Case details

Radially placed stent was within standard of care: cardiologist

SUMMARY

$0

Amount

Verdict-Defendant

Result type

Not present

Ruling
KEYWORDS
chest pain, extensive bleeding, prior carpal tunnel injury, wrist
FACTS
In 2014, plaintiff Frank Kruger, a glazier in his 40s that was on disability, underwent a stent placement for a myocardial infarction by Dr. Dimitri Sherev, a cardiologist. Kruger previously developed problems in his right hand and wrist in around 2003 and 2004. He subsequently underwent three surgeries on that arm, including an ulnar transposition and a carpal tunnel release, and from thereon, was on workers’ compensation disability from his profession. Kruger also underwent three surgeries on the other arm. When Kruger developed chest pain in 2014, he presented to Sharp Grossmont Hospital, in La Mesa, where he was seen by Sherev, the on-call cardiologist, for treatment of a heart attack. Though in the past, stents were placed femorally, through the groin, they also been placed through the radial artery in the wrist. Accordingly, Sherev placed the stent through Kruger’s right wrist. Kruger claimed that he suffered extensive bleeding during the catheterization, which put pressure on the area of the stent placement. He alleged that as a result, the surgery caused an exacerbation of his prior carpal tunnel injury. Kruger sued Sherev and Sharp Grossmont Hospital. Kruger alleged that the defendants failed to properly perform the catheterization procedure and that this failure constituted medical malpractice. Sharp Grossmont Hospital was ultimately dismissed from the case prior to trial. Thus, the matter proceeded to trial against Sherev only. Plaintiff’s counsel contended that Sherev failed to timely diagnose the excess bleeding that occurred during the catheterization and thereby caused pressure to build up in the cavity and compressed the nerve, causing an aggravation of Kruger’s prior carpal tunnel injury. The plaintiff’s orthopedic experts opined that Kruger’s right wrist problems occurred due to the bleeding of the compartment during catheterization by Sherev. The plaintiff’s cardiology expert opined that, knowing Kruger’s past problems and surgeries with his right hand and wrist, Sherev fell below the standard of care by not placing the stent traditionally through the groin and that there was no reason to not place the stent through the groin. The defense’s cardiology expert opined that the catheterization through the wrist was fine and within the standard of care. The expert also opined that placing the stent through the wrist is the preferred and safer method, as there is less of a risk of injury then going through the groin., Kruger claimed that he suffered extensive bleeding during the catheterization, which put pressure on the area of the stent placement and caused an exacerbation of his prior carpal tunnel condition in his right, dominant hand. He alleged that although his arm was not asymptomatic at the time of the procedure, it was better the year before the procedure than it was after the surgery. Thus, Kruger claimed that the catheterization caused a re-exacerbation of his prior carpal tunnel syndrome. Kruger claimed that in the year before the procedure by Sherev, he was able to do things he had not been able to do for the previous nine years, such as surfing; cooking; playing the guitar, keyboards and drums; and using his right arm for activities of daily living. However, he claimed that after the surgery, he suffered pain and a loss of sensation in his right hand, causing him to be unable to use his hand or carry any weight with it at all. The plaintiff’s treating physiatrist testified that Kruger was basically asymptomatic in his wrist at time of surgery, but became symptomatic after the procedure. Although Kruger had been on disability from his job as a glazier since his prior surgeries, he had also worked as the lighting director for the Ocean Beach band, Slightly Stoopid, which traveled nationally. Thus, Kruger claimed he suffered a loss of earnings due to not being able to perform lighting work for the band during tours. Defense counsel argued that Kruger’s alleged carpal tunnel syndrome was not caused by the catheterization performed by Sherev. The defense’s expert cardiologist opined that he did not see how the placement of the stent could have caused Kruger’s wrist injury or even the alleged bleeding at the time of surgery. The defense’s expert hand surgeon opined that Kruger’s alleged injury was not caused by the radial catheterization and questioned whether Kruger’s injury was even real or not, noting that there were conflicting nerve tests reported, some of which showed there was no injury. Specifically, one of the plaintiff’s treating hand specialists, Dr. Merlin Hamer, an orthopedic surgeon, testified that the EMG testing of the right hand/wrist was normal after the surgery by Sherev, but that a different treating hand specialist, Dr. Chris Pallia, a sports medicine expert, testified that Kruger showed a positive EMG testing.
COURT
Superior Court of San Diego County, San Diego, CA

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