Ms. C, a nurse practitioner, worked at a boarding school. The students received a traditional high-school education and intense sports training all in the same location. The academy also provided training facilities for professional athletes. The school itself was on a sprawling property with football and baseball fields; an Olympic-size swimming pool; indoor and outdoor basketball courts; and indoor gym facilities with treadmills, elliptical machines, stair climbers, and other cardiovascular and weight-training devices.

Ms. C had been at the academy for two years and enjoyed the work far more than she had her previous job in a pediatric practice. Her job was largely divided into two categories: intake work at the start of the school term and maintenance the remainder of the year. All new student-athletes had to pass a physical exam to be part of the sports-training program. Two weeks before the start of the year, Ms. C and Dr. D (who was hired on a temporary basis) examined the students before certifying them as healthy for training.

The rest of Ms. C’s job involved attending to sick students and the occasional accident. Serious injuries, such as fractures, were treated at the local hospital. Most students came to her clinic for ice, ibuprofen, bandages, and advice.

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Shortly before the school year was set to begin, Ms. C and Dr. D were conducting the entry physicals. The clinicians worked well together. Ms. C would walk the students (and often their parents) through the paperwork, take a family history, measure BP, draw blood, check the basics, and then turn the patient over to Dr. D for a brief exam. If everything was in order, both clinicians would sign off on the paperwork.

Mike was 16 years old and a prospective basketball player. Ms. C had Mike’s mother, Mrs. E, fill out the paperwork while she took the young man’s measurements. Everything appeared normal, and Ms. C recorded Mike’s BP, height, and weight on the chart. Ms. C went through the family history and noted that Mike’s father had died of a heart condition at age 32 years. She made a mental note to point this fact out to Dr. D when he took the file. But by the time the physician arrived, Ms. C had already moved on to the next student. Dr. D scanned Mike’s file, saw nothing out of the ordinary, and signed his approval.

Two months into the semester, the clinic phone rang. One of the coaches told Ms. C to come to the gym right away. “One of the boys has collapsed,” he shouted. “I’ve called 911.”

Mike was found lying on the gym floor next to the treadmill, surrounded by frightened teammates. “What happened?” Ms. C asked the coach. She was told that Mike had been running on the treadmill and suddenly fell to the floor, unconscious and unresponsive.

Mike’s breathing was shallow; his lips were bluish-white. Everything Ms. C learned in training fled her mind, and she froze, helplessly looking down at the boy. Eventually, an emergency medical technician pushed her out of the way and began administering CPR. Another paramedic rushed in with a defibrillator. But it was too late. Mike was officially pronounced dead at the hospital. The cause of death was determined to be hypertrophic cardiomyopathy.

Ms. C felt tremendous guilt for not providing CPR (although she was later told that it would not have helped) and failing to point out the family history of heart disease. Meanwhile, Mike’s heartbroken and angry mother decided that someone should be blamed for her son’s death. She hired a plaintiff’s attorney and sued the sports academy, Dr. D, and Ms. C.

Following her attorney’s advice, Ms. C agreed to take the case to trial. The plaintiff’s cardiologist testified that Mike’s medical history required an echocardiogram be performed. Such a test would have led to a diagnosis of the hypertrophic cardiomyopathy and precluded the student from the strenuous activity that resulted in his death, according to the witness. The plaintiff also alleged that the academy employees, who were present at the time of the collapse, failed to take appropriate measures (e.g., administration of CPR or use of a defibrillator). The defense argued that Mike had inherited a heart disorder that was neither symptomatic nor apparent on physical examination. The defense contended that Mike’s mother, who was aware that the boy’s father died of a hereditary heart condition at a young age, failed to take measures to have her son properly evaluated by a cardiologist before participating in sports.

After two days of deliberation, the jury found the sports academy not negligent in its emergency response efforts but 18% negligent for failing to discover the heart defect. Dr. D and Ms. C were each found 18% negligent. Mike’s mother was found 46% negligent. The jury awarded $1.5 million in total damages before reduction of comparative fault by the mother.

Legal theory

In cases involving multiple defendants, different levels of liability can be assessed based on the amount of negligence the jury believes each party was responsible for. But liability is not limited to the defendants. In some cases, the plaintiff is partially responsible for the injury. If the jury makes that determination, and the total monetary award will be reduced by the amount of the plaintiff’s negligence (46% in this case). In some states, if the plaintiff is found to be 50% or more responsible for the injury, they cannot collect at all, even if the defendant was partially responsible.

Protecting yourself

Warning bells went off for Ms. C when she read about the family history of fatal heart disease, yet she neglected to recommend an echocardiogram or make a note on the file to bring it to the physician’s attention. Do not ignore such warnings. Family history—especially if it involves death at a young age—can suggest a hereditary condition. Simply ignoring this because of the boy’s youth and apparent good health was a mistake. It’s always best to err on the side of caution, especially when the test involved is noninvasive and simple. n

Ms. Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.