As a Houston, Texas attorney focusing on medical malpractice cases, I have seen an increasing trend in cases arising from stroke misdiagnosis. This is a rather strange development, considering the advances in stroke educational outreaches and medical research over the past decade.
Signs and symptoms of stroke
Stroke is the fourth leading cause of death in the United States and the number one cause of long-term disability in adults.
Since the U.S. Food & Drug Administration (FDA) approved the clot-busting drug tPA, health professionals gave more attention to the speed of getting stroke patients treated. In line with this focus, the American Heart Association and American Stroke Association have sponsored one of the all-time best public awareness campaigns for stroke symptoms, using the acronym FAST:
F: Face Drooping (Does one side of the face droop or is it numb?)
A: Arm Weakness (Is one arm weak or numb?)
S: Speech Difficulty (Is speech slurred?)
T: Time to Call 9-1-1 (Call 9-1-1 is someone shows any of these symptoms and say, “I think this is a stroke.”)
Stroke Certification
Stroke certification began after the Brain Attack Coalition made recommendations for the establishment of primary stroke centers. The primary stroke center (PSC) designation began in 2004, and the comprehensive stroke center designation (CSC) was announced in 2012.
Currently, three separate nonprofit organizations have accredited hospitals for stroke certification: The Joint Commission, DNV GL, and Healthcare Facilities Program.Stroke centers must be recertified every two years.
There are some significant differences between the capabilities of primary stroke centers and comprehensive stroke centers.
Primary Stroke Centers (Level I)
∙ Stabilize and treat most cases of acute ischemic stroke
∙ No requirement for advanced imaging (CT angiography, CT perfusion, or transcranial doppler)
∙ No requirement endovascular intervention
∙ No requirement for a separate neuroscience intensive care unit (ICU)
∙ Access to neurosurgery within two hours
∙ Send complex patients and those who require advanced intervention to comprehensive stroke centers
Comprehensive Stroke Centers (Level II)
∙ Treat all types of stroke patients, both ischemic and hemorrhagic and including complex cases requiring advanced technology, specialized diagnosis, and higher levels of treatment
∙ 24/7 access to advanced imaging, including CT angiography, CT perfusion, or transcranial Doppler
∙ 24/7 access to endovascular interventions, such as mechanical thrombectomy for acute ischemic stroke, aneurysm coiling, and arteriovenous malformation embolization
∙ 24/7 staffing of neurocritical care experts in a dedicated neuroscience intensive care unit (ICU)
∙ Received patients from primary stroke centers after they are stabilized
Support Stroke Centers (Level III)
Texas recognizes a third level of stroke facilities, which provide access to stroke care but do not meet all the criteria required to be designated as a Primary or Comprehensive Stroke Center. These hospitals must have a Primary or Comprehensive Stroke Center that agrees to collaborate with them.
Quality of care concerns: Ambulance crew hospital selection
As a Houston, Texas medical malpractice attorney, I have met with many stroke patients and family members. One of the most common complaints is how, after the 9-1-1 call, an emergency medical technician (EMT) ambulance crew transported the patient to a hospital that the family did not desire.
Ambulance drivers seem, almost invariably, to tell patients and family members that they are required to take stroke patients to the “nearest stroke center.”
Medical evidence shows that the best results are obtained when appropriate patients are treated with the clot-busting drug tPA within 60 minutes of the beginning of stroke symptoms. Thus, the role of EMTs is hugely important. In a 2017 stroke conference in Houston, several presentations focused on giving EMTs the role of doing field tests or assessments to determine whether they should transport a patient to a Primary Stroke Center or Comprehensive Stroke Center. I expect that we will see more of this over the next decade.
In the meantime, the American Heart Association and American Stroke Association created 2013 guidelines for ambulance crews. They encourage EMTs to take patients with suspected stroke to the highest level of stroke care within no more than an additional 15-20 minutes of transport time. This means that an EMT crew should bypass a Primary Stroke Center very close to a patient’s house if a Comprehensive Stroke Center is nearby. These guidelines were informed by medical evidence showing that mechanical thrombectomy (a procedure offered at Comprehensive Stroke Centers for removing a stroke-causing blood clot) and tPA have even better results than tPA alone.
Quality of care concerns: Stroke Center misdiagnosis
I have handled medical malpractice lawsuits where patients were taken to well-known Houston area stroke centers with classic stroke symptoms, but were misdiagnosed and discharged. In one case, the patient was sent home three days in a row with the diagnosis of a migraine headache. In another case, the patient was told that it was all in her head (a diagnosis of psychogenic reaction). Both patients experienced massive strokes and by not being properly treated will live with devastating impairments for the rest of their lives.
If you find yourself in a situation where the doctors and nurses are discounting stroke symptoms, I encourage you to be firm. Be careful to explain comprehensively and thoroughly all of the symptoms, including the time they started, to each doctor and nurse. In addition, stroke centers are sometimes staffed with residents, doctors who are still in training. Before consenting to discharge, ask to be seen in person by an attending (fully trained) physician from the stroke team.
