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Failure to Diagnose Case Settles for Over $2M

Three physicians accused of failing to promptly treat a patient's heart condition agreed on March 6 to a $2.35 million settlement in an Ocean County wrongful death suit by the patient's family, Rabkin v. Varma.

Jonathan Rabkin, 53, went to the emergency room at Community Medical Center in Toms River on Oct. 18, 2013, for sudden-onset upper abdominal pain radiating to the back with associated nausea and vomiting. The attending emergency room doctor, Vikram Varma, ordered a CT angiogram of the chest with contrast, but then cancelled the contrast administration due to concerns about elevated creatinine in Rabkin's system, according to plaintiff attorney Daryl Zaslow of Eichen Crutchlow Zaslow in Edison.

Radiologist Paul Shieh, who interpreted the CT scans, noted a 5-centimeter aortic aneurysm. Shieh's report noted that the results were relayed to the emergency room, but Varma testified that Shieh told him there was "no acute process," and Varma also said he was never told that a 5-centimeter aortic aneurysm was found, Zaslow said.

Three hours after Rabkin arrived at the hospital, Varma admitted him for observation, turning him over to on-duty hospitalist Luzminda Anama. Later the same day, Rabkin had a CT scan with contrast, revealing an extensive tear in the aorta and blood in the pericardial sac of the heart. Plans were then made to transfer Rabkin to Pennsylvania Hospital, in Philadelphia, for surgical repair of the torn aorta. But Rabkin soon became unstable and could not be resuscitated. He was pronounced dead 10 hours after his arrival.

The medical malpractice suit named Varma, Shieh and Anama. If a timely diagnosis had been made, Rabkin could have easily been transferred to another hospital for heart surgery, the suit claimed. The suit also challenged the decision to transfer to a Philadelphia hospital rather than much-closer Jersey Shore University Medical Center, which was capable of performing the procedure, Zaslow said.

The suit claimed Varma's decision to call off the contrast CT test deviated from the standard of care because a non-contrast test could not reliably diagnose or rule out the existence of aortic dissection. And the suit claimed Shieh's failure to promptly contact Varma and notify him of the test results were a deviation from the standard of care. Anama deviated from the standard of care by not promptly ordering the CT scan with contrast, the suit claimed.

According to Zaslow, defense experts opined that even if Rabkin were diagnosed with an aortic dissection within three hours of his arrival at the emergency room, it still would have taken him six to 10 hours to transfer him to another institution capable of performing the surgery, and therefore he would not have been saved.

The settlement was reached during a settlement conference with Superior Court Judge Craig Wellerson. The terms call for Varma to pay $1.25 million, Shieh to pay $750,000, and Anama to pay $350,000.

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