Stroke Medical Negligence Delayed Diagnosis

Case Example: Failure to Administer tPA

Patient: The Patient suddenly develops slurred speech, right sided weakness, and facial drooping while at work. His coworkers recognise the signs of a potential stroke and call emergency immediately.

Emergency Response:

a) The Patient is transported to the nearest hospital by ambulance, arriving in the A&E within 45 minutes of symptom onset.

b) Time of stroke onset: Documented by paramedics as approximately 2:15 PM.

Initial ED Evaluation:

a) Upon arrival at 3:00 PM, the Patient is alert but exhibits clear right sided weakness and difficulty speaking. His symptoms suggest a likely ischemic stroke.

b) Vital signs: Blood pressure is elevated at 180/95 mm Hg, but otherwise stable.

c) NIH Stroke Scale (NIHSS): Assessed as moderate, scoring 10 (significant symptoms but no immediate life threatening findings).

Delays in Care:

a) Imaging Delayed: The A&E is busy, and the Patient’s CT scan (non-contrast) is delayed due to other critical patients. The scan is performed around 4:00pm approximately an hour after arrival confirming no bleeding in the brain (necessary to rule out haemorrhagic stroke before tPA administration).

b) Consultation Delayed: The neurology team is contacted, but due to miscommunication, they arrive at 5:00pm well after the patient’s initial arrival.

tPA Decision:

a) By the time the Patient is reassessed, it’s 5:30pm over three hours after symptom onset. The treating team decides not to administer tPA due to concerns about the effectiveness outside the time window. 

b) No mechanical thrombectomy is considered since the hospital lacks the resources, and the Patient is not transferred to another facility.

Outcome:

a) Over the next 24 hours, the Patients symptoms worsen. He loses nearly all motor function on his right side and experiences severe difficulty with speech (aphasia).

b) The Patient undergoes rehabilitation, but his recovery is slow and incomplete. He is left with permanent right sided paralysis and severe speech impairments, which significantly impact his quality of life.

Important Points of the Case:

  1. Timely Administration of tPA.
  2. Communication Breakdown.
  3. Missed Transfer Opportunity.

Failure to administer tPA or consider mechanical thrombectomy in a timely manner led to a preventable poor outcome for the Patient’s underlying importance of rapid stroke diagnosis and treatment in eligible patients.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/