We are here to help
If you or someone you care for has been seriously injured by a botched diagnosis and treatment of a stroke, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Listing of Texas Stroke Facilities
The Texas Department of State Health Services maintains three lists of hospitals with stroke certification.
Texas Comprehensive (Level I) Stroke Facilities
Baylor University Medical Center
Dallas, 75246 (TSA-E)
Expires 4/1/2019
CHI St Luke’s Health Baylor College of Medicine Medical Center
Houston, 77030 (TSA-Q)
Expires 7/1/2019
Clear Lake Regional Medical Center
Webster, 77598 (TSA Q)
Expires 6/1/2019
Dell Seton Medical Center at The University of Texas
Austin, 78731 (TSA-O)
Expires 6/1/2019 (with contingencies)
Harris Health System Ben Taub Hospital
Houston, 77030 (TSA-Q)
Expires 7/1/2018
Houston Methodist Hospital
Houston, 77030 (TSA-Q)
Expires 5/1/2018
John Peter Smith Hospital
Ft. Worth, 76104 (TSA-E)
Expires 12/1/2019
Kingwood Medical Center
Kingwood, 77339 (TSA-Q)
Expires 10/1/2019
Medical City Dallas Hospital
Dallas, 75230 (TSA-E)
Expires 4/1/2020
Medical City Fort Worth
Fort Worth, 76104 (TSA-E)
Expires 9/1/2019
Medical City Plano
Plano, 75075 (TSA-E)
Expires 2/1/2020
Memorial Hermann Hospital
Houston, 77030-1501 (TSA-Q)
Expires 11/1/2017 (Extended 11/1/2018)
Methodist Hospital
San Antonio, 78229 (TSA-P)
Expires 4/1/2019
Parkland Memorial Hospital
Dallas, 75235 (TSA E)
Expires 8/1/2019
St. David’s Medical Center
Austin, 78705 (TSA-O)
Expires 10/1/2018
St. Luke’s Baptist Hospital
San Antonio, 78229 (TSA-P)
Expires 12/1/2019
St. Luke’s The Woodlands Hospital
Houston, 77384 (TSA-Q)
Expires 7/1/2018
Seton Medical Center – Austin
Austin, 78705 (TSA-O)
Expires 7/1/2019
Texas Health Harris Methodist Hospital Fort Worth
Fort Worth, 76104 (TSA-E)
Expires 10/1/2018
Texas Health Presbyterian Hospital Dallas
Dallas, 75231 (TSA E)
Expires 1/1/2019
University Hospital
San Antonio, 78229 (TSA P)
Expires 7/1/2018
UT Southwestern Zale Lipshy University Hospital
Dallas, TX 75390 (TSA-E)
Expires 3/1/2018
Valley Baptist Medical Center – Harlingen
Harlingen, 78550 (TSA-V)
Expires 9/1/2018
Texas Primary (Level II) Stroke Facilities
Abilene Regional Medical Center
Abilene, 79606 (TSA D)
Expires 7/1/2018
Baptist Hospital of Southeast Texas
Beaumont, 77701 (TSA R)
Expires 12/1/2019
Baptist Medical Center
San Antonio, 78205 (TSA-P)
Expires 6/1/2018
Baylor Scott & White All Saints Medical Center at Fort Worth
Fort Worth, 76104 (TSA-E)
Expires 10/1/2018
Baylor Scott & White Medical Center - Centennial
Frisco, 75035 (TSA-E)
Expires 9/1/2019
Baylor Scott & White Medical Center – College Station
College Station, 77840 (TSA-N)
Expires 10/1/2019
Baylor Scott & White Medical Center – Garland
Garland, 75042 (TSA E)
Expires 8/1/2018
Baylor Scott & White Medical Center – Grapevine
Grapevine, TX (TSA-E)
Expires 7/1/2019
Baylor Scott & White Medical Center – Hillcrest
Waco, 76712 (TSA-M)
Expires 9/1/2019
Baylor Scott & White Medical Center – Irving
Irving, 75061 (TSA-E)
Expires 8/1/2019
Baylor Scott & White Medical Center – Lake Pointe
Rowlett, 75088 (TSA-E)
Expires 10/1/2019
Baylor Scott & White Medical Center – Lakeway
Lakeway, 78738 (TSA O)
Expires 10/1/2018
Baylor Scott & White Medical Center – McKinney
McKinney, 75077 (TSA E)
Expires 10/1/2019
Baylor Scott & White Medical Center – Plano
Plano, 75093 (TSA-E)
Expires 7/1/2019
Baylor Scott & White Medical Center - Round Rock
