A Medical Controversy
Sunday, February 10, 2008
BY MARY JO LAYTON

The family of a North Bergen woman has sued Holy Name Hospital in Teaneck, claiming she died after cardiologists botched an angioplasty and the hospital had no cardiac surgery team to save her.

Pearl Sullivan, a 75-year-old grandmother of nine, died two days after cardiologists punctured an artery in her heart, the family's attorney said.

The case is likely to inflame the bitter debate about the safety of elective angioplasty at hospitals like Holy Name. The hospital is one of nine in New Jersey participating in a controversial national study of the procedure at facilities that don't have cardiac surgical teams on-site to handle possible complications. The issue has pitted hospitals and cardiologists against each other in court and in hearings in Trenton. At stake for them is a share of the $300 million made on angioplasties every year in New Jersey.

"A simple in-and-out procedure on Friday turned into Sunday at the funeral home making plans to bury my mother," said Scott Sullivan, the youngest of Pearl Sullivan's four sons.

"If you're scheduling surgery where something can go wrong and you don't have adequate backup, you shouldn't be performing that surgery -- especially when there's a hospital 10 minutes away that's better prepared," he said.

The lawsuit, filed Friday in Superior Court in Hackensack, names the hospital, cardiologists Atul Sharma and Gerard Eichman, hospital employees and New York-Presbyterian Health System, Holy Name's affiliate.

The defendants "negligently, carelessly, recklessly and unskillfully" cared for Pearl Sullivan and "deviated from the accepted standards," according to the suit. Officials at Holy Name Hospital said they had not seen the lawsuit and would not comment. "This is the first we're hearing of it,'' said Catherine Yaxley, vice president of planning and government affairs.

Eichman said neither he nor Sharma could comment because federal law prevents physicians from discussing individual patients. Angioplasties are performed to clear blocked arteries in the heart. During the procedure, a catheter is inserted into the groin and a wire with a balloon tip reaches the blockage. Once the balloon inflates and opens the vessel, a wire mesh -- a stent -- may be implanted to keep the artery open.

The risk that an angioplasty patient will need emergency heart bypass surgery is less than 1 to 2 in every 1,000 patients. But on that day in 2006, Pearl Sullivan became one of those patients who needed surgery, said Lee Goldsmith, an Englewood Cliffs attorney representing the Sullivan family.

"She needed emergency bypass surgery," Goldsmith said. "She couldn't get that." Had she been at one of the 18 hospitals in New Jersey that perform open-heart surgery, her chance of survival would have been much higher, he said.

The Sullivans describe how what they were told would be a routine procedure turned into hours of anxious waiting. Finally, a doctor came out to tell them they had perforated an artery during the angioplasty, Scott Sullivan said. Two days later, Pearl Sullivan was dead.

A national study

In North Jersey, hospitals that have on-site cardiac surgery include Hackensack University Medical Center, Englewood Hospital and Medical Center, The Valley Hospital in Ridgewood and St. Joseph's Regional Medical Center in Paterson.

In 2006, the state permitted Holy Name and eight other hospitals without cardiac surgical backup to perform elective angioplasty as part of a national study by Johns Hopkins University.

Proponents say the lifesaving procedure should be offered at more hospitals and note that 27 states and many European countries allow hospitals to perform angioplasty without backup cardiac surgery teams. In fact, New Jersey may expand the number of hospitals that can participate in the study.

"The data we have today regarding the outcomes of elective angioplasty'' with and without backup surgeons "suggests that the outcomes are the same,'' said Dr. Thomas Aversano, a cardiologist who is leading the Johns Hopkins study.

The study is necessary, he said, to gather more data "before we make it national policy.''

But some cardiologists say these programs are putting patients at risk. And they worry patients may not be fully aware that they may have to be transferred if something goes wrong.

