Cases
 
     
Cases

tPA ... "it's a cookbook, like making pork roast"
 
"Proof Positive"
 

"Proof Positive" Case Summary

This case involves a patient (“Patient”) who died unexpectedly. She was a young, healthy woman who had an uncomplicated vaginal delivery of a healthy baby three days before her death. On the day of her demise, she first presented to her personal doctor with dyspnea. She was sent to the emergency department of the local hospital where she was found to be hypoxic. A chest X-ray was normal. She was started on heparin for a suspected pulmonary embolism (PE) and transferred to a university hospital for further care.

At the university hospital, she was seen by several doctors, including emergency department (ED) residents and attending physicians, as well as residents and an attending doctor from the intensive care unit (ICU). A transthoracic echocardiogram was performed, showing evidence of right heart strain, elevated pulmonary artery pressures and right ventricular hypertrophy.

A plan was formulated for performing a CT scan and then taking the patient to vascular interventional radiology for a directed infusion of t-PA. However, her condition rapidly deteriorated and she suffered cardiopulmonary arrest. Resuscitation efforts failed and she died.

There was no autopsy, vascular studies of her legs (which were ordered but cancelled), V/Q scan or CT scan performed. The family brought suit for wrongful death.

The only expert for the plaintiffs was Dr. Philip G. Leavy. His deposition, which was taken on two separate days, is reproduced in its entirety. The names of the patients and physicians and hospitals have all been removed for confidentiality.

Dr. Leavy is listed as a clinical associate professor of emergency medicine at the Eastern Virginia Medical School’s Department of Emergency Medicine. As described in his deposition, his training consisted of a one year internship in surgery. He passed his board examination in emergency medicine in 1980; its first year.

He has served as a witness in many malpractice actions.

His testimony in this action is remarkable for several claims, or statements, that are not supported by the literature in general or the specific references submitted by him. These include:

  1. The claim that a PE can be diagnosed based on echocardiogram plus a high clinical suspicion of PE;
  2. The claim that treating “submassive PE” with t-PA or other thrombolytics represents the standard of care;
  3. Failure to read the references he provided in support of the above contentions;
  4. Misquoting submitted literature or references.

These are described in the description of the deposition.

Removed names in the full deposition:
[Patient] – Patient who died
[Husband] – Patient’s husband when she died
[Mother] – Patient’s mother
[Father] – Patient’s father
[Doctor #1] – ED attending physician
[Doctor #2] - Resident working in the ED when patient arrived
[Doctor #3] – Resident who replaced Doctor #2
[Doctor #4] – ICU attending doctor
[Doctor #5] – Internal Medicine Resident
[Doctor #6] – ICU Resident
[Outside Doctor] – Physician from community hospital who transferred patient to specialty hospital
[Nurse] – One of the nurses working in the ED

Links

Selected Deposition Testimony
Deposition in Full
Brief Discussion of Submassive Pulmonary Embolism

Note: Dr. Leavy has not replied to our letters offering a chance to respond.

 

 

 

 

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