Eric Turkewitz, The Turkewitz Law Firm, New York, NY
Tuesday, February 5, 2008
The Medical Malpractice Trial of John Ritter
Four years ago comic actor John Ritter suddenly died from an aortic dissection after being rushed to the emergency room from the set of his sitcom, 8 Simple Rules ... For Dating My Teenage Daughter. A medical malpractice action ensued. The defendants include a radiologist that did a scan two years before and failed to note any enlargement of the aorta in the 54-year old actor, and a cardiologist that saw him in the emergency room at Providence St. Joseph Medical Center in Burbank, California.According to this story in USA Today:
[T]he cardiologist [was] summoned to the emergency room at Providence St. Joseph Medical Center in Burbank after Ritter was taken there complaining of nausea, vomiting and chest pain. Plaintiff's lawyers say a chest X-ray should have been performed before Lee treated Ritter.Kevin M.D. has previously written on this case. But, not being in the courtroom, he has to work from public accounts. He offers us this along with a longer analysis at the link:
The doctor's lawyers say that there wasn't enough time for that and that a chest X-ray ordered earlier inexplicably was not done. They say Ritter's symptoms were more consistent with a heart attack than anything else and had to be treated quickly.
Was it malpractice? Tough to say. The question I'd be interested in would be how long it took for the ER to order that chest CT scan.His family says that he likely would have survived with prompt treatment and that the treatment for the aortic dissection is the opposite of treating him for a heart attack. The hospital, by the way, has already settled.
My personal view: Suits against emergency departments are very difficult, though not impossible. Jurors will, if given half a chance, give the benefit of the doubt to emergency room physicians, often times even if their own protocols are violated. I have no idea what will happen in this particular case since I won't be in the courtroom hearing the evidence, but I say with some confidence that the scenario presented in the news media presents a difficult factual pattern if the hospital was the culprit in failing to get the CT scan done.
With respect to the radiology films from two years earlier, that will be a classic "battle of the experts" that cannot be evaluated by people outside the courtroom unless they have seen the actual films at issue.
Jury selection starts today.
Labels: Interesting Cases in the News, Medical Malpractice
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folks:
Eric doesn't know what he doesn't know (look up the mortality of an acute thoracic aorta dissection eric). For those interested on the medical take on the subject look at the below sites written by docs.
http://doctorrw.blogspot.com/2008/02/ill-take-67-million-to-go-with-that.html
http://allbleedingstops.blogspot.com/2008/02/malpractice-and-john-ritter.html
Eric doesn't know what he doesn't know (look up the mortality of an acute thoracic aorta dissection eric). For those interested on the medical take on the subject look at the below sites written by docs.
http://doctorrw.blogspot.com/2008/02/ill-take-67-million-to-go-with-that.html
http://allbleedingstops.blogspot.com/2008/02/malpractice-and-john-ritter.html
# posted by 
: February 06, 2008 8:41 PM
: February 06, 2008 8:41 PM
I'm not sure what the criticism is here. I'm not in the courtroom listening to evidence and have offered no opinion on whether the case against these two docs has merit.
I know there are some folks who know everything about a malpractice case from reading an article in USA Today, but I'm not one of them.
I know there are some folks who know everything about a malpractice case from reading an article in USA Today, but I'm not one of them.
I repeat eric:
"look up the mortality of an acute thoracic aorta dissection"
You don't know what you don't know.
"look up the mortality of an acute thoracic aorta dissection"
You don't know what you don't know.
# posted by : February 06, 2008 9:59 PM
: February 06, 2008 9:59 PM
Simply repeating yourself doesn't help since you didn't say much the first time. There is one defendant who did a radiological study two years before and a cardiologist who was treating on the day of death. Those represent different scenarios.
And merely because a prognosis isn't good doesn't mean a medical professional gets a grant of immunity. Lung cancer, for example, has a generally poor prognosis. I don't know what the law in CA is, but in NY if malpractice results in depriving the patient of a chance for that cure, that might be compensable. So if, for example, there is a 20% survival rate for a particular condition, that might, (or might not) be compensable under CA law. I don't profess to know the state of CA law on the subject.
With too many variables, and little actual knowledge of the case since all I have is a press account or two, I won't offer an opinion on the merits.
And merely because a prognosis isn't good doesn't mean a medical professional gets a grant of immunity. Lung cancer, for example, has a generally poor prognosis. I don't know what the law in CA is, but in NY if malpractice results in depriving the patient of a chance for that cure, that might be compensable. So if, for example, there is a 20% survival rate for a particular condition, that might, (or might not) be compensable under CA law. I don't profess to know the state of CA law on the subject.
