased the chance for a better outcome. https://brainlaw.com/medical-malpractice/stroke-misdiagnosis/

Source: Stroke

A stroke is a medical emergency requiring prompt diagnosis and timely treatment. When brain tissue is deprived of oxygen, cell death can rapidly take place. Timely intervention will prevent cell death and lead to a better outcome. The tragic consequences of a stroke can be limited or even reversed, if treatment is rapidly instituted.

Source: Stroke

It is important that the signs and symptoms of a stroke be promptly recognized so the victim can be transported to a medical center for timely treatment. Delays in diagnosis and delays in treatment can have tragic consequences.
The recognized signs and symptoms of a stroke are:

  • Sudden numbness, tingling, weakness or loss of movement to face, arm, or leg
  • Sudden vision changes
  • Sudden speech difficulty
  • Sudden confusion or trouble understanding simple sentences
  • Sudden dizziness or problems walking or balance
  • Sudden or severe headache

Source: Centers for Disease Control and Prevention (CDC)

The acronym FAST (Facial drooping, Arm weakness, Speech difficulties and Time) has been used by the National Stroke Association, American Heart Association and others to educate the public on detecting symptoms of a stroke.

Source: National Stoke Association

The American Heart Association and the American Stroke Association has developed clinical guidelines to be used by physicians, and hospital emergency departments, and stroke centers for the diagnosis and stroke. These guidelines are frequently updated.

Our New York Medical Malpractice and Stroke Malptractice Attorneys have frequently encountered cases where these stroke treatment guidelines, unfortunately have not been followed. https://brainlaw.com/medical-malpractice/stroke-misdiagnosis/

Source: Get With the Guidelines (American Heart Association)

When a patient with as suspected stroke arrives in a hospital emergency department, stroke guidelines require that a neuro-radiology study be performed of the brain to rule out a stroke.

Our New York medical malpractice and stroke malpractice law firm recently successfully prosecuted a case where our client who arrived at hospital with a suspected diagnosis of a stroke did not receive a timely scan of his brain leading to the failure to timely institute treatment that would have increased his chances for a better outcome. https://brainlaw.com/medical-malpractice/stroke-misdiagnosis/

Source: Get With the Guidelines (American Heart Association)

The recognized gold standard treatment for a stroke is the administration of a clot clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). This medication can be administered to a patient within the first 4 ½ hours following the development of a stroke.

Our New York based medical malpractice attorneys have successfully prosecuted cases where tPA was not timely administered to our client despite the knowledge by the emergency department physician that his patient was having a stroke.

Source: National Stoke Association

The story of tPA and the controversy within the medical profession concerning its benefits and use is fascinating and makes for an interesting read.

Source

tPA is now the standard treatment in the United States for stroke victims. Before tPA can be administered, physicians must go through a check list to determine its safety for the individual patient. These are some of the items on the tPA criterial check list.

The full tPA check list for the contraindications for tPA can be found at: https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000086

In addition to medication, a surgical procedure known as a thrombectomy which mechanically clears the stroke by pulling it our of the brain is now widely available. This procedure provides additional means for treating stroke victims beyond the 4.5 hour time window for tpA. Using this surgical treatment, in many patients, treatment can take place up to 24 hours after a stroke. The procedure gas been nicknamed, “Mr Clean”

Source: British Medical Journal

It is important for medical providers to identify the source and cause of an individual’s stroke so as to prevent a recurrent second stroke since 25 percent of all strokes are repeat strokes. The most common cause or repeat stokes are atrial fibrillation, carotid artery disease, and uncontrolled hypertension. With proper and timely treatment, these repeat strokes are preventable.

Source: National Stroke Association; https://www.ncbi.nlm.nih.gov/pubmed/11441572

Mobile stroke detection ambulances with the ability to take mobile CT scans and administer tPA to a patient before arrival at a hospital are now being used to reduce the time period before life-saving treatment commences. These mobile units save precious time and can lead to better outcomes.

In prosecuting a medical malpractice stroke case, it is important that attorneys obtain the following documents in pre-trial discovery to prove malpractice on the part of the doctor and hospital:

  • Certified Stroke Center Application to DOH
  • Stroke Protocols
  • Review Radiological Studies
  • Audit Trail for Timing

The legal doctrine known as proximate cause is an important consideration for medical malpractice attorneys prosecuting a stroke malpractice case.  This doctrine when applied to stroke cases asks the question of what the outcome would have been for the individual  patient if a timely diagnosis  was made. or timely treatment was instituted.  The law changes from State to State.  It is commonly known as the “loss of chance for a better outcome.”  in some states any loss of a chance for a better outcome can be considered by a jury.  In other states, the standard is more probable than not.

In prosecuting a stroke malpractice case, the patient’s attorney needs to consult with the following experts:

  • Emergency Department Physician
  • Neurologist
  • Neuro-radiologist
  • Neuro-interventional surgeon
  • Cardiologist
  • Rehabilitation medicine
  • Life care planner

The stroke malpractice attorneys at De Caro & Kaplen, LLP routinely consult with these experts in evaluating and prosecuting a stroke malpractice case.

In a stroke medical malpractice action, damages may be awarded for:

  • Past and future costs related to medical treatment and rehabilitation
  • Lost income caused by time away from work, and the partial or total inability to return to the work force, or advance within one chosen field of employment.
  • Assisted medical devices needed for mobility
  • Pain and suffering
  • Loss of enjoyment of the pleasures and pursuits of life
  • Loss of sexual intimacy with a spouse as a result of injury

It is important that the malpractice attorney, obtain a day in the life video which will document the daily life and limitations an individual has as a result of their stroke.

Additionally, the attorney must retain the services of a life care consultant to determine the needs and future costs of care.

The stroke malpractice attorneys at the New York malpractice firm of De Caro & Kaplen, LLP will consider all of these areas of recovery to obtain full and fair compensation for their clients.

Malpractice attorneys pursing a case for stroke victims, must be aware that their clients may not be obtaining the best care because of insurance company limitations.

Source: Achieves of Physical Medicine and Rehabilitation

When a stroke is suspected, it is important to call 911 without delay. The sooner treatment is started, the better the chance for a good recovery.

Michael V. Kaplen, is board certified in medical malpractice and a member of the Board of Governors of the American Board of Professional Liability Attorneys. He is a partner in the New York medical malpractice law firm of De Caro & Kaplen, LLP and frequently prosecutes cases of stroke misdiagnosis and treatment.

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