Article

Cardiac misdiagnosis

On 20 May 2003, Mr H (age 63) presented at a district general hospital (DGH) with central chest pain and epigastric pain together with marked increase in blood pressure. He eventually underwent a CT scan with contrast and was subsequently transferred to a tertiary centre of excellence in London, where he was reported to have a Type A aortic dissection, which could be treated only with surgery. Type A aortic dissection is a surgical emergency and half of patients die within 48 hours if surgery is not undertaken.

However the CT scan taken at the DGH had poor contrast and there was a movement artefact present on the scan films which had been wrongly interpreted by the radiologist as a Type A aortic dissection. The cardio-thoracic surgeons at the centre of excellence received the patient on the basis that he had a Type A aortic dissection and, having reviewed the scan films themselves, accepted that diagnosis. The cardiothoracic surgeon did not involve the specialist radiologists at the centre of excellence. A trans-oesophageal echocardiogram (TOE) was also done but it was never clear that this was undertaken by someone appropriately qualified to interpret a TOE. When the claimant underwent cardio-thoracic surgery it was found that he did not have a Type A dissection but rather a Type B dissection, which could have been controlled and was, in fact, controlled thereafter with medication. The surgery had been un-necessary. Mr H reacted adversely to the surgery psychologically and was unable to work thereafter. He also developed keloidal scarring following the open chest surgery.

The National Health Service Litigation Authority on behalf of the DGH, accepted that the CT scan had been taken with poor contrast and also conceded that there was a movement artefact, but denied liability on the basis that a reasonable radiologist could still have interpreted the scan as showing a Type A dissection. The NHSLA argued that the tertiary centre of excellence had formed its own view on the basis of the CT scans, that there was a Type A dissection and that broke the chain of causation of any alleged negligence against the DGH. We obtained reports from a radiologist and a professor of cardio-thoracic surgery. All of the radiologists who reviewed the scan, save for the radiologist at the DGH, identified the movement artefact and could not identify a Type A aortic dissection. Our surgeon reported that the treating cardio-thoracic surgeon should have referred the patient to radiologists to undertake their own CT scan with contrast. Had this been done it would have ruled out a Type A dissection and the surgery would have been avoided. The defendant’s case was that the surgeon himself was experienced in interpreting such scans and it was a surgical emergency. In terms of causation, it was argued that the claimant would have been incapacitated by a Type B dissection in any event. Following negotiations the case settled for £50 000. The sum was largely influenced by the fact that Mr H was close to retirement at the time of the error. The case illustrates that ironically defendants may stand a better chance of avoiding liability if errors are made by more than one hospital.

For further enquiries please contact Graham Bell (view full profile) on 01892 701358 or email graham.bell@ts-p.co.uk.

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