Florida – Internal Medicine – Tissue Plasminogen Activator Administered To A Patient With A History Of Intracranial Hemorrhage

On 3/12/2014, a 78-year-old male presented to the medical center.  Upon admission, a brain CT revealed a history of intracranial hemorrhage.

On 3/15/2014, a stroke alert was called due to the belief that the patient had suffered a stroke, setting in motion a hospital protocol to check for stroke.

A stat CT scan revealed subacute or chronic left suboccipital stroke, which did not correspond with the patient’s acute symptoms.

An internist ordered a neuro consult and gave a history that did not include intracranial hemorrhage.  He ordered and confirmed tissue plasminogen activator (“tPA”) to be administered to the patient, which is contraindicated for patients with a history of intracranial hemorrhage.  He did not obtain an MRI of the brain.

The Medical Board of Florida judged the internists conduct to be below the minimal standard of competence given that he did not order an MRI of the brain since symptoms and the stat CT did not correspond.  He ordered tPA for a patient with a history of intracranial hemorrhage.  He also failed to give an accurate history of intracranial hemorrhage to the neurologist.

It was requested that the Medical Board of Florida order one or more of the following penalties for the internist: permanent revocation or suspension of his license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, probation, corrective action, payment of fees, remedial education, and/or any other relief that the Medical Board of Florida deemed appropriate.

State: Florida

Date: April 2017

Specialty: Internal Medicine, Neurology

Symptom: N/A

Diagnosis: Neurological Disease

Medical Error: Improper medication management, Failure to order appropriate diagnostic test, Failure of communication with other providers

Significant Outcome: N/A

Case Rating: 2

Link to Original Case File: Download PDF

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