The Legal Examiner Mark The Legal Examiner Mark The Legal Examiner Mark search twitter facebook feed linkedin instagram google-plus avvo phone envelope checkmark mail-reply spinner error close
Skip to main content

I came across this interesting case, today; a Massachusetts jury has found a doctor negligent in the death of a college basketball player. The 22 year old student collapsed and died, during a 2005 game, of hypertrophic cardiomyopathy.

At issue in the case was the fact that the doctor had examined the student in 2001 for the purpose of determining whether he was medically eligible to play college sports. The exam disclosed a "slight systolic murmur" but the doctor declared the student in excellent health, placed no physical restrictions on him, and signed a clearance form to that effect. But, the doctor also, apparently, ordered an electrocardiogram (EKG), which would have revealed the more serious condition, but the test was never performed. According to attorneys representing the plaintiff, her opinion to clear him to play should not have been made without further examination and workup.

I want to focus on one area of controversy in the case because it points out the difference between a plaintiff’s attorney’s perspective of medical malpractice litigation and a defendant’s attorney’s perspective. Plaintiff’s attorney argued that more workup was necessary and that the clinic had no record of the plaintiff ever being examined there (except for the completed release form). As a result, they argued, successfully, I might add, that nobody followed up and the condition went undiagnosed. Defense attorneys argued that the physician ordered the EKG and that the plaintiff never showed up. They argue that it is sad that a young man died, but the doctor "ordered the test".

Sounds reasonable to some, right? The doctor ordered the test, the plaintiff didn’t show (if you are inclined to believe the defense’s argument); what more can be done? The plaintiff is responsible for his own death, right?

Wrong. Here’s the problem: If the doctor felt that an electrocardiogram was indicated and a preliminary exam found a "slight systolic murmur", why did the doctor clear the student to play? Why did she sign the form? He was a young, impressionable, athelete; she was the professional. Why not condition his clearance upon the completion of the test? I am certain that this was the "more workup" that the plaintiff’s attorneys were refering to.

Here is my message to the defense attorney: Yes, sir, it is a sad case, and maybe your client ordered the test. But her failure to complete her examination before declaring the student to be in "excellent health" breached the standard of care, directly caused his death, was negligence, thus was medical malpractice. Even if the young student failed to show up, his attendance would have been guaranteed, had she conditioned his clearance on completion of the EKG. Failing to do so was, in my opinion (and the Suffolk County jury’s) malpractice. While other doctors examined the student over the last few years of his life, all of whom were provided the heart murmur report, their apparent negligence does not excuse the first doctor’s original negligence in losing track of her patient and failing to perform the test she deemed necessary.

Lawsuit Financial, the pro-justice lawsuit funding company congratulates the attorneys and the family of this unfortunate young man on finally receiving justice in this case and we offer our condolences to the family on the loss of a vital and talented young man. Their attorney said (about the family): “They finally feel like justice has been done.’’ Amen to that.

10 Comments

  1. Gravatar for lisa salberg

    I could not agree more with your take on this important case. I have had the honor of working with this family since the death of their son. It was clear to me within a few short days that this doctor failed to deliver the standard of care required, it took 5 years to play out in the court.

    Antwoine did not die in vain... this case will bring attention to this important issue.

    Thank you!

  2. Lisa: Thanks for the kind words. I try to educate the public about important legal issues as often as I am able to. The defense that "she ordered the test" bothered me because the doctor had to do very little to prevent this young man's death. All she had to do was refuse to clear him to play without the EKG. Simple, huh?

  3. Gravatar for Jim O'Hare AIC AIS VP med mal claimsj
    Jim O'Hare AIC AIS VP med mal claimsj

    How many active athletes have slight heart murmurs, have an active college career and do not die young?- Most of them.

    Sad case and condolences to the family. This is a rare outcome compared to the thousands of kids that play ball with a cardiac problem.

    I read the article highlighted inside your article, and 5 other physicians also had the diagnosis of the slight murmur and cleared him to play. Where were they and why is their clearance not considered negligence? None of them thought an EKG was warranted?

    These type deaths are in the news a dozen times a year and somebody must be at fault each time. I know that I am in the minority on this site, but think about it for a second.

    Do you think that this young man would quit a game that he loves just because a doctor told him that he could not play "organized" ball? New rule- if you have a slight heart murmur stick to Nintendo because something bad could happen. Preserve your life by not living it, cause something bad could happen. Really?

    Is this were we want to go with this? If he was given a script for an ekg, and didnt go. 1) - the doc should have chased him down or 2) - definatly would have disclosed the terminal time bomb.

    Mark , how can you dismiss 5 other docs seeing this patient subsequent to the defendant doc and state with a straight face, that the 1st doc should have chased him down, because of the slight murmur!! That is 3 light years away from the standard of care.

    Regards Jim

  4. Gravatar for Lisa Salberg

    Mark,

    It was beyond simple and her failure to use good judgment denied this young man his life.

    Thanks for reporting on the legal side of the tragic case.

