Tried 10/14/14 – 10/24/14

Mary Kay Scott represented a defendant endocrinologist in a medical negligence matter for Survival Action and Wrongful Death in Woodstock in McHenry County Illinois recently. The two week trial took place from October 14, through 24, and resulted in a not guilty for all parties. The plaintiff was a 49 year old, obese woman, with history of hypertension for several years and diabetes treated by diet only. She was seen by her primary care physician, and a low TSH lab was obtained on June 5, 2008, and she was re-tested on June 9, 2008, and found to again have low TSH, and at this time an elevated Free T4 suggesting hyperthyroidism. She was referred by the primary care physician, and an appointment for follow-up was made on June 23, 2008. In the interim, the plaintiff went to Centegra Hospital NIMC, for chest pain and shortness of breath, with extreme hypertension and tachycardia. She had elevated troponins, and had a full cardiac workup, including stress testing, echocardiogram, and a cardiac catheterization. Her blood pressure and tachycardia came down during the ER portion of the stay with medication, and remained stable throughout the hospitalization. During that hospital stay, the interventional cardiologist ordered thyroid labs, which returned with the TSH lower than the prior labs , and the Free T4 elevated beyond the limits of the labs assays. She was discharged by the cardiologist without him having reviewed the labs on June 21, 2008. She went home, had her birthday party, and saw family and friends and went shopping. She was to have medical management of her heart issues, and to start a cardiac rehabilitation program.

She came to the endocrinologist’ previously set appointment on June 23, 2008, in the afternoon and was evaluated by him. Her blood pressure was 118/64 normal, and she was tachycardic without an exact heart rate noted. Importantly she was on a beta blocker which treats the tachycardia associated with hyperthyroidism. Beta blocker was agreed by all physicians to be the first treatment for hyperthyroidism, which to this point had no known cause. The doctor was aware of the hospital stay and the cardiac catheterization, and had the labs from June 9, which is what he relied on, and he ordered testing to determine the cause of the hyperthyroid condition. She left his office with her husband, went shopping, talked on the phone and with friends and was outside while her husband barbecued. She felt nauseous and got ill in the bathroom, came back out, and her eyes rolled back into her head in a split second. EMT’s responded and she had ventricular fibrillation and asystole and could not be revived when brought back to Centegra Hospital.

The plaintiff’s theory of the case was the thyroid tests suggested severe hyperthyroidism or thyroid storm. That condition is characterized by unstable blood pressure, which is extremely high, fevers, mental status changes and an extremely ill presentation. The plaintiff’s theory was that the endocrinologist should have ordered the labs from the hospital, and spoken to the doctor’s there and immediately admitted the patient for treatment with PTU and monitoring so her event would have been capable of resuscitation in the hospital. It was admitted by the plaintiff’s endocrinology expert Dr. Donald Skor of St. Louis, MO, that the patient was not in thyroid storm at her primary care physician, during the hospitalization, or during the office visit with the endocrinologist. Further it was admitted by the plaintiff’s endocrinology expert, that labs do not diagnose thyroid storm, it is a clinical diagnosis, and the patient did not have any of the signs or symptoms of thyroid storm.

The defense theory was that the patient was not in thyroid storm, and there was no need to obtain the labs, as thyroid labs change due to the half-life of Free T4 over 4-6 weeks , and the labs from June 9 were the reliable labs. The patient was sick in the hospital, which lowers TSH, and the cardiac catheterization needed the use of heparin, which creates a test tube elevation in the Free T4 labs, so those were not reliable. Further PTU does not treat all causes of hyperthyroidism, and the appropriate plan for workup, along with the beta blocker was in place. Further you do not hospitalize patient’s with normal blood pressures, and some tachycardia, as many hyperthyroid patients have tachycardia. Additional treatment with more beta blockers would lower the normal blood pressure and endanger the patient. Finally ventricular fibrillation is not related to hyperthyroidism, and there is no way to predict an arrhythmia, and the patient died of sudden cardiac death, which is not related to hyperthyroidism.

The plaintiff asked for $7,005,631.52, a claim for pecuniary loss for her husband and grown children, and the funeral bill. No medical bills were submitted pursuant to motions in limine as the hospital care and the endocrinology office visit were required and not caused by any alleged deviations by the defendants. The plaintiff’s counsel did not put in any number for the pain and suffering between the discharge of June 21, and the death on June 23, and during closing argument on behalf of the endocrinologist it was argued that he did not even meet her until the afternoon of June 23, so damages prior to that could not be awarded.
Closing arguments of the plaintiff and three defendants and jury instructions took three and ½ hours, and the verdict came back in two and ½ hours. Joshua Bell was involved in preparation of the case, the motions in limine conference, as well as expert and defendant preparation.