Cardiac clearance lawsuit

[ucladoc2b]

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https://www.belllawfirm.com/wp-content/uploads/2026/06/2021-05-14-Yarbrough-Amended-Complaint-FS.pdf

Pt cleared for colectomy for a mass despite high coronary calcium score above 400 and positive stress test from a year before (DIMPS negative). Unsure if symptomatic. Has type II MI. Undergoes 10 hour CBAG. Likely graft failure.

Widow sues based on that he should have not been cleared. Wins $18m.

 

[urge]

What’s is a positive stress test dobutamine negative?

 

[Account1]

https://www.belllawfirm.com/wp-content/uploads/2026/06/2021-05-14-Yarbrough-Amended-Complaint-FS.pdf

Pt cleared for colectomy for a mass despite high coronary calcium score above 400 and positive stress test from a year before (dobutamine negative). Unsure if symptomatic. Has type II MI. Undergoes 10 hour CBAG. Likely graft failure.

Widow sues based on that he should have not been cleared. Wins $18m.

Unaddressed positive stress test is automatic request for cardiac clearance for us.

However this seems reasonable to sue for assuming true:

"53. Dr. Friedland did not follow up with Mr. Yarbrough on the calcium scoring. Dr. Friedland thereby violated the standard of care.

54. Instead, on October 30, 2018, CardioVascular Group sent a letter to Mr. Yarbrough, telling him in essence that his calcium scoring results were unconcerning"

Guy ordered the test himself, and cleared him for elective procedure anyway after a hugely positive result (469). Easy case. Looking up the defendant, graduated med school in the early 80s. Probably behind the times, or just doesn't care or isn't careful. Seems reasonable he got destroyed in this.

 

[ucladoc2b]

What’s is a positive stress test dobutamine negative?

Had a treadmill stress test with EKG changes. Had a subsequent dobutamine stress test that was negative according to the complaint.

 

[urge]

Had a treadmill stress test with EKG changes. Had a subsequent dobutamine stress test that was negative according to the complaint.

Why would anyone get a 2nd stress test after a positive one? Is it 2 out of 3, wins?

 

[ucladoc2b]

Why would anyone get a 2nd stress test after a positive one? Is it 2 out of 3, wins?

Sorry. He got a dual isotope exercise test. Allows visual imaging of any defect.

 

[emergentmd]

Positive Treadmill with EKG changes.... Time for a cath. I don't get doing a dobutamine stress as a neg means little IMO and what happens if the has an MI on the table. You already chanced it with a treadmill stress test that had EKG changes.

 

[ucladoc2b]

Positive Treadmill with EKG changes.... Time for a cath. I don't get doing a dobutamine stress as a neg means little IMO and what happens if the has an MI on the table. You already chanced it with a treadmill stress test that had EKG changes.

That being said. Would the cath supersede a colectomy for a mass? The AHA guidelines would have delayed that surgery 6-12 months circa 2018 with DES placement and DAPT. This is basically the crux of the allegation.

 

[emergentmd]

That being said. Would the cath supersede a colectomy for a mass? The AHA guidelines would have delayed that surgery 6-12 months circa 2018 with DES placement and DAPT. This is basically the crux of the allegation.

If you deemed the colectomy emergent, then bless him as an emergency and take him for surgery similar if he was having a emergent dissection.

If you are his doc and you believed he needed clearance, then you essentially have deemed that the surgery could wait until he is cleared. Doc went down the road that clearance was needed before surgery then essentially ignored the positive finding and cleared him for surgery. Dobutamine stress does not clear him with a pos treadmill/EKG changes IMO and I believe most cardiologist would agree. Anyhow, doc contradicted himself with his care.

 

[Account1]

That being said. Would the cath supersede a colectomy for a mass? The AHA guidelines would have delayed that surgery 6-12 months circa 2018 with DES placement and DAPT. This is basically the crux of the allegation.

I think documentation of risk benefit discussion with the patient would be necessary. If family had been explained the pros and cons of each approach then far less likely to have the lawsuit.

 

[emergentmd]

I think documentation of risk benefit discussion with the patient would be necessary. If family had been explained the pros and cons of each approach then far less likely to have the lawsuit.

Concur. If I thought surgery outweighed possible MI during surgery, then let the pt family know. They can consent knowing an MI is likely or wait til cath done first.

 

[urge]

That being said. Would the cath supersede a colectomy for a mass? The AHA guidelines would have delayed that surgery 6-12 months circa 2018 with DES placement and DAPT. This is basically the crux of the allegation.

Why are you assuming stents over a CABG?

 

[dannyboy1]

Was anesthesia named? Or did the cardiac clearance do its job and shield them?