One study reported a 38 percent greater risk of death if the elective angioplasty is done at a hospital without backup surgeons. In New Jersey, cardiologists packed a state hearing after reports that at least four, and possibly as many as seven, angioplasty patients in the state had died who had the procedures at hospitals without backup.

"We're asking patients to accept risk. You have to ask whether that's ethical or not,'' said Gary S. Young, executive vice president of Cooper University Hospital in Camden. Cooper, which has a cardiac surgery unit, is among a group of hospitals that have sued to prevent those without backup surgeons from offering the procedure.

Both sides agree on one thing: The economics of medicine plays a powerful role. About 28,000 procedures are performed in the state annually at a cost of $11,000 to $18,500. Angioplasties bring in more than $300 million a year to New Jersey hospitals.

"The only reason this was being done was for money," Goldsmith said. "This is all about the economics of medicine, and patient care is secondary."

For the Sullivans, this lawsuit is not about a payout and they are not anticipating a blockbuster verdict if they prevail. Pearl Sullivan was the kind of plaintiff most attorneys aren't interested in - - she was a grandmother, not a breadwinner in her prime. In the cold calculations of medical malpractice, where awards are calculated in part on lost wages, Pearl Sullivan's value can't be quantified in lost paychecks.

The family filed the suit because they say Holy Name Hospital never informed them of the risk Pearl Sullivan faced because a cardiac backup team wasn't on-site, her son said. Had they known, they would have gone to another hospital.

"I brought her here," Scott Sullivan said, his eyes filling with tears.

"If this prevents one more person from going in there disillusioned or given a false sense of security," he said, "then my mom will not have died in vain."

She loved the slots

Pearl Sullivan was a heavy smoker and suffered from chronic obstructive pulmonary disease, which damaged her lungs, Scott Sullivan said. She suffered a heart attack in 1999, underwent emergency angioplasty at Holy Name Hospital -- emergency angioplasties have traditionally been allowed at these hospitals -- and recovered, he said.

She managed trips to the casinos with her husband of 52 years, Thomas. She loved the slots. She also loved to surprise her husband. One day in her early 40s she dyed her dark-brown hair platinum blond. At age 59, she got her driver's license -- not to drive but to get her own credit card.

From their small North Bergen apartment, she orchestrated holiday gatherings at her sons' homes -- the First Communions, birthdays, graduations and Christmas celebrations with her sons and their families, Scott said.

But by 2006, she was getting short of breath occasionally -- especially going up the steep hills in North Bergen on her daily walk to buy lottery tickets, her husband said. She'd pause at the Little League field bench, collect herself and head home, scratching the numbers while curled up on the couch.

Shortly before Thanksgiving in 2006, her cardiologist, Dr. Gerard Eichman, told her she needed an angioplasty, Scott recalled. She scheduled it for Dec. 1 so she would be recovered enough to enjoy Christmas.

"They told us it was no big deal," her son said.

Pearl Sullivan was admitted to Holy Name Hospital on Dec. 1. As a nurse wheeled her away on the gurney, her husband got teary-eyed. "You're a wuss. I'm going to slap you,'' she joked.

The procedure began shortly before 9 a.m., Scott Sullivan said. Thirty to 40 minutes later, the family was told a stent would have to be implanted, he said. Eichman told the family the procedure should take another "40 minutes tops," Scott Sullivan said, adding: "He sounded very optimistic."

At 10:15, a nurse informed the family that Pearl Sullivan was fine but that it would take another half hour, her son said.

Nearly three hours passed. Scott Sullivan tried to console his crying father. Shortly after 1 p.m. he said he went to the nurses' station and demanded to know what was happening.

Dr. Atul Sharma, a cardiologist involved in the case, approached the Sullivans to explain the complications, Scott Sullivan said. Sharma told the family there was a blockage around the artery "that they were chipping away at to get the stent through and ruptured the artery," Scott Sullivan said.

"They could have stopped at that point," Goldsmith said, before attempting to insert the stent. "They didn't," he said.

