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

Heading: Delay in Ordering Stress Test

Text: It is also undisputed that Dr. Kardesch ordered a thallium stress test at St. Joseph's Hospital, but it was not performed until October 22, 2001, a full 11 days after he decided that Mr. Mitchell needed to have a stress test. The reason for the delay is in dispute. According to Dr. Kardesch, after instructing his medical assistant to direct Mrs. Mitchell to take her husband to the emergency room, Mrs. Mitchell made a follow-up call to the office stating that her husband was at work feeling fine, that he had no further chest problems and no chest pain. Although this lessened Dr. Kardesch's suspicions of coronary artery disease, he testified that he next asked his assistant to schedule a stress test and thought the test would just be done the next day . . . . He further stated that it was [p]retty rare to have an occasion when St. Joseph's was not able to perform a stress test within a day or two if fitting with the patient's schedule and, if it could not, arrangements could be made at another hospital. According to Dr. Kardesch, The plan was to check with Mr. Mitchell's work schedule and have Mrs. Mitchell let Dr. Kardesch's office know a good date for Mr. Mitchell to have this stress test. Dr. Kardesch's assistant testified that she could not recollect the reason why the stress test was not scheduled until October 22, 2001, but in her deposition she stated that was the first time we could get it scheduled . . . . She also agreed, Normal procedure to do any [thallium stress] test is the next day. You always schedule it for the next day. If it isn't scheduled, then there is a reason because of the patient's schedule. The fact remains that the test was not scheduled for 11 days. Mrs. Mitchell testified this was because Dr. Kardesch's assistant simply told her that Dr. Kardesch was going to order a stress test and that the assistant would get back to Mrs. Mitchell with the appointment. It was not until about a week later that the assistant called and told her that the stress test had been scheduled for October 22. Mrs. Mitchell said the delay was not because of her husband's schedule, that she would have taken him to receive the stress test [w]henever they wanted me to. She said Mr. Mitchell's convenience was never an issue and the delay was not for [Mr. Mitchell's] convenience. He could have gone at any time. Must have been for their convenience. Mrs. Mitchell's expert, Dr. Singer, testified that had Mr. Mitchell received a stress test October 11, 2001, there would have been signs of myocardial ischemia that were not later found due to the delay in testing. He said Dr. Kardesch failed to appropriately evaluate, diagnose and treat Mr. Mitchell . . . on or after October 11, 2001. If the testing had been done earlier, Dr. Singer testified to a reasonable degree of medical certainty, Mr. Mitchell would not have developed a heart attack, and he would not have this need to have an emergency catheterization, and he would not have had the [complications] that particularly resulted in the . . . infarct that killed him. Dr. Patricia Cole testified that the delay did not affect the stress test results and that Dr. Kardesch did not deviate from the standard of care. She explained, to a reasonable degree of medical certainty, that if Mr. Mitchell showed symptoms of myocardial ischemia October 11, 2001, those same signs also would have been present during the October 22 stress test.