# Patient's Sudden Cardiac Death Follows Hospital Discharge Without Protective Device that Patient's Cardiologists Had Recommended (\$700,000 settlement)

The family of John Doe has settled a wrongful death case against a physician arising out of communication errors that culminated in Mr. Doe’s dying from cardiac arrhythmia. Mr. Doe’s death occurred after he was discharged from a Missouri teaching hospital without a commonly prescribed wearable device that administers a defibrillator shock to the heart to restore normal heart rhythm when the patient experiences certain types of cardiac arrhythmias. One of the many physicians who participated in Mr. Doe’s care had recommended this device to Mr. Doe and Mr. Doe had specifically requested it. Nevertheless, none of Mr. Doe’s physicians placed an order for the device from the manufacturer. The defendant physician authorized Mr. Doe’s hospital discharge without the device despite Mr. Doe’s cardiac status that placed him at high risk for a fatal arrhythmia. Four days after discharge, Mr. Doe experienced sudden arrhythmia and he collapsed at his home. A family member called 911 and ambulance personnel responded. All efforts to revive Mr. Doe failed. In addition to settling the case for \$700,000, the hospital that employed the defendant physician announced that it has taken measures to improve communication between hospital personnel.

Mr. Doe, a 58-year-old married father of two emancipated children, initially presented to the subject hospital emergency department with aphasia (difficulty with speech). His work up confirmed that he had experienced a stroke and Mr. Doe was admitted into the care of the neurology service. Additional testing confirmed that Mr. Doe had sustained a recent myocardial infarction that reduced his ejection fraction to 25% to 30%. (Ejection fraction is a measurement of the amount of blood that is pumped out of the heart with each contraction. Normal ejection fraction ranges from approximately 55% to 65%.) Cardiology physicians were called in to consult in Mr. Doe’s care in light of the determination of recent myocardial infarction.

It is well established that ejection fraction below 40% places the patient at high-risk for developing a fatal cardiac arrhythmia. In this circumstance, the recommended treatment is surgical implantation of a cardioverter-defibrillator that can correct most cardiac arrhythmias. However, implantation is commonly delayed with patients who have experienced a recent myocardial infarction to allow for recovery from the myocardial infarction which may result in improved ejection fraction to a level such that an implantable cardioverter-defibrillator is unnecessary. Zoll Medical Corporation is the exclusive manufacturer of wearable cardioverter-defibrillators (LifeVests).

On the second day of his five day hospitalization, one of Mr. Doe’s cardiologists “highly recommended” that Mr. Doe use a LifeVest to protect him from the time of hospital discharge up until re-evaluation of his ejection fraction. Mr. Doe immediately requested the cardiologist to order the LifeVest but, as mentioned, no order was placed by that physician nor by any of the many physicians who participated in Mr. Doe’s care.

Mr. Doe was scheduled for discharge on his fourth day of hospitalization but he was kept an extra day to allow for delivery of the LifeVest. When the Lifevest still had not arrived on day five of Mr. Doe’s hospitalization, the defendant physician discharged Mr. Doe, advising him that the LifeVest would arrive at his home “the next day.” (The discharging physician was apparently unaware that the LifeVest was never ordered from the manufacturer.)

Upon discharge, Mr. Doe returned to his home in northern Indiana with family members. The LifeVest did not arrive the next day nor did it arrive on post-discharge days two and three. Mr. Doe died during the early morning hours of post-discharge day four. The defendant physician asserted Mr. Doe was comparatively at fault for failing to contact anyone at the hospital about the LifeVest not having been delivered as promised which diminished the verdict potential of the family’s claim.

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