Medical records indicate the artery was "perforated," Goldsmith said.

Pearl Sullivan was stabilized and returned to a critical-care unit, he said. Sharma told the Sullivan family that the next 24 to 48 hours were critical, Scott Sullivan said.

She improved enough by Saturday afternoon that she was able to talk with her family. She told her husband she loved him. "Don't worry about me," she told her son.

On Sunday, the family was called around 10 a.m. and urged to come to the hospital immediately, Scott Sullivan said.

Scott, a lieutenant in the North Bergen Police Department, raced from his shift and arrived first. A doctor, a Catholic priest and a nurse took him into a room and told him his mom had died.

Medical records show Pearl Sullivan had a heart attack, but that wasn't the cause of her death, Goldsmith said. Goldsmith says that during the angioplasty and the complications, a blockage was created. She had a heart attack, the heart wall ruptured which lead to a massive hemorrhage, he said.

Pearl was rushed to the operating room, and died during surgery, Goldsmith said.

Her 80-year-old husband said he never questioned Eichman's suggestion to have the surgery at Holy Name Hospital. Pearl trusted her cardiologist.

"She had a lot of faith in him," he said. "But I know they didn't so something right." Certificate of need

New Jersey could expand the elective angioplasty study to 12 hospitals. A total of 23 hospitals are seeking what's known as a certificate of need to perform the procedure, said Tom Slater a spokesman for the state Department of Health and Senior Services. A recommendation is expected in June. The original nine hospitals have all applied and are still performing elective angioplasties.

Holy Name Hospital refused to discuss its program last week with The Record. But in an article published last November, Yaxley, the hospital's vice president, said: "It's a wonderful study and great for medicine."

Proponents of angioplasty at community hospitals say critics are just trying to protect their share of a lucrative market.

But Cooper hospital's Young says outcomes are typically better in cardiac surgery centers because they have high volume.

"Nobody in New Jersey is so distant from a full-service cardiac surgical center,'' he said.

He also notes that the American Heart Association, American College of Cardiology and Society for Cardiovascular Angiography and Intervention all say that elective angioplasty should only be done at hospitals with a backup surgical team.

When the Hopkins study began in 2006, 19 states permitted elective angioplasty without on-site backup surgeons. Now, 27 permit the procedure, said Aversano, the study leader.

Aversano has expressed exasperation at how intense the debate over safety and angioplasties has become in New Jersey.

He said he could not discuss any patient's case, and that any deaths or adverse events are scrutinized by safety review boards at each hospital, as well as Johns Hopkins. Holy Name, he said, remains in the study.

It is not clear if Pearl Sullivan was one of the patients in the study. What is known is that Holy Name would not have been permitted to perform the elective angioplasty without participating in the Hopkins study.

Last week, Scott Sullivan clutched a newspaper article that appeared last June in which Holy Name reported performing 116 angioplasties since April 2006. A hospital spokeswoman reported that none of the patients had complications requiring them to be transferred to a hospital with backup cardiac surgery.

© The Bergen Record, 2008:  As Published in the Bergen Record, Sunday, February 10, 2008

• For more information, go to Contact
• Email G H at info@goldrich.com
• Copyright © 1997-2008 by: Goldsmith Harz, LLP
• Website and Internet guidance by: Windco.com, Inc.

About New Jersey Medical Malpractice lawyers| Announcements about Medical Malpractice law | Medical Malpractice Attorneys Areas of Practice | Unsafe Products Litigation Attorney Profiles  | Contact Medical Malpractice Attorneys Goldsmith  Harz  | Medical Malpractice Lawyer Legal Links | Publications of Federal Tort Litigation Attorneys Goldsmith Harz  | Medical Malpractice Lawyers News Page  | Seminars in Medical Malpractice law and Personal Injury law | Main Page of P I Law Firm Goldsmith Harz Internet Links for businesses, friends, and research | Site Map