NEW ULM - A Twin Cities cardiologist and a New Ulm Medical Center (NUMC) emergency department nurse testified Thursday in a wrongful death lawsuit against Allina Health System and NUMC in Brown County District Court.
Tom Davis, M.D., a cardiologist at Park Nicollet Heart Center in St. Louis Park and NUMC Emergency Department Registered Nurse Katie Wohlers testified about the medical condition of a 45-year-old Iowa trucker who collapsed and died despite resuscitation efforts in the NUMC emergency department the evening of Oct. 25, 2006.
An autopsy determined his cause of death was cardiac dysrythmia (irregular heart beat), with underlying coronary artery disease, according to court documents.
Veryln Buls, who weighed more than 400 pounds when he died, according to court records, had been admitted earlier that day, complaining of an itchy rash from his knees to his neck. His vital signs showed abnormally low blood pressure (82/50 and later 86/54) and a high heart rate of 128 beats a minute (60 to 100 beats a minute is normal), Wohlers said.
She said Buls told her he did not have chest pains when he initially came to the hospital and that he did not appear to be ill other than a rash. She gave Buls directions to Walgreens in New Ulm after he got a prescription from emergency department physician Dale W. Bohlke, M.D.
Davis said many people visit hospital emergency rooms complaining of "crushing chest pains," and doctors do further tests for stress by ordering electrocardiograms (EKGs). He said principal congestive heart failure symptoms are chest pains, fluid in lungs and swollen ankles.
"Did Dr. Bohlke follow the appropriate standards of care with Mr. Buls?" Minneapolis attorney Lindsay G. Arthur, representing Allina and NUMC, asked Davis.
"Yes," Davis said.
Waterloo, Iowa attorney James H. Cook, representing Karen Buls, trustee for the heirs and next-of-kin of Veryln Buls, said Buls' vital signs taken at NUMC included low blood pressure.
"Was anything done to treat it?" Cook asked Davis.
"Yes, Dr. Bohlke told him to stop taking his high blood pressure medication and wrote prescriptions for drugs to raise it," Davis said.
"You wrote in your affidavit that the only way to save Buls' life at the time was angioplasty (mechanically widening narrowed or obstructed arteries)," Cook said.
"I didn't say that at all," Davis said.
"You wrote that in your affidavit," Cook said.
"Yes, but the interpretation is wrong," Davis said.
"No EKG was done, and no blood was drawn," Cook said. "You have to examine a patient before ruling things out, don't you? You gather information and diagnose."
"When a patient doesn't complain of chest pains, you don't do an EKG," Davis said. "The patient came in with an itchy rash."
"He never complained of chest pain but was never asked if he had it in the past," Cook said.
Davis said angioplasty could not be performed at NUMC, so a heart center would be called and the patient's condition discussed with a cardiologist. The patient would need to be transported very rapidly to a facility that could do an emergency angiogram, as a bridge to emergency bypass surgery. If a patient's heart was beating irregularly, electric shock would be used to get it back into regular rhythm.
"Would he have made it to a heart center?" Arthur asked.
"No, there wasn't time," Davis said.
Arthur asked Wohlers if Buls was verified to be critically ill when he initially checked into NUMC.
"No," she said. "He told me he had high stress and rash in recent months but was in no apparent distress other than the rash. His oxygen saturation was good, and he was breathing normally. He denied having chest pain. He was a smoker with hypertension history and an elevated heart rate and denied having any allergies."
Closing arguments and jury instructions begin at 8:30 a.m. today in the third-floor courtroom.
The lawsuit filed Sept. 30, 2010 seeks more than $50,000 for Buls' next-of-kin plus $10,000 for funeral and burial expenses.
(Fritz Busch can be e-mailed at firstname.lastname@example.org).