Stroke: A Legal and Medical Overview
Every year, thousands of Americans suffer devastating consequences when healthcare providers fail to properly diagnose and treat strokes. At Van Wey, Metzler and Williams, we understand the life-altering impact of medical negligence in stroke cases and fight tirelessly to secure justice for victims and their families.
Understanding Stroke
A stroke occurs when blood flow to part of the brain is interrupted, either by a blockage or bleeding. Without oxygen and nutrients, brain cells begin dying within minutes. This is why immediate medical intervention is crucial – every minute counts when it comes to preserving brain function and saving lives.
Types of Strokes
Ischemic Stroke (87% of cases)
· Caused by blood clots blocking vessels in the brain
· Can result from atherosclerosis, embolism, or other circulatory conditions
· Requires immediate evaluation for clot-busting medication
Hemorrhagic Stroke (13% of cases)
· Results from bleeding in or around the brain
· Often caused by high blood pressure, aneurysms, or blood vessel malformations
· Requires different emergency interventions than ischemic strokes
Transient Ischemic Attack (TIA or “mini-stroke”)
· Temporary blockage causing brief stroke-like symptoms
· Major warning sign for future strokes
· Requires urgent medical attention and preventive care
Stroke Litigation
When it comes to medical malpractice litigation, stroke cases occupy a unique and important space due to the critical need for timely diagnosis and treatment. Stroke is a leading cause of death and disability in the United States, and failures in stroke diagnosis or treatment can lead to devastating outcomes.
Common Stroke Cases
The most frequently litigated stroke cases typically involve:
Failure to Administer Tissue Plasminogen Activator (tPA):
tPA is a clot-busting medication approved for use in ischemic strokes when administered within a specific time window—typically 3-4.5 hours from symptom onset. Failure to recognize stroke symptoms resulting in delays in administration of tPA due to misdiagnosis is the most frequent type of stroke litigation.
Misdiagnosis of Stroke:
Stroke symptoms can mimic other conditions such as migraines, seizures, or hypoglycemia. Failing to properly evaluate a patient presenting with symptoms like unilateral weakness, facial droop, aphasia, or slurred speech can result in a missed opportunity for life-saving intervention.
Delays in Diagnostic Imaging:
The use of computed tomography (CT) or magnetic resonance imaging (MRI) is critical for distinguishing between ischemic and hemorrhagic strokes. Delays in ordering or performing these imaging studies can result in delayed or inappropriate treatment.
Failure to Transfer to a Stroke-Certified Facility:
When a facility is unequipped to handle acute stroke care, failure to timely transfer a patient to a certified stroke center may result in claims of negligence.
Stroke during Pregnancy
Preeclampsia is a serious condition during pregnancy marked by high blood pressure and signs of organ damage, typically involving the liver and kidneys. It usually arises after 20 weeks of pregnancy in women whose blood pressure had previously been normal.
When healthcare providers fail to properly recognize and monitor preeclampsia during pregnancy, they put both mother and baby at severe risk of life-threatening complications, including stroke.
Preeclampsia causes dangerously high blood pressure that can lead to cerebral hemorrhage or ischemic stroke if left untreated. Warning signs like severe headaches, visual disturbances, and rapidly rising blood pressure readings require immediate medical attention, yet these critical symptoms are sometimes overlooked or dismissed by negligent practitioners.
The standard of care requires regular blood pressure monitoring, urine protein testing, and careful observation of symptoms throughout pregnancy. When doctors or nurses breach this standard by missing preeclampsia indicators or delaying treatment, they may be held legally accountable for resulting strokes that cause devastating brain damage, permanent disability, or death.
Defined Treatment Protocols in Stroke Care
Stroke care is governed by clear and evidence-based guidelines from organizations such as the American Heart Association (AHA) and the American Stroke Association (ASA). Key elements include:
· Rapid Identification of Stroke:
The acronym FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911) highlights the urgency of stroke symptoms. Emergency medical services play a critical role in pre-hospital triage to ensure that patients reach appropriate care facilities. According to the AHA/ASA guidelines, pre-hospital notification by EMS can significantly reduce treatment delays (Stroke Guidelines, 2019).
