A 60-year-old civilian employee at the Naval Shipyards in Bremerton started having pain in his left elbow. X-ray confirmed the presence of a loose body and osteophytes in his elbow. The orthopedic surgeon recommended, and the employee agreed to, arthroscopic surgery. The surgeon also ordered an ECG, as part of the work-up for surgery. The ECG was performed later that same afternoon.
The ECG was read by a cardiologist. It revealed abnormalities in the patient’s heart consistent with atherosclerotic cardiovascular disease. There is no evidence that the cardiologist reported his findings to the patient or anyone else.
The arthroscopic surgery took place six weeks later. The anesthesiologist noted the abnormal ECG in his pre-op anesthesia evaluation, but there is no evidence that he informed the patient of the abnormality, discussed it with the surgeon, or that he took any other action in response to it.
The patient survived the surgery. Over the next three months he was seen five times for follow-up from the surgery. The surgeon “discharged” the patient from care and cleared him to return to work. Three days later, he died. The cause of death was the atherosclerotic disease that had been discovered by the ECG some three and a half months earlier.
The difficulty in this case was causation. The question was whether treatment would have saved his life. We worked with our experts and agreed that treatment would have made a difference.