report of a medical malpractice induced death due to dipyridamol thalium perfusion scan

ABSTRACT

Currently Fschemic Heart Diseases are evaluated by nuclear techniques imaging of mqocardical perfasion. Cardiologist with CPR instruments Should be Stated in all nuclear imaging Centers. Our patient was a 56 years old woman with a history of hypertension and ischemic heart disease which was hospitalized because of acute pulmonary edema in a hospital in 2003.During hospitalization period her cardiac enzymes rose. Her lectrocardiograph showed left bundle branch block pattern and her Ejection Fraction in echocardiography was 40%. 2 days after dicharge from the hospital according to her doctor advice referred to a nuclear medicine center for Dipyridamol Thalium Scan Perfusion test [SPECT] at 8.30 pm. During infusion of scan specific drug she complained of headache, cough and dyspnea which were relived with primary cares.During this period she was under observation of a cardilogist. After infusion she waited in the waiting room until the time of imaging .After one hour and a half gamma camera imaging began and at the 15th min of imaging process she complained of dyspnea and her respiratory rate began to decrease. At this time, 2 imaging technicians and one nurse which were available on her side began primary cardiopulmonary resuscitation and then she was transferred to the emergency center of a hospital. CPR continued and the patient was admitted to ICU. At 1.30 Am of the following day she died at ICU and death certificate was issued for her at the hospital without biopsy. Following protest of her family, the case was propounded in one of the especial commissions of legal medicine organization and the final decision of the commission was declared as follows The role of burden of disease in death of the patient 75% The role of technical assistant of the institute in death of the patient because of not existence at the institute during the test ant not programming for attendance of a cardiologist during all phases of the test 15% The role of cardiologist in death of the patient because of not following the patient procedure and leaving institute before the end of imaging process 10%. At the majority of cases, the only reason that causes our physicians in spite of their wisdom and specialty are found guilty in the courts is unawareness of their legal responsibilities. The other important point in this case is issuing the death certificate without referring the cadaver to the legal medicine center for biopsy which could change the outcome of the court