· Time-Sensitive Administration of tPA:
Eligibility for tPA is determined by factors including time from symptom onset, absence of contraindications (e.g., recent surgery, bleeding disorders), and imaging findings. Hospitals are required to have protocols in place to evaluate and treat patients rapidly, often referred to as “door-to-needle” time goals. The current recommendation is to administer tPA within 60 minutes of the patient’s arrival at the hospital.
· Endovascular Therapy for Large Vessel Occlusion (LVO):
For patients with LVOs who are ineligible for tPA or present after the time window, mechanical thrombectomy may be performed. The AHA/ASA recommends thrombectomy within 6 hours of symptom onset, with some evidence supporting its use up to 24 hours in select cases.
Consequences of Mismanaged Stroke Care
The consequences of failing to diagnose or treat a stroke can be catastrophic. Many stroke survivors experience permanent neurological deficits, including paralysis, loss of speech, or cognitive impairments, significantly reducing their quality of life and impacting their ability to work. In some cases, untreated strokes can result in death. For families, these outcomes often result in significant emotional and financial burdens, which form the basis for legal damages in litigation.
Stroke-Certified Facilities: Are They a Safer Option?
The designation of hospitals as Primary Stroke Centers (PSC) or Comprehensive Stroke Centers (CSC) by organizations like The Joint Commission or DNV Healthcare reflects their adherence to rigorous standards in stroke care. These facilities are equipped with specialized teams, imaging capabilities, and the ability to provide advanced treatments such as thrombectomy.
Certification Authorities and Standards
· The Joint Commission:
This organization certifies hospitals as PSCs or CSCs based on adherence to protocols for stroke care, including timely administration of tPA and the availability of neurointerventionalists for thrombectomy. Details about certification criteria can be found on their official website.
· DNV Healthcare:
DNV also provides certification based on ISO 9001 standards, emphasizing continuous quality improvement. Their certification standards for stroke centers are available on the DNV website.
· American Heart Association/American Stroke Association:
The AHA/ASA collaborates with The Joint Commission to promote the Get With The Guidelines® – Stroke program, which emphasizes data-driven performance improvement.
Should Patients Seek Out Certified Stroke Centers?
Whenever possible, stroke patients should seek care at a certified stroke center, particularly those with Comprehensive Stroke Center status for more severe cases. These facilities are more likely to have the stroke protocols and personnel in place to handle complex cases, which may impact the timing of appropriate intervention and reduce the likelihood of medical errors. For a detailed list of certified stroke centers, patients can visit the websites of the certifying bodies or use tools like the AHA/ASA Stroke Center Locator.
How We Can Help – The VWMW Comprehensive Approach
If you or a loved one has suffered due to delayed or improper stroke care, our experienced medical malpractice attorneys can help determine if negligence occurred. Our team conducts thorough investigations of potential stroke malpractice cases and works with leading medical experts to review medical records, current scientific literature, brain imaging studies, hospital stroke protocols and documentation of long-term impacts and damages.
Supporting Your Recovery
Our commitment extends beyond the courtroom. We routinely connecting clients with top rehabilitation specialists and assist with insurance and disability claims. Throughout the litigation process, we coordinate with life-care planners and help secure necessary medical equipment and home modifications to maximize the quality of life for our clients.
Time Limitations Apply
Most states have strict deadlines for filing medical malpractice claims. Don’t wait to seek legal counsel if you suspect negligent stroke care. Contact us today for a free consultation to discuss your case.
Discuss Your Options with a Medical Malpractice Attorney Today
The impact of a severe stroke is devastating. Depending upon which parts of the brain are injured, a stroke victim may lose the ability to walk, talk, process information, control emotion, or even lose all motor function. Stroke victims are often unable to return to work. They may require expensive medical care, therapy, and help with normal activities of daily life for the rest of their lives.
Under the right circumstances, a stroke victim may have a medical malpractice case based upon the failure to properly prevent or treat the stroke. Contact Van Wey, Metzler & Williams to discuss your legal options.
Justice Secured for Delay in Stroke Intervention
A client who suffered an ischemic stroke in West Texas was denied timely tPA treatment, resulting in permanent brain damage. VWMW filed a medical malpractice lawsuit against the responsible hospital and doctors and successfully obtained a significant confidential settlement.
