Peter Spataro and Amy Sumner Successfully Defend Cardiologist in Wrongful Death Suit

Peter Spataro, with the assistance of Amy Sumner, prevailed in defending cardiologist Dr. Mark Chin in a wrongful death case tried in Jefferson County, Missouri. The plaintiffs, the family of Jamie Swyers, alleged Dr. Chin was negligent in failing to order a stress test that would have led to the discovery of significant coronary artery disease. Jamie Swyers died at age 29 years old on May 12, 2002 of an acute myocardial infarction.

Mr. Swyers originally presented to Jefferson County Memorial Hospital emergency room shortly after midnight on Saturday, April 6, 2002 (about five weeks before his death) with complaints of constant, sharp, stabbing mid-sternal chest pain that increased with deep inspiration or bending. Approximately eight years earlier Mr. Swyers was diagnosed with systemic lupus erythematosis, a chronic inflammatory disease of the connective tissue that can attack multiple organs in the body. The physician who treated his lupus was Dr. Donovan Polack. Dr. Inderjit Singh was on call for Dr. Polack's group the weekend of April 6 and admitted Mr. Swyers under his care. Dr. Singh ordered a cardiology consult from Dr. Chin.

After reviewing Jamie Swyers' history, exam, and available labs, Dr. Chin described Mr. Swyers as suffering from pleuritic chest pain over the past several days, non-cardiac in origin, caused by painful breathing. He attributed this problem to Mr. Swyers' lupus. The pain was aggravated with deep breathing but not by meals or physical activity as would be seen in ischemic heart disease. Mr. Swyers experienced similar symptoms one year prior which had been attributed to pleuritis, a flare-up of lupus. Serial EKGs showed some Q wave and nonspecific ST wave abnormalities. Dr. Chin noted an outpatient stress test would be performed after a myocardial infarction (MI) was ruled out to ensure there were no underlying cardiac problems.

Dr. Chin ruled out an MI through negative cardiac enzyme tests and a pulmonary embolus by a negative CT scan. After reviewing four EKGs, Dr. Chin noted that they were abnormal but did not show signs of ischemia. He concluded Mr. Swyers' symptoms were caused by pleurisy or pericarditis secondary to lupus. In his consultation note, Dr. Chin added, "Need to rule out lupus heart and coronary heart disease." "Lupus heart" was a reference to Mr. Swyers potential for early onset coronary artery disease as a complication of his lupus. Dr. Chin concluded his note with a recommendation that Mr. Swyers could be discharged but, "...would advise outpatient echo and treadmill stress test for further cardiac evaluation." Dr. Chin verbally advised Mr. Swyers to obtain a stress test on an outpatient basis on Monday, April 7 or the following day. Dr. Chin testified the stress test was to further investigate Mr. Swyers' potential for coronary artery disease, given his non-specific EKG changes and history of lupus. Dr. Chin wrote his instructions for a stress test on a prescription pad, but did not write the order in the chart.

Prior to Mr. Swyers discharge, attending physician Dr. Singh told Mr. Swyers to follow up with his lupus physician, Dr. Polack, in two weeks and to also follow the instructions of Dr. Chin. Jamie Swyer's girlfriend at the time, Laura McKinney, and Jamie's mother, Deborah Swyers, both claimed Dr. Chin never mentioned a stress test or that Mr. Swyers had possible heart problems.

Mr. Swyers failed to keep his appointment on April 25, 2002 with Dr. Polack. Two and a half weeks later, on May 12, 2002, Jamie Swyers died outside of his apartment. Paramedics were unable to resuscitate him. Dr. Mary Case, the Jefferson County medical examiner, performed an autopsy on Mr. Swyers after he had already been embalmed. Dr. Case found substantial adhesions around his pericardium and pleural spaces, and a 95% occlusion of his left anterior descending coronary artery. She concluded the cause of death was acute heart failure secondary to severe coronary artery disease. However, she did not perform a microscopic exam of the heart. After the lawsuit was filed and slides were made for the defense experts, Dr. Case reviewed the slides as well and concluded Mr. Swyers' 95% occlusion included evidence of a very recent blood clot that formed when the plaque ruptured in the artery.

