Urgent Care Heart Attack & Chest Pain Misdiagnosis Expert Witness
Evaluating Standard of Care in Missed Myocardial Infarction Cases
Chest pain is the ultimate "low frequency, high risk" complaint in Urgent Care medicine. While the vast majority of chest pain patients have benign conditions, the failure to identify the one patient having a heart attack is catastrophic.
Dr. Max Lebow provides expert analysis for cases involving Missed Myocardial Infarction and Failure to Refer, helping attorneys determine if the provider's risk assessment met the prudent Urgent Care Standard of Care.
The Urgent Care Constraint: No "Rule Out" Capability
In an Emergency Room, "ruling out" a heart attack involves serial EKGs and troponin (cardiac enzyme) blood tests over several hours. Urgent Care centers generally do not have these capabilities.
Therefore, an Urgent Care provider cannot "rule out" a heart attack in the same way an ER can. The Standard of Care shifts from definitive diagnosis to defensible risk stratification:
Immediate Triage
Was the patient brought back immediately for evaluation, or were they left in the waiting room despite "red flag" symptoms?
EKG Utilization
Was a 12-lead EKG performed promptly? Was it interpreted correctly?
Transfer Decision
If the provider could not definitively identify a benign cause, did they refer the patient to the ER for the "standard of care" workup that the clinic could not provide?
Key Questions Dr. Lebow Investigates
Dr. Lebow reviews the medical record to answer specific forensic questions regarding the encounter:
Was the Triage Appropriate?
Protocols usually dictate that any patient with active chest pain must be seen immediately. Delays in the waiting room often constitute a primary breach of duty.
Was the History "Anchored"?
Did the provider anchor on a benign diagnosis (like acid reflux) without asking critical questions about cardiac risk factors (family history, exertion, radiation of pain)?
Did They Ignore Abnormal Vitals?
A common error Dr. Lebow identifies is "not heeding an abnormal vital sign," such as elevated blood pressure or heart rate, which can be a physiologic response to cardiac ischemia.
The "GERD" Trap
Diagnosing a 50-year-old male with "new onset heartburn" without an EKG or referral is a classic fact pattern in missed MI cases.
Common Misdiagnosis Patterns
Atypical Presentations
Women, diabetics, and elderly patients often present with "fatigue," "nausea," or "jaw pain" rather than crushing chest pain. Dr. Lebow evaluates if the provider maintained a high enough index of suspicion.
Musculoskeletal Diagnosis
Attributing chest pain to "muscle strain" without a reproduction of tenderness on the physical exam.
Failure to Compare
Not comparing a new EKG to an old one (if available) to look for subtle changes.
Why "ER Standards" Don't Apply (And Why That Matters)
Opposing experts often argue that the Urgent Care provider should have "run the enzymes." Dr. Lebow effectively rebuts this by explaining that Urgent Care centers typically lack the stat labs required for this.
Instead, he focuses on the referral decision: Once the provider realized they couldn't rule out a heart attack with the tools available, did they call 911 or send the patient to the ER?
Was It Negligence or a Difficult Diagnosis?
Not every missed heart attack is malpractice. Some presentations are truly silent. Dr. Lebow helps you distinguish between an inevitable bad outcome and a preventable error in decision-making.
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