With too many variables, and little actual knowledge of the case since all I have is a press account or two, I won't offer an opinion on the merits.
"And merely because a prognosis isn't good doesn't mean a medical professional gets a grant of immunity"
Nobody is talking immunity here eric. The simple fact here eric is a thoracic aortic arterial dissection is a (relatively) rare entity with a very high mortality. An acute MI is a common occurence that has good treatment if caught in time. Multiple sources have stated how the cardiologist was at the bed side in 10 minutes. You get a cardiologist at your bed side and wisked off to the cath suite in that time frame for one reason...the objective evidence, which we don't know, (troponins, EKG, etc) supports an acute MI. The chest X-ray is a red herring. Many institutions don't even complete x-rays in clear evidence of an acute MI. As every first year medical student will tell you, time is heart muscle in the setting of an acute MI. The retroscope is the easy part eric. The odds are if this guy was Joe Schmoe instead of John Ritter this would have never have gone to trial.
Nobody is talking immunity here eric. The simple fact here eric is a thoracic aortic arterial dissection is a (relatively) rare entity with a very high mortality. An acute MI is a common occurence that has good treatment if caught in time. Multiple sources have stated how the cardiologist was at the bed side in 10 minutes. You get a cardiologist at your bed side and wisked off to the cath suite in that time frame for one reason...the objective evidence, which we don't know, (troponins, EKG, etc) supports an acute MI. The chest X-ray is a red herring. Many institutions don't even complete x-rays in clear evidence of an acute MI. As every first year medical student will tell you, time is heart muscle in the setting of an acute MI. The retroscope is the easy part eric. The odds are if this guy was Joe Schmoe instead of John Ritter this would have never have gone to trial.
# posted by : February 09, 2008 9:46 AM
: February 09, 2008 9:46 AM
The retroscope is the easy part eric.
That's why I don't do it, and didn't offer an opinion on the details of this case, other than to say that ER cases are notoriously difficult and the juries very sympathetic toward the physicians.
The odds are if this guy was Joe Schmoe instead of John Ritter this would have never have gone to trial.
I agree, because CA has tort "reform" that very sharply limits compensation for pain and suffering, only cases with large economic damages can generally be considered by the attorney. It's not that it wouldn't go to trial, but that it may never have even made it into suit due to the protections and de facto immunities offered by CA law. I wrote about that issue recently here:
Another tort "reformer" sees the light
That's why I don't do it, and didn't offer an opinion on the details of this case, other than to say that ER cases are notoriously difficult and the juries very sympathetic toward the physicians.
The odds are if this guy was Joe Schmoe instead of John Ritter this would have never have gone to trial.
I agree, because CA has tort "reform" that very sharply limits compensation for pain and suffering, only cases with large economic damages can generally be considered by the attorney. It's not that it wouldn't go to trial, but that it may never have even made it into suit due to the protections and de facto immunities offered by CA law. I wrote about that issue recently here:
Another tort "reformer" sees the light
Interesting discussion.
Statistics describe groups, not individuals. The more apropos question is whether or not Ritter's acute aortic dissection was diagnosable and treatable in a time frame that would have minimized morbidity and/or mortality -- not whether a majority of acute dissections are or are not. If the dissection was diagnosable and treatable, and if an ordinary doctor would have suspected it, worked it up, diagnosed and treated it, then it's negligence to fail to.
I find it troubling that so many physicians feel that they are entitled to be treated differently from the rest of us when they act wrongfully. I find it even more troubling to see a physician oversimplify an issue by using a blanket statistic. I highly doubt the physician, upon discovering an acute aortic dissection in one of his patients, would simply inform the patient that survival is unlikely -- therefore he's not going to treat the condition. Seems like a double standard all around, no?
Statistics describe groups, not individuals. The more apropos question is whether or not Ritter's acute aortic dissection was diagnosable and treatable in a time frame that would have minimized morbidity and/or mortality -- not whether a majority of acute dissections are or are not. If the dissection was diagnosable and treatable, and if an ordinary doctor would have suspected it, worked it up, diagnosed and treated it, then it's negligence to fail to.
