Opinion ID: 1890528
Heading Depth: 2
Heading Rank: 3

Heading: Stress Test Results

Text: Once the thallium stress test was completed October 22, 2001, Dr. Kardesch read the results and informed the Mitchells that Mr. Mitchell's test was normal and immediate treatment was not required. Further, he reported that Mr. Mitchell's ability to perform on the treadmill was above average, that he had not complained of chest pain during the stress test, and that the results of the test were negative . . . by EKG criteria. The test, however, had to be stopped because Mr. Mitchell became short of breath. The cardiologist recorded that, at 38.7 percent, Mr. Mitchell had a mildly depressed ejection fraction. Dr. Kardesch explained the term ejection fraction: When the heart fills up, and is beating to get the blood out, it never really empties completely. The normal amount for emptying is 50 to 60 percent. That's called an ejection fraction. Dr. Kardesch did not tell the Mitchells about the depressed ejection fraction as he felt the reading just was wrong. Dr. Kardesch explained, It was a good test otherwise, and . . . the nuclear fraction is always much lower than the echocardiogram.. . . I really didn't believe that it was truly that low, and I was going to get an echocardiogram. He continued, And I figured, well, I was going to see him right away. Dr. Kardesch, however, did not order an echocardiogram, and he was mistaken that he had scheduled an appointment with Mr. Mitchell right away. Mr. Mitchell had a heart attack three days later. Dr. Singer testified that Dr. Kardesch's failure to send Mr. Mitchell to a specialist for further testing constituted a deviation from the standard of care. If Dr. Kardesch did his job right . . . he simply had to say, [`]This is a potential problem. We need to have it looked at at a higher and more specialized level. . . . ['] At that point, if Dr. Kardesch had sent Mr. Mitchell to receive a catheterization, according to Dr. Singer, a specialist would have been able to fix that vessel, and that would have prevented the occurrence of the heart attack that did [Mr. Mitchell] in three days later. Dr. Cole testified that, to the contrary, it was not a deviation from the standard of care for Dr. Kardesch to not compare the results with the July 2000 catheterization test, in which the result was 50 percent. Both readings, she stated, constituted a mild depression and, in light of the different technique used on the second occasion, that test did not per se represent a significant change from the July 2000 test. As a result, Dr. Kardesch's reading of the stress test complied with the standard of care.