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Case Descriptions

1) Failure to Timely Diagnose and Treat Stroke

The plaintiff, age 49, went to the emergency department with transient episodes of blurred vision and numbness of the right hand. He was examined by the emergency physician and a nurse. The ED physician diagnosed a transient ischemic attack and contacted the patient's family physician, who admitted the patient. Over the course of the next few hours, the numbness in the patient's right hand returned, and his hand became clumsy. The family physician consulted a neurologist, who examined the patient, but determined that the three-hour time for administration of tPA had passed.

By the next day it was clear that the plaintiff had suffered a stroke on the right side, and made only a partial recovery.

The plaintiff alleged negligence against both the ED physician and the family physician.

2) Failure to Timely Diagnose and Treat Heart Attack

A 52 year old female patient with obesity and Type 2 diabetes presented to her family physician complaining of chest pain. She was diagnosed with atypical chest pain, treated for heartburn (gastro-esophageal reflux) and scheduled for a stress test.

A few days later, before the stress test was done, she developed worse chest pain and went to the emergency department. A cardiac evaluation was done by a physician assistant (PA) and was negative (non specific EKG findings and a negative troponin). Her pain resolved after treatments with antacids. The PA and emergency physician discharged her after discussion with her primary care physician (family physician).

The next day, the patient's chest pain returned again. She was taken to the nearest hospital by EMS, where she was found to be having an acute STEMI (heart attack).

The issues in the case involved the family physician, the PA and the ED physician. The plaintiff alleged failure to recognize acute coronary syndrome or unstable angina by the family physician, and failure to refer to a cardiologist. The issue for the emergency physician and PA was failure to diagnose and failure to treat in a timely fashion.

3) Alleged Assault

A 35 year-old woman was accused of assaulting her boyfriend by “choking him to unconsciousness” while they were both seated in her car. Boyfriend alleged that “she reached across the car and choked me until I passed out and urinated on myself.” Emergency department records showed that he had no injuries, and revealed that he was an ex-Marine, trained in martial arts, and was much bigger than his alleged assailant. The defendant admitted that they were having a verbal argument in the car, but claimed that her boyfriend had threatened to file a false report if she broke up with him. She claimed that she was physically incapable of choking him, especially while seated in the car, since she is much smaller than he is. Dr. Gerard wrote an expert report describing that the medical facts, as well as the physics of the alleged assault, supported the defendant's version of events. The judge ruled in favor of the defendant.

4) Altercation

A 45 year-old male was accused of first degree assault during an altercation. The defendant was accused of stabbing the alleged victim in the abdomen with a pocket knife. The alleged victim told the police that he recognized his assailant. The defendant denied being part of the altercation, and claimed that he was physically unable to have stabbed the defendant due to a “weak right arm from a birth defect.”

Dr. Gerard reviewed the medical records of both the victim and the defendant. The victim's medical records showed a stab wound to the abdomen that required surgery, but the victim had a good outcome. The victim’s medical records contained descriptions to the nurses that “I was drunk, and I'm not sure who did this to me, but I think it was a guy I know” (suggesting reasonable doubt about his statements to the police).

The defendant’s medical records showed that he was born with an atrophic (abnormal) right arm, due to a congenital nerve injury. His records suggested that he was physically incapable of committing the crime since eyewitnesses had described the assailant as right-handed (“stabbed him with a knife in his right hand”).

Dr. Gerard's physical exam of the defendant confirmed that he was physically incapable of stabbing someone with a knife. His expert testimony in court led to a jury verdict of “not guilty.”

5) Rape

An alleged victim claimed that she was physically assaulted during a rape. She completed a police report, and was evaluated in the emergency department by a SAFE/ SANE nurse. A “rape kit” was completed, and the nurse's exam included an assessment of her physical injuries. The SAFE nurse used an “alternative light source” (ALS) and found “hidden bruises” to her legs and back that “were not visible without ALS.” The alleged victim was also evaluated by the emergency physician, who did a physical exam documenting “no visible injuries, but I did not do a gynecological exam. Please see the SAFE nurse exam.”

Dr. Gerard wrote an expert report, describing that “ALS can be used to look for body fluids, but there is no scientific evidence to support its use in looking for hidden bruises.” The emergency department records also did not show any bruises. Dr. Gerard's findings were used as part of a successful defense.


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