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The plaintiffs, family of Jamie Swyers, alleged Dr. Chin was negligent in failing to communicate that a stress test needed to be performed on Jamie Swyers to rule out coronary artery disease. Plaintiffs argued if Jamie underwent a stress test during or immediately following his hospital visit on the weekend of April 6, 2002, significant narrowing of the left anterior descending artery would have been discovered and it could have been treated.

Plaintiffs relied on the medical testimony of Dr. Mary Roman, a cardiologist from Cornell University in New York. Dr. Roman testified that abnormal ST segment and Q waves on the patient's serial EKGs were diagnostic of ischemia and that coronary artery disease needed to be ruled out on an inpatient basis. Dr. Roman believed the coronary artery occlusion found by pathologist Dr. Case would have been disclosed by a stress test a month prior to Jamie Swyers' death. Dr. Roman testified that Jamie Swyers would still be alive today because a stress test would have led to successful treatment of his ischemic heart disease.

Plaintiffs also presented testimony of Jamie Swyers' mother and his girlfriend at the time, Laura McKinney. Ms. McKinney claimed she was in the room when Dr. Chin spoke with Mr. Swyers and that he never mentioned anything about a stress test or possible heart problems. She admitted, however, a stress test was mentioned by a nurse. The mother also testified she spoke with Dr. Chin and that he never told her son he needed a stress test to rule out coronary artery disease.

Experts for the defense, Dr. Richard Brasington, a rheumatologist, and Dr. Patricia Cole, a cardiologist, both from St. Louis, refuted Dr. Roman's opinions regarding the EKGs and care of the patient. While Drs. Brasington and Cole agreed the ST waves showed a nonspecific abnormality, they completely disagreed that the EKGs were diagnostic of ischemia. Both agreed with Dr. Chin's diagnosis that Jamie Swyers exhibited a classic presentation of pleuritic pain secondary to lupus during his April hospital visit. Dr. Cole testified she saw no evidence of ischemia and considered it within the standard of care to not have ordered a stress test at all. Dr. Cole believed that Dr. Chin was being "compulsive" in ordering a stress test.

The defense also presented cardiologist and pathologist, Dr. Ahvie Herskowitz, to examine slides taken of Mr. Swyers' heart vessels by the original pathologist Dr. Case. Dr. Case performed a gross examination of Mr. Swyers but did not review the slides under a microscope at the time of the autopsy. Dr. Herskowitz testified that a plaque rupture and blood clot formed in a section of the left anterior descending (LAD) artery which was no older than a few hours at the time of Mr. Swyers' death. Another section of the LAD was found to be 80% occluded by Dr. Case's gross examination, but under the microscope, Dr. Herskowitz believed it was about 70% narrowed.

Given Herskowitz's microscopic findings, Drs. Cole and Herskowitz believed if Jamie Swyers underwent a stress test in April, it would not have disclosed any coronary artery disease. They testified that the section of the LAD that was 70% occluded at death, would have been closer to 60% narrowed in life, and possibly even less, during Jamie Swyers' hospital visit in April. A 60% or less narrowing will not usually be picked up on stress testing. Also, the area of the acute plaque rupture contained a clot that was only a few hours old. In April, this same area would have been 60% or less blocked and therefore, a stress test at that time would not have been positive.

The trial began on June 1, 2009 and closing arguments were given on June 4, with a jury verdict in favor of Dr. Chin shortly thereafter. The jury attributed 100% fault to decedent Jamie Swyers for failing to follow Dr. Chin's instructions for a follow-up stress test. In summary, the jury believed the testimony of Dr. Chin that Mr. Swyers was told to undergo a stress test but he failed to follow Dr. Chin's advice.

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