MISSOURI -- If paramedics arrive on a scene where a patient is unconscious, there is implied consent to help him. But defense attorney Frederick Starrett argued in this case that when somebody is conscious and capable of making decisions, paramedics cannot force him to go to the hospital.
Plaintiff's attorney Ed Dougherty said this wasn't a case of a patient refusing care but rather of the emergency medical technicians not following their own protocol of putting the patient on an IV, which would have allowed them to give him cardiac drugs when he needed them.
This case was tried Nov. 26 to Dec. 14, 2007. It arose from a 911 call made from the plaintiff's home on Aug. 20, 2004. The complaint was chest pain.
Starrett said that when the Metropolitan Ambulance Services Trust crew arrived on the scene, they found Jeffrey Allen sitting on the couch in his living room in no apparent immediate distress. He was conscious and able to communicate with the crew. He responded to questions and indicated that while he had earlier complained of chest pain, at that time he was having some stomach pain or discomfort, which he described as indigestion.
The crew assessed Allen and tried to persuade him to go to the hospital, Starrett said. While they were doing that, Allen announced he was going to the bathroom and proceeded to do so. Within a few minutes of his return, he went into cardiac arrest and all efforts to resuscitate him in the field and in the hospital were unsuccessful.
An autopsy performed that same day indicated that Allen had died of a dissecting aortic artery.
Starrett said the evidence showed that the most significant danger of a dissecting aorta is immediate death. This can happen in one of two ways. The first is that the patient will bleed out from a rupture of the wall of the aorta, and the other is a malperfusion syndrome caused by occlusion of an artery supplying a vital organ, such as, in this case, the heart.
He said although there was a hospital approximately one mile from the Allen house, it didn't have the capability to handle a dissecting aneurysm. It would have been necessary after arrival at that hospital and diagnosis in the emergency room for Allen, had he still been alive, to have been transferred to another hospital.
Starrett said the evidence also showed that death was caused by an occlusion of the left main coronary artery, which feeds the heart, and by the time the MAST crew arrived on the scene, there was nothing anyone could have done to save the plaintiffs' decedent.
Dougherty disagreed with this summary. He said the paramedic and EMT failed to give adequate care when they arrived on the scene. There was no heart monitor applied, only one set of vitals taken and no IV placed.
He further said that Allen never refused treatment or transfer to a hospital, as was confirmed by the fire department personnel who were the firstresponders on the scene. Still, the MAST crew did nothing to stop the patient from going to the bathroom, and when he returned and went into ventricular tachycardia, they could not give him cardiac drugs because they had not put an IV in him. He also said that they never shocked him, and he deteriorated into ventricular fibrillation and cardiac arrest.
Dougherty said that he argued that Allen should have been transported to the hospital shortly after the crew arrived, should have been placed on an IV, never should have been allowed to exert himself by going to the bathroom without a monitor, and at least should have been shocked when he went into ventricular tachycardia.
Dougherty also said most people survive a dissecting aorta if they are kept out of cardiac arrest and do not rupture the wall of the aorta. If Allen had not exerted himself by getting up and going to the bathroom, even a partial occlusion of the coronary arteries could have been avoided.
He said the widow refused a $500,000 settlement because she was so outraged by the conduct of the MAST crew.
The jury found 9-3 for the defense.
Starrett said that one of the defendant's most important arguments (and one that was contrary to the plaintiff's case) was that the MAST crew could not force Allen to go to the hospital against his wishes nor physically prevent him from going to the bathroom in his own home.
"You can't treat anyone if they won't let you," Starrett said. "It's a team deal. "
Starrett said a strategy that worked in this case was repeating in his closing argument the exact words that the plaintiff's experts said.
"If you can use the actual transcript for closing, it's very effective," he said.
Facts of the Case
Type of Action: Wrongful Death
Court: Jackson County Circuit Court
Case Number/Date: 0516-CV18924
Verdict or Settlement: Defense verdict
Plaintiff's Expert: Theodore Tully, Jr., Westchester, N.Y. (paramedic), Dr. Robert Goldweber, Pasadena, Calif. (emergency medicine), David Kastl, Hilton Head Island, S.C. (cardiothoracic surgeon), Ralph Lazzara, Oklahoma City (electrophysiologist), John Ward, Prairie Village, Kan. (economist)
Defendant's Experts: Dr. Frederic Seligson, Kansas City (cardiothoracic surgeon), Dennis Allin, Kansas City, Kan. (emergency medicine)
Special Damages: $4.5 million
Last Pretrial Demand: $1.5 million
Last Pretrial Offer: $500,000