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For an initial courtesy consultation, contact us at (410) 730-5016 or (410) 720-6129. The information provided herein is not intended to be legal advice, and should not be considered as such.
A DISCUSSION OF SOME CURRENT CRITERIA FOR DIAGNOSING AND TREATING STROKE FROM A LEGAL PERSPECTIVE:
A major legal liability issue regarding stroke revolves around the use of tPA (tissue plasminogen activator : a clot busting drug). Not administering the drug for a qualified patient could likely constitute a departure from good and accepted medical practice --- and lead to a medical malpractice lawsuit.
There are published criteria for the use of tPA by such organizations as the American Heart Association, the American Medical Association, and the American Hospital Association ,et al.
pTA can be initiated , generally, within 3 hours of onset of stroke, but poor documentation in the patient's medical chart of the time of onset can make the physician particularly vulnerable to a malpractice action. And, failure to consult family members as to time of onset can lead to mistakenly
withholding tPA.
It has become more common to find cases where tPA was withheld than cases where it was given inappropriately (against the American Hospital Association guidelines). A major risk factor is
bleeding into the brain. As of 2009, tPA may now be used up to 4.5 hours after onset of a stroke.
The efficacy of tPA as initially reported was 30-38%, thus depriving a patient of the opportunity of
a better outcome. A retrospective statistical review posits that the rate of improvement is actually 60%., i.e. more likely than not to have a better outcome.
The lack of administration of heparin/Coumadin is more problematic. Coumadin is the standard
of care for cardiac -sourced emboli to the brain (atrial fibrillation, ventricular aneurysm with clot).
It is not currently proven to be of value for other types of stroke, TIA or stroke in evolution ( so-called " warning stroke"). However , liability may ensue from withholding Coumadin (such as dental surgery) and never re-instituting it, resulting in stroke.
Transient Ischemic Attacks (TIAs) have received a great deal of attention in the most recent medical literature. A TIA may be considered a medical emergency as the risk of stroke in the immediate following days is high. TIAs are treated with aspirin, Plavix or Aggrenox (except cardiac sources = heparin/Coumadin). Normally, appropriate work-up may discover a severe carotid stenosis, which may be treated by surgery. It is believed that platelet inhibitors such as aspirin are statistically effective at about 30%, and there is minimal difference among them.
Heparin Induced Thrombocytopenia (HIT) is another relatively new issue in diagnosing and treating strokes. Failure to recognize this entity can result in thrombosis of cerebral veins, arteries and stroke.
Posterior Reversible Encephalopathy Syndrome (PRES) is rare, but if untreated can result in stroke. PRES is seen in pre-eclamptic/eclamptic women and requires aggressive blood management. Stroke usually results in blindness due to the posterior brain location of this under-recognized obstetrical problem.
[http://www.medquestltd.com/medquest-neurologist-discusses-current criteria -for diagnosing-and-
treating stroke]
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