Delayed Cardiac Cath $45 Million
The Baltimore Medical Malpractice Lawyer Blog reports medical malpractice verdicts. This post discusses a delayed cardiac cath that resulted in death.
Time is Heart Muscle: When Delayed Cardiac Cath Becomes Medical Malpractice
The difference between life and death during a massive heart attack is often minutes. In the world of cardiology, a widely understood and critical concept is that “time is heart muscle.” Minutes can waste due to hospital negligence, miscommunication, or—shockingly—internal policy. The results of a delayed cardiac cath can be catastrophic. It can lead directly to multi-million-dollar medical malpractice verdicts.
A recent jury verdict serves as a grim and powerful example. It highlights high-stakes legal ramifications. The healthcare system prioritized internal patient retention over a patient’s most urgent need for life-saving care.
The Crisis: Understanding the Causes of a Heart Attack
A heart attack is also medically a myocardial infarction (MI). It occurs when a portion of the heart muscle doesn’t receive enough oxygenated blood. A blockage in one of the coronary arteries typically caused the lack of blood flow.
The vast majority of heart attacks are caused by Coronary Artery Disease (CAD), a condition where a waxy substance called plaque—made of fat, cholesterol, and other materials—builds up inside the arteries, a process known as atherosclerosis.
The critical event that triggers a heart attack is the rupture of this plaque. When a plaque deposit breaks open, a blood clot rapidly forms on its surface. If this clot completely blocks the artery, it will cut off blood flow to the heart muscle. This causes the muscle to begin dying within 30 minutes of the blockage. This complete blockage, often identified on an electrocardiogram (ECG) as an ST-Elevation Myocardial Infarction (STEMI), is a true medical emergency that requires immediate intervention.
While less common, other causes of a heart attack include:
- Coronary Artery Spasm: A sudden, severe tightening of the artery that temporarily stops blood flow, which can occur even without significant plaque buildup.
- Spontaneous Coronary Artery Dissection (SCAD): A life-threatening, non-traumatic tear that forms inside the artery wall.
- Coronary Artery Embolism: A blood clot that travels from another part of the body and lodges in a coronary artery.
We will see below that the patient must get to a cardiac cath lab without delay.
The Life-Saving Solution: The Cardiac Catheterization Lab
For a patient suffering a STEMI, the definitive, gold-standard treatment is a procedure doctors perform in a specialized area of the hospital – the Cardiac Catheterization Laboratory (Cath Lab).
A cath lab is a high-tech examination room with advanced imaging technology. It is used to both diagnose and treat a variety of heart conditions. The primary emergency procedure performed is:
- Coronary Angiogram: The doctor, often an interventional radiologist or interventional cardiologist, inserts a catheter—a long, thin, flexible tube— through an artery, usually in the wrist or groin, and threads it up to the heart. A special dye is injected, and X-rays are taken to visualize the arteries and pinpoint the exact location and severity of any blockage.
- Percutaneous Coronary Intervention (PCI) / Angioplasty and Stenting: Once the doctor finds the blockage, they inflate a tiny balloon at the tip of the catheter to compress the plaque and open the artery. In most cases, a metal mesh tube called a stent is then permanently implanted to prop the artery open and restore blood flow.
This procedure is a race against the clock. The current standard of care for a patient who must be transferred from one facility to another for this procedure—known as the “first medical contact-to-device” time—is recommended to be no more than 120 minutes. Every minute lost means more heart muscle dies, leading to permanent damage and a significantly lower chance of survival.
Not All Hospitals Are Equipped: Understanding Cardiac Care Levels
The critical nature of a heart attack requires a high level of specialized care, and not every hospital can provide it. In many states, cardiac catheterization services are categorized into different levels based on their capabilities, particularly whether they can provide interventional procedures and surgical backup:
- Level I: Typically offers low-risk or diagnostic-only catheterization services.
- Level II: Offers some high-risk and interventional procedures (like PCI), but does not have on-site open-heart surgical back-up.
- Level III: Provides the highest level of care, offering all risk and all interventional procedures, with mandatory on-site open-heart surgical back-up. These hospitals are often comprehensive cardiovascular centers and are the ideal, non-negotiable destination for a STEMI patient.
Hospitals that are not Level III or a PCI-capable facility must adhere to strict transfer protocols. This is to ensure the rapid moving patients suffering a STEMI to a center that can provide definitive cardiac cath care without delay.
The EMS Protocol: The Prehospital Deciding Factor
The race to the cath lab begins the moment the Emergency Medical Services (EMS) team arrives on the scene. First responders are the first crucial link in this chain of survival:
- Diagnosis: First responders use a prehospital 12-lead ECG to rapidly diagnose a STEMI. The presence of ST Elevation of ≥2 mm in two or more adjacent leads is often the trigger for immediate action.
- Activation: Once EMTs confirm a STEMI, EMS protocols dictate immediately activating the receiving hospital’s cath lab team while the patient is still en route. This pre-alerting ensures that the team, including an interventional cardiologist, is ready upon the patient’s arrival.
- Destination Decision: Critically, first responders are to bypass community hospitals that lack PCI capabilities and transport the patient directly to the closest Level III or PCI-capable facility. In ideal scenarios, the EMTs take the patient straight to the cath lab, bypassing the Emergency Department (ED), to minimize the crucial “door-to-balloon” time.
This system is designed to overcome initial obstacles and eliminate unnecessary delays at facilities that cannot provide the necessary care.
A Fatal Cardiac Cath Delay: The $45 Million Malpractice Verdict
The recent verdict is a devastating illustration of what happens when this critical system breaks down.
The decedent suffered a fatal heart attack after EMTS first took him to a local hospital. This was a facility that was, by all accounts, unequipped to perform the urgent catheterization and stenting he desperately needed. The emergency responders alerted the hospital staff to the severity of his STEMI condition. They also conveyed his need for a PCI-capable center. However, the staff at the local hospital made the fatal decision to admit him to their facility.
The staff did not immediately direct the ambulance to the nearby, fully equipped facility. Instead, they admitted the patient. They then transferred him by helicopter to a different hospital within the same network. This internal transfer, which allegedly prioritized keeping the patient within the hospital system rather than providing immediate care, resulted in a delay of nearly 90 minutes.
The decedent died shortly after arriving at the receiving hospital, without ever getting the life-saving intervention he required.
The family filed a medical malpractice lawsuit against the health network. It argued that the system acted with negligence. It further prioritized its own internal financial or patient retention goals over the patient’s established, time-sensitive medical needs. A jury agreed with the family. It found the hospital acted with reckless disregard. The jury delivered a staggering $45 million verdict to the widow and minor children.
The Legal Ramifications of Delayed Cardiac Cath
The $45 million verdict sends an unambiguous message. Healthcare systems have a duty to adhere to established, life-saving protocols. This is especially true for time-critical conditions like a heart attack. When a hospital is aware of a patient’s need for an immediate procedure—such as a PCI in a cath lab—and they fail to transfer the patient to an appropriate facility in a timely manner, it constitutes a clear deviation from the standard of care.
The standard of care demands efficiency, coordination, and a singular focus on the patient’s well-being. A transfer delay, whether driven by administrative inertia or prioritizing internal network revenue, is a form of medical negligence that can—and in this tragic case, did—cost a life. For victims and their families, a medical malpractice lawsuit is often the only path to accountability and justice when a system fails at the moment it was most needed.
If you have been injured by delay in getting to a cardiac cath lab, or were injured in the lab, see below to contact the Kopec Law Firm.
Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.