 

[dannyboy1]

https://www.belllawfirm.com/wp-content/uploads/2026/06/2021-05-14-Yarbrough-Amended-Complaint-FS.pdf

Pt cleared for colectomy for a mass despite high coronary calcium score above 400 and positive stress test from a year before (DIMPS negative). Unsure if symptomatic. Has type II MI. Undergoes 10 hour CBAG. Likely graft failure.

Widow sues based on that he should have not been cleared. Wins $18m.

So basically guy has an NSTEMI after procedure but was stable. Goes for CABG and dies because of CABG complications. Don’t really see how the cardiac clearance played a role. CABG is not risk free. Likely similar outcome had he delayed the colectomy for CABG. Keep in mind the colectomy was on June 7 from which he subsequently recovered absent a troponin leak. CABG is not until June 21. No signs of heart failure or organ dysfunction prior to CABG. I see the negligence on the part of the cardiologist/surgeon/anesthesiologist but don’t really see how it caused this outcome…,

 

[ucladoc2b]

So basically guy has an NSTEMI after procedure but was stable. Goes for CABG and dies because of CABG complications. Don’t really see how the cardiac clearance played a role. CABG is not risk free. Likely similar outcome had he delayed the colectomy for CABG. Keep in mind the colectomy was on June 7 from which he subsequently recovered absent a troponin leak. CABG is not until June 21. No signs of heart failure or organ dysfunction prior to CABG. I see the negligence on the part of the cardiologist/surgeon/anesthesiologist but don’t really see how it caused this outcome…,

Agree mostly. The colectomy doesn’t really change that this pt still has high grade stenosis. The allege that they never informed the surgeon of the high CAC. Still, this sounds like mostly bad CABG outcome.

And on a side note, the expert witness used is around 73 years old. Seems a little out of modern practice with some of his conclusions.

 

[emergentmd]

If a stress test was not done and he had an MI, then you have a leg to stand on. If you do a test and then not address the positive test and a bad outcome happens, then you are on shaky ground.

I think the path is either
1. Do not do stress test, deem it emergent, and then if he had an MI then it was an unknown issue before procedure. Happens all the time in medicine
2. Do a stress test and if you deem a cath would delay a very imp procedure, then talk to the family/document their wishes. If they want the heart evaluated before Colectomy or colectomy knowing risks of positive stress test, then document their understanding/wishes

Doc took the worse path IMO by doing a test, having a positive result, then not following up (atleast I assume it was not documented). Now you have a sad/pissed off family who was not able to help direct their family's medical care

 

[Guillemot]

I did not read the article, but I want to say the following: proceeding with a case after a positive stress test is potentially reasonable.

Per the AHA guidelines routine revascularization preoperatively does not decrease MACE unless it is left main disease or triple vessel disease, greater than I believe 50% and 70% respectively.

Therefore, revascularization may only be indicated in “high risk” positive stress tests. That does not mean the patient is at low risk. It just means that revascularization doesn’t change the risk.

After a positive stress test, though, I would not proceed with surgery without consultation with cardiology despite the guidelines. They are just guidelines after all, and I would want an expert to weigh in on the individual patient.

 

[chessknt]

Bonkers outcome. Even the first page of the lawsuit is insane--he has colon cancer but is expected to live another 20 years? Did they consult Jesus to ask him for a miracle as well? How is this not 100% a bad CABG outcome where all the scrutiny falls on the cardiac surgeon alone?

If he gets cabg first and the surgeon actually succeeds and has to wait months to recover enough to tolerate the colectomy and it metastasizes which person gets the 18 million lawsuit in that scenario?

 

[CopaceticOne]

If a stress test was not done and he had an MI, then you have a leg to stand on. If you do a test and then not address the positive test and a bad outcome happens, then you are on shaky ground.

I think the past this either
1. Do not do stress test, deem it emergent, and then if he had an MI then it was an unknown issue before procedure. Happens all the time in medicine
2. Do a stress test and if you deem a cath would delay a very imp procedure, then talk to the family/document their wishes. If they want the heart evaluated before Colectomy or colectomy knowing risks of positive stress test, then document their understanding/wishes

Doc took the worse path IMO by doing a test, having a positive result, then not following up (atleast I assume it was not documented). Now you have a sad/pissed off family who was not able to help direct their family's medical care

For any trainees reading this thread, I want to stress that this is exactly correct in my opinion. I also work in a preop clinic seeing the very high risk patients in an effort to optimize them, as best as possible, for surgery.

Cancer surgeries fall often into an ugly gray zone. Wait too long and it might progress to the point of resection no longer being an option. But, ignore symptoms and bad things can happen even if the procedure is technically perfect.

True shared decision making with the patient is the key. Sometimes patients will surprise you with the route they choose and why. Just give them the known facts and potential outcomes, in simple terms, and talk them through what it can mean.

