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Saturday, October 4, 2008

We can still do some good: Public learning from a fatal misdiagnosed aortic dissection

This story was the subject of a particularly popular seminar at the conference today of the American Society for Healthcare Risk Management in Boston. It was so popular that the room was filled to capacity, leaving many others outside – like me. So this story comes from Michael O’Connor of the Omaha World-Herald, rather than from the presentation by lawyer Sara Juster, Vice President of the hospital:

Watch a new video produced by Methodist Hospital and you'll see Tyler Kahle looking just like he did the weeks before he died: chiseled face, short brown hair and a big smile.

The death of the 19-year-old Omahan five years ago resulted in a lawsuit against Methodist and an out-of-court settlement that included creation of the video.

Parts of the 20-minute video are a tribute to the young man. It shows him graduating from high school, skateboarding, wave-boarding and doing the high-energy activities he loved.

Other parts carry messages that legal experts say are surprising and uncommon.

In the video, initiated by Methodist, the hospital's doctors acknowledge the mistakes that Methodist made in diagnosing the medical problem that caused his death. Legal experts say it's rare for doctors and hospitals to publicly acknowledge mistakes after a settlement.

"It's more common that they don't parade around [saying] that we made a mistake," said Craig Dallon, a professor at the Creighton University School of Law.

What's also unusual, he said, is that Methodist has posted the video, made in cooperation with Tyler's family, on its Web site and plans to distribute it as a DVD nationally to educate other hospitals and doctors about the aortic dissection that led to Tyler's death.

"It was a way to memorialize Tyler, and we hope to prevent this from happening again," said Sara Juster, a vice president for Nebraska Methodist Health System, whose duties include overseeing the hospital's legal cases.

During negotiations for the settlement with the man's family, Methodist raised the idea of the video and the family backed it, said Juster and Deb McMillan, Tyler's mother.

Deb said the video provided the justice she wanted for her son. She wanted Methodist to publicly admit its mistakes. She also wanted the hospital to help educate other health care providers and prevent deaths.

"If I can't have my son back, we [can still do] some good," she said.

During an eight-day span in fall 2002, Tyler went twice with chest pains to the Methodist emergency room and once to his family doctor at Methodist Physicians Clinic.

All three times, Methodist physicians diagnosed and treated Tyler for upper respiratory problems.

Deb repeatedly told Methodist doctors about her son's family history of aortic dissection, but he was never given a scan for the ailment. He died four days after his last trip to the Methodist emergency room.

Aortic dissection — deadly if not diagnosed quickly — is a tear in the lining of the main artery for blood leaving the heart. It can be spotted with medical imaging equipment and can be treated. The ailment, which killed actor John Ritter, runs in families, including Tyler's.

In the video, Methodist doctors say Methodist did not take into account Tyler's family history of aortic dissection and did not consider the fact that it can occur in young people.

Dr. Anton Piskac, Methodist vice president for quality improvement, said in the video: "We had multiple opportunities to do the right thing and repeatedly neglected to do so."

Dallon, the law professor, said the video may reflect the frustration some doctors and hospitals have with defense attorneys who typically advise not to acknowledge any mistakes. The "I'm sorry" laws in Nebraska and more than 25 other states are another sign, he said.

Nebraska's law, approved in the last session, makes a health care provider's expression of apology, sympathy or compassion inadmissible as evidence of liability in a lawsuit.

Juster said Methodist wanted to share its experience because hospitals across the country have lacked an understanding that young patients with a family history of aortic dissection can suffer from it.

She said Methodist did not offer to produce the video as a way to reduce the financial payment to Tyler's family that was part of the settlement. Both sides declined to reveal the amount.

Omaha attorney Jeffrey Welch, who represented Tyler's family, said money wasn't the family's priority. They wanted to keep the young man's memory alive and prevent other deaths.

Advice to parents: If you disbelieve a doctor's diagnosis, ask what else it could be. If you know an inheritable condition may be involved, ask if that can be ruled out as a diagnosis, and why.

See a short video by a survivor about an instructive medical error.


Anonymous said...

For more information on Tyler Kahle and the lifesaving aortic dissection bundle, visit www.bestcare.org/Tyler. We encourage you to visit the site to watch the video "The Tyler Kahle Story: Aortic Dissection at Any Age," order a free DVD copy and share feedback with us. Please use the lessons we have learned to raise awareness of aortic dissection and to make the systemic changes needed to prevent similar tragedies.
Julie Cerney
Nebraska Methodist Health System

Anonymous said...

I was present at the session, and can personally attest to the impact of having Tyler's mom speak, followed by Ms. Juster with the hospital's perspective. The video is exceptional, and I would highly recommend it!

We at the National Marfan Foundation have also created educational resources that supplement NMHS's video nicely, which we also offer free of charge. Our program "Emergency Diagnosis and Treatment of Aortic Dissection" is CME accredited and available in our online Marketplace at www.marfan.org.

Jonathan Martin, MS
Director of Education
National Marfan Foundation