Background
Darci White died on August 13, 2016, approximately four hours after arriving at Advocate Condell Medical Center’s emergency department following a syncope episode. She was treated by Dr. Ronald Shenfeld, an emergency physician employed by Infinity Healthcare Physicians, LLC. Her condition deteriorated with repeated episodes of loss of consciousness and ultimately cardiopulmonary arrest at 8:50 p.m. An autopsy revealed massive acute pulmonary thromboemboli in the bilateral main stem pulmonary arteries.
Michael White, Darci’s husband, filed suit claiming that Dr. Shenfeld and the hospital deviated from the standard of care in three respects: failing to consider pulmonary embolism early in the course of treatment, failing to perform point-of-care ultrasound (POCUS), and failing to administer anticoagulant therapy (heparin or tPA). Plaintiff also asserted that the hospital was liable due to Nurse Amy Spaid’s failure to communicate critical information to Dr. Shenfeld, including that Darci’s oxygen saturation had dropped to 88% in the ambulance and that she had experienced additional syncopal episodes.
Following a jury trial in October 2023, the jury returned a verdict for plaintiff in the amount of $25 million, including $3 million for grief and sorrow and $5 million for loss of society. The trial court denied defendants’ post-trial motions and entered judgment on the verdict, including prejudgment interest.
The Court’s Holding
The Illinois Appellate Court affirmed the judgment in its entirety, rejecting all of defendants’ arguments. The court upheld the jury’s verdict despite defendants’ challenges based on claimed insufficiency of expert testimony to prove negligence and causation.
The evidence established that Darci presented with hemodynamic instability, repeated syncopal episodes, and documented hypoxia (oxygen saturation of 88% in the ambulance and 89% upon hospital assessment). Multiple expert witnesses testified that the standard of care required Dr. Shenfeld to consider pulmonary embolism earlier given these red flags, particularly the combination of syncope, hypoxia, tachycardia, and hypotension. Experts opined that POCUS should have been performed shortly after arrival or immediately arranged with another physician, and that anticoagulation therapy should have been initiated sooner. Had these steps been taken before 8:30 p.m., the experts concluded it was more likely than not that Darci would have survived.
The court found that Nurse Spaid’s failure to communicate that Darci’s oxygen level had dropped to 88% in the ambulance and that she had experienced two additional syncopal episodes en route constituted a deviation from the standard of nursing care. The jury was entitled to find this communication failure contributed to Dr. Shenfeld’s delayed consideration of pulmonary embolism as a diagnosis.
Key Takeaways
- Emergency physicians must consider pulmonary embolism in the differential diagnosis when patients present with syncope accompanied by hypoxia, hemodynamic instability, and tachycardia, even when dehydration is also suspected.
- Point-of-care ultrasound should be performed or immediately arranged when clinical findings suggest possible pulmonary embolism, and delay in diagnosis and treatment can be negligent even if the condition is ultimately fatal.
- Nursing staff must communicate critical vital sign abnormalities (particularly low oxygen saturation) and multiple syncopal episodes documented during transport to the treating physician, as failure to do so can constitute medical negligence.
- Expert testimony establishing that proper diagnosis and anticoagulation therapy would “more likely than not” have prevented death satisfies causation requirements in medical negligence cases, even when defendants present contrary expert opinion regarding prognosis.
Why It Matters
This decision reinforces that emergency physicians cannot rely on a single working diagnosis (here, dehydration) when a patient presents with multiple objective findings of hemodynamic compromise. The constellation of syncope, hypoxia, tachycardia, and hypotension should trigger consideration of life-threatening conditions such as pulmonary embolism, not merely benign causes. The court’s affirmance confirms that the standard of care in emergency medicine requires aggressive diagnostic evaluation—including bedside ultrasound—when the clinical picture suggests serious cardiopulmonary pathology.
Additionally, this case emphasizes the critical role of nursing communication in the chain of emergency care. The failure to relay that a patient’s oxygen saturation dropped to 88% in the ambulance directly impacted the physician’s clinical assessment and diagnostic approach. Health systems handling emergency patients must ensure robust communication protocols, as gaps in information transfer between paramedics, triage nurses, and treating physicians can constitute negligence independently and contribute to missed diagnoses. The substantial damages award signals that courts will hold healthcare providers accountable when failures in diagnosis and communication lead to preventable deaths.