William H. Chamblee and Annik L. Morgan obtained a unanimous defense verdict in favor of a radiologist who interpreted a non-contrast head/brain CT scan during an acute stroke protocol. The case was tried in the 416th Judicial District Court, Collin County, Texas. The Plaintiffs’ claimed that the radiologist failed to accurately interpret the CT scan, and missed the finding of hyper-dense middle cerebral artery (MCA). The Plaintiffs further claimed that as a result of the radiologist’s failed interpretation, the patient was not properly diagnosed with an ischemic stroke which prevented the patient (Plaintiff) from receiving proper treatment. In addition, Plaintiffs’ argued that the “missed scan” evidences the radiology practice group’s failure to properly staff the hospital with radiologists who have an expertise in interpreting non-contrast head/brain CT scans during an acute stroke setting.
The case facts involved a 36 year old patient Plaintiff (patient) who presented to the emergency department of a primary stroke center, after passing out. The ER physician activated the stroke protocol and ordered a CT scan. In an acute stroke setting a CT scan must be interpreted within 45 minutes of the patient’s arrival. Therefore, within a matter of minutes from the CT order, the radiologist interpreted the scan and informed the ER physician that the scan was normal. The radiologist then completed and signed the radiology report.
The radiologist’s findings established that the patient had no bleeding or any other contraindications to tPA (tissue plasminogen activator); a “clot busting” treatment administered to patients exhibiting signs of ischemic stroke. At the time of the incident, the American Heart Association/American Stroke Association (AHA/ASA) Guidelines required that tPA be administered within 4.5 hours of symptom onset.
The ER physician continued with the stroke protocol and consulted with a tele-neurologist. The tele-neurologist interpreted the images and found that the CT scans were normal; he had not seen the radiology report, nor was he aware of the radiologist’s findings. The tele-neurologist then conducted a physical examination and clinical assessment of the patient. The tele-neurologist diagnosed the patient with having a psychogenic episode. This resulted in termination of the acute stroke protocol and the patient did not receive tPA.
It was later determined that the patient had suffered an ischemic stroke.
A hyperdense MCA, when actually present, can be evidence of an occlusion in a vessel, which can be an early sign that the patient is suffering an ischemic stroke, if it correlates with the patient’s clinical presentation and assessment.
The Plaintiffs’ arguments regarding a “missed” hyper-dense MCA were futile as both of defense’s expert witnesses, who are both highly regarded and credentialed stroke experts, involved in acute stroke settings on an everyday basis, reviewed the images extensively and testified that there was no hyper-dense MCA visible on the original CT scan. These experts included a fellowship trained neurologist with expertise in stroke imaging and an interventional neurologist who chairs the radiology department of a major hospital.
The neuro-radiologist reviewed the patients actual CT images live in front of the jury, demonstrating that there was no evidence of any such finding. The neurology expert later testified that most patients suffering from an acute ischemic stroke have a normal CT scan and that stroke is a clinical diagnosis to be made by the neurologist.
Plaintiffs’ Counsel presented figures from a life care plan that included loss earnings, for a total damage amount over $14.8 million. After 2 ½ days of evidence and arguments by Counsel, the jury rendered a take nothing verdict in favor of the radiologist and the radiology practice group.