Diagnostic process is focus of wrongful death trial

NEW ULM – How doctors investigate symptoms of incoming patients and when further action is called for were the focus Wednesday in the wrongful death lawsuit against Allina Health System and New Ulm Medical Center (NUMC) in Brown County District Court.

The lawsuit, which was filed Sept. 30, 2010, seeks over $50,000 for the next-of-kin plus $10,000 for funeral and burial expenses of 45-year-old Iowa trucker Verlyn Buls, who collapsed and could not be resuscitated on Oct. 25, 2006 in the NUMC emergency department. He had been admitted that morning with urticaria of unknown origins (or hives), hypotension (86/54, abnormally low blood pressure) and a history of taking anti-hypertensives ( drugs used to treat high blood pressure, and tachycardia, or a heart rate exceeding 100 beats per minute), according to the court documents. He was re-admitted that evening to the ER, where he collapsed. The autopsy determined the cause of death was cardiac dysrhythmia (irregular heart beat) with underlying coronary artery disease, according to court documents.

The civil lawsuit names Dale W. Bohlke, M.D., as the physician who sent Buls home after measuring his heart beat and other vital statistics without ordering further testing. The lawsuit alleges Bohlke, nurses and other professional and non-professional employees were negligent in the care and treatment of Buls.

Dr. Louis Ling, associate medical director for medical education at Hennepin County Medical Center and associate dean for graduate medical education at the University of Minnesota Medical School testified Wednesday as an expert witness called by the Allina defense.

Ling testified on the process doctors follow to determine the appropriate responses for symptoms of incoming patients. First, doctors must check the immediate vitals of a patient to determine if quick response is needed. Then, the doctors are responsible to ask investigative questions about why the patient came to the hospital to determine which reasonably possible problems exist.

He said Bohlke acted correctly during Buls’ initial visit to the ER in not ordering an electrocardiogram (EKG) scan because Buls did not inform the doctor of his earlier chest pains. He said Buls vitals then improved, compared to those taken by a nurse when he first arrived at the hospital. The lower results could have reasonably been determined to his recovery from the physical exertion of walking into the hospital, given his being overweight at 400 to 450 pounds.

Ling also testified that recent studies have shown doctors that unnecessary testing can be detrimental to patients.

When cross-examined about factors such as Buls lifestyle habits that put him at high risk of heart attack, Ling maintained his position. He said it was a correct choice similar to Bohlke’s decision to not test for other medical problems.

Dr. Lindsey Thomas, forensic pathologist with Hennepin County Medical Center, testified about her examination of the medical autopsy on Buls. She said the results showed Buls had all of the major arteries to his heart narrowed up to 90 percent due to health complications and that scarring tissue on the heart indicated he had previously suffered at least two undiagnosed heart attacks.

Addressing Tuesday testimony by doctors given on behalf of the plaintiff, Thomas said the narrowing of the arteries that caused complications and death would not have been addressed by items like anti-coagulates and glycerin. She said they address other problems that can cause heart attacks that were not present in this case.

She testified that she believed Buls had already reached the limit of his life expectancy due to the condition of his heart, and that he would likely have not lived long if he had survived the heart attack.

In cross-examination, Thomas said she had not dealt with live patients in 33-years since her residency and that she had no official certification for her life expectancy assertions.

Bohlke returned to the witness stand for Allina. He repeated the points laid out by Ling, asserting he had made the correct decision because Buls did not inform him of the chest pains he had experienced. He testified that he had asked about things like chest pressure, but considered it possible that Buls did not associate that with the same as asking about chest pain, He said that if he had been informed about the chest pain, he would have moved to further action with Buls.

The trail will continue today at 8:30 a.m.

(Josh Moniz can be e-mailed at jmoniz@nujournal.com)

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