I’m not here to define the difference between malpractice, negligent homicide or out and out murder, but the story I am going to tell you is nothing less than murder; murder that took place in a hospital about twenty years ago and occurred not because of malice or stupidity but because of arrogance and self-centeredness.
In the late 1980s, at a major public city hospital, an African American man in his twenties was admitted to the intensive care unit with heart failure. An electrocardiogram (ECG) suggested he had a large heart attack. While I do not recall all of the patient’s symptoms I do remember that he had not been feeling well for about two weeks and that his wife brought him to the hospital because he looked very ill. Sensitive blood tests did not confirm he had a heart attack -- possibly because it had occurred as much as two weeks earlier (these tests are only positive for several days after a heart attack).
As is the case in most city hospitals the patient was admitted to a group of medical residents who were supervised by, and took their orders from, senior physicians employed by the hospital. I became involved because the academic center I was training at had an affiliation with the public hospital and it was my job (usually a different cardiology fellow rotated through that hospital every month) to consult, when called, on patients admitted with heart problems.
In any event, two of the most senior and quite brilliant doctors (although they were not cardiologists) at the city hospital came to the conclusion that this young man had not had a heart attack but suffered from a very unusual presentation of myocarditis – an acute inflammation of the heart -- even though the ECG indicated a heart attack had occurred. I suggested to both doctors, and to their medical residents, that they might indeed be right about the myocarditis, but that this young man also could also have coronary artery disease and that if we didn’t act on it the results would be catastrophic. I brought my attending in to speak to them, and even though he agreed with my diagnosis and suppositions, he was too indifferent or too timid to persuade the men to reconsider their strongly held opinion.
The two doctors did not want to hear about the possibility that the patient had coronary disease; they were certain he had myocarditis and should be treated for this illness and sent home. When I voiced my belief that it was a potentially grave error not to send this patient for an angiogram to make certain he did not have coronary disease, I was ordered to stop writing notes in the chart and not to see the patient again. Perhaps I could have done more, but only two years before I was reprimanded by a vice-chairman of medicine ( I later found out that he sent a letter out to my supervisor suggesting he review my patient’s charts) because I questioned a doctor’s order to transfuse a patient – even though the medical literature supported my opinion. And I guess I just did not want to take any more risks fighting with powerful and spiteful men. Not back then anyway.
As it turns out, the patient did indeed have coronary disease. He had a second heart attack, just as he was being discharged from the hospital, and died a few days later. The autopsy confirmed the presence of severe coronary artery disease. Yet with almost no regrets or remorse the two senior doctors circulated articles to the staff about how rare viruses might cause unusual heart attacks. Neither ever apologized to me, or more importantly, to the patient’s wife, and nothing ever came of this episode. No one was reprimanded and both doctors continue to teach at major medical centers to this day.
I always tell young physicians and physician assistants that hubris kills more patients than ignorance. Two arrogant senior physicians and their crew of younger residents were as blind to reason as the members of an unjustly inflamed and murderous mob. And that, together with the indifference or cowardice of others, who might have spoken out, but did not, caused the death of this young man.