Interpretation of an echocardiogram (Case #239)

• Medical Probability: 2 / 10
• Medical Error Summary: Unless echo was grossly misinterpreted and had wall motion Abnormalities, decreased lv function I do not see relevance for its misinterpretation leading to death
• Causation Probability: 2 / 10
• Causation Summary: Again I don’t see how echo interpretation could lead to a bad outcome here
• Expert Summary: I am a level 3 board certified echocardiographer, former lab director
• Similar Summary: Frequency would read these and would expect them to be normal

Medical Clearence prior to Orthopedic Surgery (Case #241)

• Medical Probability: 10 / 10
• Medical Error Summary: Whomever gave clearance cannot rely on labs from 8 months prior and certainly must perform ekg on obese patients with cardiac risk factors ..additionally the Surgical centers should have verified such...
• Causation Probability: 10 / 10
• Causation Summary: Not checking labs and ekg seems to have directly led to the cardiac arrest
• Expert Summary: I enjoy reviewing cases and have sense of who is responsible for medical errors such as these
• Similar Summary: This is unusual—labs and ekg are always done prior to preop Clearance…how could this md give clearance—I suspect pt could not perform 4 Mets

DVT resulting in death (Case #252)

• Medical Probability: 1 / 10
• Medical Error Summary: Patient was appropriately on DVT prophylaxis with both lovenox and SCDs.. While his SOB may have indeed been due to pulmonary embolism, there is no medical error here as patients are often tachycardic...
• Causation Probability: 1 / 10
• Causation Summary: There is no negligence to have caused any medical error in this case for above
• Expert Summary: As a hospital based cardiologist, I am the first person called when a patient is short of breath post operatively
• Similar Summary: I have encountered this multiple times (Although patients do not die) dual Prophylaxis should be effective over 99% of the time

Failure to properly read CT Angiogram leads to unnecessary surgical procedure (Case #258)

• Medical Probability: 2 / 10
• Medical Error Summary: Firstly, without reviewing the images, It is critical to note that despite a coronary calcium score of zero you can still have significant Coronary artery disease. The prior report says “no signific...
• Causation Probability: 2 / 10
• Causation Summary: This patient has new chest pain and a new evaluation is warranted. Even if the CCTA overcalled a “lesion “ That is not causation if there is a complication for me later procedure.
• Expert Summary: I deal with these cases all the time. While complications from cardiac catheterizations are rare, they do happen and while litigation can ensue, in this case there is no harm caused by The physician w...
• Similar Summary: I see “over reads “on CCTA Often. Usually, it is in the setting of calcified arteries which was not the case here

Preoperative clearance prior to elective hysterectomy. (Case #429)

• Medical Probability: 6 / 10
• Medical Error Summary: To be clear, I do not think the cardiologist committed any medical error since he/she was very clear about the risk of bleeding and stroke with this high blood pressure. It seems the blood pressure wa...
• Causation Probability: 10 / 10
• Causation Summary: The patient had a stroke. Of course that is bodily injury. once we say there is Medical error, that must be causation by default.
• Expert Summary: I see these patients all the time.. there is likely some blame to be placed on the patient who is walking around with a blood pressure that high for 15 years and I suspect that the patient has been no...
• Similar Summary: Usually I see a blood pressures up to the 240s, systolic.. Very unusual to see Systolic blood pressure up to 300.— I would have repeated a complete work up for secondary causes— even if the patien...

Post cervical laminectomy, possible delayed diagnosis of CSF infection (Case #441)

• Medical Probability: 5 / 10
• Medical Error Summary: The leukocytosis was not addressed but did the pt recieve streroids for COPD as they usually do--that would explain the increase in WBC
• Causation Probability: 1 / 10
• Causation Summary: What injury? So long as the infection cleared with the antibiotics and pt did not get endocarditis, etc
• Expert Summary: Ideal expert is ID which I am not
• Similar Summary: Very unsual to have GNR infection from the surgery

Patient did well after surgery. 3 days later CT showed massive aspiration. Plastic found in left bronchi. Died two weeks later of hypoxic respiratory failure. (Case #458)

• Medical Probability: 5 / 10
• Medical Error Summary: There was likely a mishap with regards to foreign body appearing in the lungs. I suspect it was from an attempted ng tube placement gone wrong(in other words it being placed initially in the airway ra...
• Causation Probability: 5 / 10
• Causation Summary: Well there are many medical mishaps here the ones that concern the most are the decubitus ulcers and lack of nutrition from delay in placement of TPN. While the others are unfortunate, they don’t...
• Expert Summary: Unfortunately, caring patients in the ICU, We see these kinds of complications all of the time. This sounds like a disgruntled daughter and while she may give poor reviews to this hospital, the onl...
• Similar Summary: I have seen several poor nasogastric tube placements and yes, sometimes they lead to aspiration pneumonia.. usually family members are unaware of these events, especially since NGT placement, no longe...

**Req IM practicing as Primary Care expert** Questionable finding on ultrasound not investigated. (Case #465)

• Medical Probability: 10 / 10
• Medical Error Summary: As soon as these neck were found, patient should have been referred to specialist or had next CT performed
• Causation Probability: 10 / 10
• Causation Summary: this is pretty clear.. in 3/23, PCP should have addressed these neck masses
• Expert Summary: I send patient was for carotid ultrasounds on a daily basis and very frequently have to deal with these findings that are not cardiac but are obviously consequential
• Similar Summary: I frequently fine thyroid nodules on my carotid ultrasounds and will refer to PCP, endocrine for further evaluation

Cardiac arrest during elective outpatient ablation for a-fib. (Case #505)

• Medical Probability: 7 / 10
• Medical Error Summary: 1. Sounds like he was in decompensted chf prior to the procedure —worsening doe and needs diuresis prior to ablation..if ef was 50% 4 months prior sounds like there is a change and this should have ...
• Causation Probability: 8 / 10
• Causation Summary: Yes giving anesthesia to a patient in ADHF is a contraindication unless surgery is urgent AND risk is properly explained to pt and family—this was elective however!
• Expert Summary: I take care of these patients on a regular basis and always have to determine daily for multiple patients in office and hospital who is “clear” for a procedure/surgery
• Similar Summary: I’ve only had a cardiac arrest at induction a few times but only with patients at very high risk for procedure, e.g older patients with known cad and active chf and risk is always explained in deta...