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Unqualified Experts in Failure to Timely Administer tPA Claim; Clots


A patient was admitted to the hospital due to the new onset of hypertension, malaise, fevers, night sweats, Raynaud’s phenomenon, and a positive antinuclear antibody (ANA) test. In Raynaud’s phenomenon, also called Raynaud’s syndrome, smaller arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to the affected area. ANA tests help evaluate a patient for autoimmune disorders.

 

The following day, the patient underwent an angiogram of the upper extremities. An angiogram is a medical imaging technique used to visualize the inside of blood vessels.

 

Two hours and fifteen minutes after the angiogram, the patient developed nausea, left facial droop, an inability to move the left arm, and weakness in the left leg. A stroke code was called. Hospital staff considered whether to administer tissue plasminogen activator (tPA), a protein involved in the breakdown of blood clots used to treat ischemic type strokes. tPA needs to be administered within three hours of the onset of stroke symptoms or up to four hours and 30 minutes in certain eligible patients. A CT scan of the patient’s brain was ordered to determine any tPA contraindications. Three hours and 55 minutes after the onset of symptoms, a telestroke consultant recommended treatment with tPA. The final decision to administer the tPA was made four hours and 15 minutes after the onset of symptoms. The tPA was not administered within four hours and 30 minutes of the onset of symptoms. Consequently, the order for tPA was cancelled.

 

The patient brought a health care liability claim against the hospital. The complaint argued the hospital’s treatment of the patient fell below the standard of care when hospital personnel failed to mix the tPA and administer the tPA to the patient within ten minutes of the order for the tPA given by the telestroke consultant.

 

In support of the complaint, the patient provided two expert opinions. One expert was a board-certified neurologist who worked in a stroke center. The expert was not a nurse and was not a hospital employee. The expert explained that the expert had clinical experience in giving tPA to patients and evaluating the outcomes of patients after tPA was given. The second expert was board-certified in internal medicine, rheumatology, and geriatrics. The expert was on the attending staff at a hospital. The expert had diagnosed and treated patients like the patient at issue in this case and conferred with radiologists and primary care providers in the administration of tPA in a hospital setting.

 

The County Court at Law No. 1 of Nueces County, Texas, denied the hospital’s motion to dismiss.

 

The Court of Appeals of Texas, Corpus Christi-Edinburg, reversed. The court held that the trial court abused its discretion in overruling the hospital’s objections to the reports of the patient’s experts.

 

The trial court abused its discretion in overruling the hospital’s objections to the reports of the patient’s experts. To opine on the standard of care applicable to a non-physician health care provider, an expert must meet certain qualifications, including knowledge of accepted standards of care for the health care services relevant to the pleaded claim and actively rendering health care services relevant to the pleaded claim. The health care services relevant to the pleaded claim involved hospital personnel mixing and administering tPA. The court concluded that the trial court abused its discretion by concluding that the patient’s expert neurologist was qualified to opine on the standard of care applicable to the hospital because the patient’s expert failed to demonstrate knowledge of accepted standards of care for hospital personnel in mixing and administering tPA and failed to demonstrate that the expert was actively mixing and administering tPA. The patient’s other expert did not indicate in a non-conclusory fashion that the expert was actively mixing and administering tPA. The court concluded that the trial court abused its discretion by concluding that the patient’s other expert was qualified to opine on the standard of care applicable to the hospital because the patient’s other expert failed to demonstrate knowledge of accepted standards of care for hospital personnel in mixing and administering tPA and failed to demonstrate that the expert was actively mixing and administering tPA.

 

The Court of Appeals of Texas, Corpus Christi-Edinburg, reversed the trial court’s denial of the hospital’s motion to exclude the patient’s experts.

 

See: Christus Spohn Health System Corp. v. Alaniz, 2018 WL 3673013 (Tex.App.-Corpus Christi, August 2, 2018)(not designated for publication).

 

See also Medical Law Perspectives Report: Stroke: Challenges, Risks, and Liability Issues

 

See also Medical Law Perspectives Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death

 

See also Medical Law Perspectives Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication 

 

 

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