    Lisa

  5. Jim: I am "dismissing" no one and nothing. I am simply saying that the negligence of 5 more doctors does not excuse the negligence of the first one. Had the permission slip been withheld pending the EKG and the defect diagnosed, the doctor would not be culpable, even if the player played and the school allowed him to. Violating doctor's orders is on the player, not the doctor. That is not the case, here. The doctor clearing him to play without completing her exam was a death sentence and the jury agreed. You have little faith in juries; I believe that they are the bedrock of our legal system. That is the major difference between us. Regards, Mark

  6. Gravatar for lisa salberg

    Jim,

    You are misguided here. The American Heart Association has guidelines for screening athletes. The presents of a murmur is indication for a complete cardiac evaluation, that was not ordered in this case. From the legal point the school was required to have a "PPE" preparticipation physical evaluation, signed to allow this young man to play, the doctor signed the form without seeing the results of the test - or in this case even making sure the test was done. The signature was proof she disregarded the signal that the AHA had clearly laid out as a risk.

    Stats - 1 in 500 have HCM, and it is the leading cause of sudden death in the young, including athletes, that is why we look for those at risk. Each year over 25 kids die from HCM while participating in athletics. You may also be interested to know that the courts have held that those who fail to meet health requirements can be denied access to playing organized sports (Knapp v. Northwestern). Further you may wish to review the Bethesda Conference 36 on this matter.

    So what happens to a young athlete who is diagnosed with HCM, they are treated for their condition and given the opportunity to LIVE their lives. No they will not play organized competitive sports, but the list of things they CAN to far out weight the list of things they can not.

    Jim - I have spoken to hundreds of parents who have lost kids, wives who have lost husband and kids who have lost parents - the one thing they have in common - if they had only been diagnosed - then they may still be here. Antwoine had a sign, a murmur (which by the way can be transient in HCM) a doctor heard it and did NOTHING that is NOT what anyone has a right to expect, we have a right to expect that a professionals follow the standard of care - she did not.

    To answer your question - how many athletes play with a murmur - the real answer is likely too many and they may in fact be at risk for sudden cardiac arrest - they all need a complete cardiac evaluation- if it were your child I am sure you would obtain all testing to ensure your child is healthy and that the reason for the murmur is well understood and managed.

    Regards,

    Lisa Salberg

    CEO and Founder

    Hypertrophic Cardiomyopathy Association

  7. Gravatar for Jim O'Hare AIC AIS VP med mal claims
    Jim O'Hare AIC AIS VP med mal claims

    Thanks Lisa: I do not pretend to have all the facts with this case. Where were the subsequent 5 docs in this case. Can I assume that they were not concerned about the murmur and did not think that an EKG was warranted? Would any of those docs refused to sign the same release that the defendant did? Was there a script to get an EKG? Is it the obligation of the doc to police the patient?

    I agree that the doc should not have signed something based on her own contingency of the ekg. Do you give any weight to the fact that 5 subsequent docs, with the same info, did not even consider an EKG? Were there any EKG's subsequent to the defendant? True that I am a claims guy offering a view at the other side of the coin,I am just trying to add a little gin to the Koolaide served here and level the floor.'

    regards Jim

  8. Gravatar for Lisa Salberg

    Jim,

    The current system only requires that at the admission to school a PPE form is completed and signed. As i mentioned earlier, a murmur related to HCM can be transient in nature there is nothing in the record that clearly notes anyone else heard the murmur.

    Let me address your questions one at a time:

    Can I assume that they were not concerned about the murmur and did not think that an EKG was warranted? You can assume whatever you want... it is never a good idea to assume - No, this was not the case.

    Would any of those docs refused to sign the same release that the defendant did? Had they been responsible to approve him to play, in my exp. the form would not have been signed until the test was complete and results evaluated.

    Was there a script to get an EKG? Remains unclear, this doctors records were a mess and a large factor in the case.

    Is it the obligation of the doc to police the patient? Yes, i would argue that the "policing" would have been simply... you get the test then i will complete the form - this happens everyday in the USA.

    Jim,

    I have worked with over 5000 families with HCM around the world. Many of whom are not getting the care they need because doctors do not understand the condition. There are however only a handful of cases that I have seen that jump out and say WOW this is MALPRACTICE - this was one such case... and the jury agreed with me on this this one. The Science, the medical literature and common sense clearly indicate this doctor failed this young man.

    I appreciate your comments in this matter but the real effort should be to educate doctors about the real risks of sudden cardiac arrest in the young and ensure those at risk get appropriate evaluations. Which mind you is not a simple process and not a 100% guarantee that we will not have a bad outcome... but its what must be done and it is a start.

    Thanks!

    Lisa

  9. Gravatar for Kent(anarad)

    I'm not an attorney or physican, nor am I as well versed as Lisa regarding HCM. However, I want to add my "2-cents", I have HCM as does my 19yr old son. We both have ICDs. His was based on a strong recommendation from his physician in Minneapolis. About 4yrs ago he collapsed in gym class even tho' they weren't doing very much. If he didn't have an ICD, he'd be gone now. My advice to anyone...EARLY Detection and Prevention(not the best word, more like Safeguards).

Comments are closed.