Case in point: Years ago I saw an older patient who was scheduled for cervical spine surgery due to critical stenosis causing progressive loss of motor function. Patient had a prior history of NSTEMI many years prior. NSQUIP & DASI scores said consider further cardiac workup.

Obviously, given that the patient was loosing ability to use their hands tilted the scales toward just proceeding to surgery. After discussion with the patient, they chose to do the cardiac testing because they never wanted another heart attack again - “worst time of my life”. Surprisingly, they were ok with loosing use of hands if it meant no MI.

Fast forward - ended up having single vessel critical stenosis, got stented, waited a few months, then spine surgery. Patient was thankfully to everyone for all of their care. They kept / regained some motor function after the surgery compared to when initially saw them in clinic.

You just never know…

 

[cittykat]

I did not read the article, but I want to say the following: proceeding with a case after a positive stress test is potentially reasonable.

Per the AHA guidelines routine revascularization preoperatively does not decrease MACE unless it is left main disease or triple vessel disease, greater than I believe 50% and 70% respectively.

Therefore, revascularization may only be indicated in “high risk” positive stress tests. That does not mean the patient is at low risk. It just means that revascularization doesn’t change the risk.

After a positive stress test, though, I would not proceed with surgery without consultation with cardiology despite the guidelines. They are just guidelines after all, and I would want an expert to weigh in on the individual patient.

Old study but relevant to your post

https://www.nejm.org/doi/full/10.1056/NEJMoa041905

 

[greatnt249]

Unaddressed positive stress test is automatic request for cardiac clearance for us.

However this seems reasonable to sue for assuming true:

"53. Dr. Friedland did not follow up with Mr. Yarbrough on the calcium scoring. Dr. Friedland thereby violated the standard of care.

54. Instead, on October 30, 2018, CardioVascular Group sent a letter to Mr. Yarbrough, telling him in essence that his calcium scoring results were unconcerning"

Guy ordered the test himself, and cleared him for elective procedure anyway after a hugely positive result (469). Easy case. Looking up the defendant, graduated med school in the early 80s. Probably behind the times, or just doesn't care or isn't careful. Seems reasonable he got destroyed in this.

469 is not "hugely positive"; it's high enough to warrant further discussion, but the score alone doesn't tell you anything about how stenosed any lesion actually is. I don't know about practice patterns where you all work, but in past 2-3 years I've noticed an uptick in radiologists highlighting coronary calcifications in routine non-gated CTs and it drives us nuts as to what to do with that information (referrals go up from freaked-out patients and their PCPs despite patient not having any cardiac symptoms).

At any rate, I don't follow the logic of this case in the sense that the patient "shouldn't have been cleared." Ultimately the crux of the argument lies in how urgently it was felt the colectomy needed to be done. That being said, briefly reviewing the case suggests that they had been asking whether the patient was even cleared for a colonoscopy.

 

[Account1]

469 is not "hugely positive"; it's high enough to warrant further discussion, but the score alone doesn't tell you anything about how stenosed any lesion actually is. I don't know about practice patterns where you all work, but in past 2-3 years I've noticed an uptick in radiologists highlighting coronary calcifications in routine non-gated CTs and it drives us nuts as to what to do with that information (referrals go up from freaked-out patients and their PCPs despite patient not having any cardiac symptoms).

At any rate, I don't follow the logic of this case in the sense that the patient "shouldn't have been cleared." Ultimately the crux of the argument lies in how urgently it was felt the colectomy needed to be done. That being said, briefly reviewing the case suggests that they had been asking whether the patient was even cleared for a colonoscopy.

Everything I can see says that > 400 indicates high risk of a significant lesion. Happy to defer if you know of something contrary to that

 

[greatnt249]

Everything I can see says that > 400 indicates high risk of a significant lesion. Happy to defer if you know of something contrary to that

Agatston score is just that, a score; it doesn't speak to how stenotic a lesion is. 400 isn't something I would ignore, but it doesn't make me think they automatically bought themselves a cath.

 

[emergentmd]

Bonkers outcome. Even the first page of the lawsuit is insane--he has colon cancer but is expected to live another 20 years? Did they consult Jesus to ask him for a miracle as well? How is this not 100% a bad CABG outcome where all the scrutiny falls on the cardiac surgeon alone?

If he gets cabg first and the surgeon actually succeeds and has to wait months to recover enough to tolerate the colectomy and it metastasizes which person gets the 18 million lawsuit in that scenario?

The overriding point is, medicine is not black/white but a shared decision making. This is the big take away. Educate the pt, let them know the pros vs cons, then let them decide. If a bad outcome happens, they will be sad but happy they had a choice. Take that away from them, then you are left with a sad AND unhappy pt = Lawsuit.

I worked EM for 20+ yrs in all types of settings. I always educate and let pts share in decision making. Only 1 lawsuit and it was a code on the floor. Just bad outcome and money grab but never in the ER.