SUCCESSFUL MEDIATION IN PACEMAKER CASE WHICH GAVE RISE TO SERIOUS LIFE THREATENING COMPLICATIONS
Posted in News on Tuesday, July 6th, 2021
Pat Daly, ably assisted by Suzanne Buckley and Aoife Daly, settled this complex High Court medical negligence case by means of Mediation on the 30th April 2021.
On the 12th January 2015, our client became suddenly unwell, with symptoms of chest pain, shortness of breath, dizziness and palpitations. He subsequently complained of abdominal cramps. He was admitted to University Hospital Limerick (“UHL”) and he was diagnosed with an abnormal heart rhythm and referred to cardiology. Of note, the client had a past medical history of sleep apnoea and a “skipped heartbeat” in 2004 and a history of vasovagal (fainting) episodes. Our client had an angiogram which was grossly normal and the client was to be discharged. However, when they removed the cardiac catheter, the client’s heart rate dropped (he had a vasovagal episode) and he was admitted to the Coronary Care Unit. A permanent pacemaker was recommended and ultimately inserted. Post the insertion of the pacemaker, the client developed inflammation of the heart muscle (pericarditis) and fluid build-up within the lining of the heart (pericardial effusion) which are serious life threatening complications. The client had five subsequent emergency admissions to UHL, three in January 2015, one in February 2015 and one in May 2015. Ultimately, on the 27th May 2015, he was transferred to the Hermitage Hospital, Dublin for a cardiac MRI and to thereafter consider removing the pacemaker. However, the MRI could not be carried out because one of the pacemaker leads was not MRI compatible but the other two component parts were MRI compatible. In the absence of an MRI, the surgery to remove the pacemaker could not be performed and the client was treated conservatively with medication. Unfortunately, the client’s employers terminated his employment in May 2015. It took some time before the client’s condition slowly improved over many months whereby he was able to carry out the majority of his activities of daily living. In August 2016, he was able to resume employment. However, the pericarditis had become chronic and he still gets flares which fortunately respond to medication.
On investigating this case, we noted that our client was investigated thoroughly by a leading sleep apnoea expert in 2004 and the outcome of the investigations established that our client’s “skipped heartbeat” was due to high vagal tone (which has an influence on breathing, digestive function and heart rate) and was not related to obstructive sleep apnoea. On researching this case at the outset, we were of the opinion that this pertinent history (whilst in the records) appeared to have not been appreciated by the clinicians in UHL in 2015, although they recorded that the client had given the history of vasovagal episodes. Therefore, their index of suspicion should have been raised that the heart rate problems could be attributed to same. Therefore, they had not considered a differential diagnosis. We advised the client to instruct a renowned UK Cardiologist who formulated the opinion that the client’s heart rate dropping was indeed due to the high vagal tone and it was negligent to insert a permanent pacemaker which caused the client to develop an inflammatory response which caused pericarditis which gave rise to pain and an effusion which caused breathlessness and gave rise to post-cardiotomy syndrome. Secondly, there was a failure to treat these conditions in a timely fashion which caused the client to develop chronic pericarditis which is a very debilitating condition which can wax and wane. Liability was disputed the Defendant’s medical experts who supported the insertion of the permanent pacemaker and expressed the opinion that the complications were known and recognised complications. However, the case settled for a six figure sum at the Mediation.
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