Patient Sent Home With Classic Signs of Heart Attack

This case involves a fifty-five-year-old male who presented to his primary care physician with complaints of worsening chest pain, chest pressure, and shortness of breath. Electrocardiogram results were abnormal and the PCP referred the patient to a cardiology group for further consultation. Additional testing was ordered, and the nuclear stress test technician reported in the patient’s chart that the patient could only withstand three minutes of treadmill testing. No immediate report to the physician was made and the patient was permitted to leave. Two additional lab diagnostic tests were ordered, and both came back abnormal. The patient was not contacted regarding these abnormalities, though, and was not asked to return for a follow-up consultation. Several days later, the patient died of a massive heart attack.

Question(s) For Expert Witness

1. Is it expected that a technician would immediately advise the cardiologist of these abnormal results?

Expert Witness Response E-004457

All EKG technicians must be able to identify the most common, the most disabling, and most life-threatening cardiac rhythms. A technician should be able to identify any ventricular rhythm; both second-degree heart blocks, either Mobitz I or Mobitz II; a complete heart block; narrow-complex tachycardia, and any ST changes suggestive of an impending myocardial event. With that being said, it is the technician’s ultimate responsibility to immediately bring this to the attention of a physician. To simply document abnormal findings and send the patient on his way was absolutely a breach in care.