Failure to Diagnose Stroke; Verdict for Physician

A patient became ill and received permission from the halfway house where the patient resided to go to a clinic for medical care. The patient complained of headache, neck pain, and dizziness. The patient was diagnosed with headache and acute sinusitis, prescribed one medication, and returned to the halfway house.


Three days later, the patient received permission from the halfway house to go to the emergency room (ER). The patient complained of worsening headache, nausea, dizziness, and vomiting. The patient reported a history of migraines. The patient was seen by an ER physician. The ER physician ordered a head CT scan that was reported as normal. The patient was treated with medication and released back to the halfway house.


Two days later, the patient was sweating, had a swollen throat, could not breathe, and experienced right side facial drooping. The halfway house did not release the patient to return to the ER for approximately twenty-four hours after the patient’s symptoms were reported to halfway house staff.


When the patient returned to the ER, the patient was triaged and seen by the same ER physician. An MRI of the brain revealed a cerebral stroke with vertebral artery dissection, a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. The patient was transferred to a medical center where the patient remained hospitalized for approximately two months. The patient suffered permanent bilateral paralysis requiring the use a wheelchair.


The patient sued the halfway house and the ER physician. The complaint alleged that the halfway house failed to get the patient needed medical attention. Additionally, the complaint alleged that the ER physician rendered negligent care, leading to delayed detection and treatment of the stroke. Before trial, the patient settled with the halfway house.


The jury instructions did not explain the effect of any fault allocation. The halfway house was listed on the verdict form as a potential nonparty at fault. During deliberations, the jury asked, “If we attribute 25 percent fault to [the ER physician] and 75 percent to [the halfway house] would [the patient] only get 25 percent since [the halfway house] has been released?” The jury also asked, “If [the halfway house] has been released how [is it] still named in the lawsuit?” The trial court answered both questions by directing the jury back to the original instructions. The jury returned a verdict that the ER physician was not negligent and, as advised by the verdict form, stopped there.


The Iowa District Court for Pottawattamie County denied the patient’s motion for a new trial and entered judgment on the jury’s verdict in favor of the ER physician. The Iowa Court of Appeals affirmed.


The Supreme Court of Iowa affirmed. The court held that the trial court did not abuse its discretion in answering the jury’s questions.


The trial court did not abuse its discretion in answering the jury’s questions. The court explained that although the trial court could have, and probably should have, given an affirmative answer to the first question, the court found no prejudice on the record. The court reasoned that the jury understood that its verdict of no negligence by the ER physician would result in no damages being awarded against the ER physician. Consequently, any jury confusion as to whether an award of some damages would be reduced was immaterial. The court concluded that the trial court did not abuse its discretion by directing the jury back to the original instructions in response to the jury’s questions.


The Supreme Court of Iowa affirmed the trial court’s entry of judgment on a jury verdict in favor of the ER physician.


See: Mumm v. Jennie Edmundson Memorial Hospital, 2019 WL 982893 (Iowa, March 1, 2019) (not designated for publication).


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