I find it troubling that so many physicians feel that they are entitled to be treated differently from the rest of us when they act wrongfully. I find it even more troubling to see a physician oversimplify an issue by using a blanket statistic. I highly doubt the physician, upon discovering an acute aortic dissection in one of his patients, would simply inform the patient that survival is unlikely -- therefore he's not going to treat the condition. Seems like a double standard all around, no?
trusty:
I find it "troubling" that you pontificate about something you know nothing about. This is the fact. An acute aortic dissection is very often indistinguishable from an acute MI. Hanging you hat on a chest X-ray for diagnosis (as this lawyer appears to be doing) shows a complete and utter lack of understanding as to the sensitivity and specificity of chest X-rays for the dignosis of acute aortic dissection. In acute MI's time is heart muscle. If docs are ordering zebra tests (ie. CT scans) on patients presenting with acute MI presentation (or rarely an aortic dissection).....heart muscle dies in the interim. Patient's dies in the interim. I am sorry you have so little understanding of the subject to give a knowledgeable response.
PS: I HAVE told a patient's family that there loved ones aortic dissection was inoperable. Very simply the patient's comorbidites were too much for a realistic chance at survival. Maybe you should stick to your nursing home chasing eh?
I find it "troubling" that you pontificate about something you know nothing about. This is the fact. An acute aortic dissection is very often indistinguishable from an acute MI. Hanging you hat on a chest X-ray for diagnosis (as this lawyer appears to be doing) shows a complete and utter lack of understanding as to the sensitivity and specificity of chest X-rays for the dignosis of acute aortic dissection. In acute MI's time is heart muscle. If docs are ordering zebra tests (ie. CT scans) on patients presenting with acute MI presentation (or rarely an aortic dissection).....heart muscle dies in the interim. Patient's dies in the interim. I am sorry you have so little understanding of the subject to give a knowledgeable response.
PS: I HAVE told a patient's family that there loved ones aortic dissection was inoperable. Very simply the patient's comorbidites were too much for a realistic chance at survival. Maybe you should stick to your nursing home chasing eh?
# posted by : February 26, 2008 9:22 PM
: February 26, 2008 9:22 PM
From an anonymous cardiologist:
A very interesting aguement. From a legal standpoint the Ritter case underscores how plaintiffs attorneys are being pushed (by tort reform) to represent high earners rather than "waste" their time on lower earning clients.
From a medical standpoint the issue is far more disturbing. This clinical scenario is every ER physician's and cardiologist's nightmare because it exposes what every doctor knows but what everyone else does not want to accept: there are significant limits to our diagnostic and therapeutic powers such that bad outcomes cannot always be avoided; even when a standard of care is met.
I agree that without full disclosure of the medical evidence it is hard to make a conclusion about the merits of this case. However, the adage that time is muscle is quite true. We, as physicians, are taught very early in medical school to think of horses when we hear huff beats, not zebras. A chest x-ray can still be relatively normal even during an aortic dissection. If John Ritter had actually suffered a heart attack instead of an aortic dissection, and if they had delayed his care to undertake a CAT scan, MRI, TEE or other study to make sure no dissection was taking place, the plaintiffs would have had grounds to sue for delaying potentially life saving care.
The physicians were damned either way. This appears more a case of bad luck and a bad outcome more than actual malpractice.
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A very interesting aguement. From a legal standpoint the Ritter case underscores how plaintiffs attorneys are being pushed (by tort reform) to represent high earners rather than "waste" their time on lower earning clients.
From a medical standpoint the issue is far more disturbing. This clinical scenario is every ER physician's and cardiologist's nightmare because it exposes what every doctor knows but what everyone else does not want to accept: there are significant limits to our diagnostic and therapeutic powers such that bad outcomes cannot always be avoided; even when a standard of care is met.
I agree that without full disclosure of the medical evidence it is hard to make a conclusion about the merits of this case. However, the adage that time is muscle is quite true. We, as physicians, are taught very early in medical school to think of horses when we hear huff beats, not zebras. A chest x-ray can still be relatively normal even during an aortic dissection. If John Ritter had actually suffered a heart attack instead of an aortic dissection, and if they had delayed his care to undertake a CAT scan, MRI, TEE or other study to make sure no dissection was taking place, the plaintiffs would have had grounds to sue for delaying potentially life saving care.
The physicians were damned either way. This appears more a case of bad luck and a bad outcome more than actual malpractice.
# posted by : March 04, 2008 3:21 PM
: March 04, 2008 3:21 PMLinks to this post:
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Eric Turkewitz has litigated New York personal injury and medical malpractice cases for over 20 years, and is the founder of The Turkewitz Law Firm in New York. His firm's website is at www.TurkewitzLaw.com.
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