Case Background
- Our client was a 45-year-old high school mechanics teacher with a history of right-sided cerebral palsy. At baseline, our client was highly functional with the ability to ambulate without assistance and speak clearly.
- He began experiencing stroke-like symptoms such as right-sided weakness, aphasia, dizziness after showering one morning.
- He was quickly taken to a local hospital where it was recognized that he was likely having an ischemic stroke.
- Miscommunication and failure to perform an appropriate workup resulted in an incorrect assessment that he experienced a “wake-up” stroke (stroke started during the night) and was therefore not an appropriate candidate to receive clot-busting medication tPA
- The hospital failed to have an appropriate Acute Stroke Protocol to ensure he was timely seen by a neurologist and the clot busting medication, tPA, was ordered and administered
- Though the stroke was recognized within the 4.5-hour window for our client to receive tPA, the emergency department physicians and staff delay and failure to administer life-saving medication lead to permanent brain damage
VWMW’s Approach and Strategy
The case required significant discovery and expert testimony to establish the miscommunication errors that led to this catastrophic outcome. Our investigation during discovery revealed that there were significant gaps in the hospital acute stroke protocol in
effect at the time that led to the communication errors between providers. The damage that was caused by the failure to act timely and appropriately could have easily been prevented. In addition to securing a recovery for our client to help with future medical care, we were also able to ensure that the hospital policy that led to the outcome was updated to hopefully prevent a similar situation for happening to any other patient in the future.
Case Outcome
This case underscores the importance of meticulous case preparation and in-depth understanding of the current science and medicine related to stroke intervention. Comprehensive investigations and a deep understanding of medical standards were essential to proving negligence against multiple healthcare providers and securing a favorable outcome for our deserving client. The strategies employed by VWMW ensured that our client received the justice and compensation that he deserved.
Justice Obtained for Missed Stroke Diagnosis
Case Summary
A client who suffered an ischemic stroke in North Texas was denied timely tPA treatment, resulting in permanent brain damage. VWMW filed a medical malpractice lawsuit against the responsible hospital and doctors and successfully obtained a significant confidential settlement.
Case Background
- Our client was a successful wealth manager who was shopping at Home Depot on a Saturday morning when he began experiencing a stroke symptom known as aphasia, which is difficulty in the ability to use and find words and finish sentences.
- After driving home, his wife immediately recognized that something was wrong and called the paramedics and he was taken to the nearest emergency department.
- At the ER, his chief complaint was “difficulty speaking” and the initial stroke screen was positive for stroke symptoms, including “expressive aphasia”.
- A neurologist was consulted but was never asked to evaluate the patient. Due to miscommunication between providers, the neurologist was told the patient’s neurological exam was normal with no objective stroke symptoms.
- Our client was discharged with a diagnosis of confusion and received no stroke treatment and no other therapeutic interventions were ordered or administered.
- Following discharge from the hospital, our client continued to have stroke symptoms. They called their primary care physician who recommended that our client go directly to the emergency department at a different hospital.
- Immediately upon arrival, our client was diagnosed with an acute ischemic stroke involving an occlusion of the left middle cerebral artery territory and evolving acute infarcts of the left parietal and superior temporal lobe.
- Since the stroke was not recognized within the critical 4.5-hour window for our client to receive clot-busting medication, the failure to administer life-saving medication lead to permanent brain damage significantly impacting his ability to return to his job as a wealth manager.
VWMW’s Approach and Strategy
The case required significant discovery and expert testimony to establish the standard of care and the sequence of communication errors that led to this catastrophic outcome. Our investigation during discovery revealed that there were significant gaps in the hospital acute stroke protocol in effect at the time that led to the communication errors between providers. Our approach also included detailed expert analysis of current medical and scientific literature regarding the difference earlier recognition and intervention would likely have made. Ultimately, we were able to demonstrate that the damage that was caused by the failure to act timely and appropriately could have easily been prevented.
Case Outcome
This case underscores the importance of meticulous case preparation and in-depth understanding of the current science and medicine related to stroke intervention. Comprehensive investigations and a deep understanding of medical standards were essential to proving negligence against multiple healthcare providers and securing a favorable outcome for our deserving client. The strategies employed by VWMW ensured that our client received the justice and compensation he deserved.