Round Rock, 78665 (TSA-O)
Expires 6/1/2018
Baylor Scott & White Medical Center – Waxahachie
Waxahachie, 75165 (TSA E)
Expires 6/1/2019
Baylor Scott & White Medical Center – White Rock
Dallas, 75218 (TSA-E)
Expires 1/1/2020
Bayshore Medical Center
Pasadena, 77504 (TSA-Q)
Expires 6/1/2019
Cedar Park Regional Medical Center
Cedar Park, 78613
Expires 4/1/2019
Central Texas Medical Center
San Marcos, 78666 (TSA-O)
Expires 12/1/2019
CHI St. Luke’s Health – Brazosport
Lake Jackson, 77566 (TSA-R)
Expires 2/1/2019
CHI St. Luke’s Health Memorial
Lufkin, 75904 (TSA H)
Expires 4/1/2019
CHI St. Joseph Regional Health Center
Bryan, 77802 (TSA-N)
Expires 2/1/2019
CHRISTUS Good Shepherd Medical Center – Longview
Longview, 75601 (TSA-G)
Expires 11/1/2019 (with contingencies)
CHRISTUS Mother Frances Hospital
Tyler, 75701 (TSA-G)
Expires 12/1/2018
CHRISTUS Spohn Hospital Corpus Christi – Shoreline
Corpus Christi, 78404 (TSA-U)
Expires 3/1/2020
CHRISTUS St. Michael Health System
Texarkana, 75503 (TSA-F)
Expires 2/1/2019
Citizens Medical Center
Victoria, 77901, (TSA-S)
Expires 12/1/2018
College Station Medical Center
College Station, 77845 (TSA-N)
Expires 5/1/2019
Conroe Regional Medical Center
Conroe, TX 77304 (TSA-Q)
Expires 7/1/2019
Corpus Christi Medical Center
Corpus Christi, 78468 (TSA- U)
Expires 5/1/2019
Covenant Medical Center
Lubbock, 79410 (TSA-B)
Expires 7/1/2020
Cypress Fairbanks Medical Center Hospital
Houston, 77065 (TSA-Q)
Expires 9/1/2019
Dallas Regional Medical Center
Mesquite, 75419 (TSA-E)
Expires 8/1/2019
DeTar Hospital Navarro
Victoria, 77902 (TSA-S)
Expires 10/1/2019
Del Sol Medical Center, a campus of Las Palmas Del Sol Healthcare
El Paso, 79925-7701 (TSA-I)
Expires 10/1/2018
Doctors Hospital at Renaissance
Edinburg, 78539 (TSA-V)
Expires 7/1/2018
Doctors Hospital of Laredo
Laredo, 78045 (TSA-T)
Expires 8/1/2018
East Texas Medical Center - Tyler
Tyler, 75701 (TSA-G)
Expires 11/1/2017 (Extended 2/1/2018)
Edinburg Regional Medical Center
Edinburg, 78935 (TSA-V)
Expires 11/1/2019
Hendrick Medical Center
Abilene, 79601 (TSA-D)
Expires 11/1/2018
Hospitals of Providence Sierra Campus
El Paso, 79902 (TSA-I)
Expires 10/1/2019
Houston Methodist Sugar Land Hospital
Sugar Land, 77479 (TSA-Q)
Expires 10/1/2019
Houston Methodist West Hospital
Houston, 77094 (TSA-Q)
Expires 9/1/2018
Houston Methodist Willowbrook Hospital
Houston, 77070 (TSA-Q)
Expires 6/1/2018
Houston Northwest Medical Center
Houston, 77090 (TSA-Q)
Expires 1/1/2019
Huntsville Memorial Hospital
Huntsville, 77342 (TSA Q)
Expires 8/1/2018
Knapp Medical Center
Weslaco, 78596 (TSA-V)
Expires 9/1/2019
Las Palmas Medical Center- A Campus of LPDS Healthcare
El Paso, 79902 (TSA-I)
Expires 10/1/2018
Longview Regional Medical Center
Longview, 75605 (TSA-G)
Expires 12/1/2018
McAllen Medical Center
McAllen, 78503 (TSA-V)
Expires 11/1/2019
Medical Center Hospital - Ector County Hospital District
Odessa, TX 79761 (TSA-J)
Expires 2/1/2019
Medical Center of Arlington
Arlington, 76015 (TSA-E)
Expires 9/1/2018
Medical Center of Lewisville
Lewisville, 75057 (TSA-E)
Expires 7/1/2019
Medical City Denton
Denton, 76210 (TSA-E)
Expires 10/1/2019
Medical City Las Colinas
Irving, 75039 (TSA-E)
Expires 4/1/2018
Medical City McKinney
McKinney, 75069 (TSA-E)
Expires 9/1/2018
Medical City North Hills
North Richland Hills, 76180 (TSA-E)
Expires 7/1/2019
Medical City Weatherford
Weatherford, 76086 (TSA-E)
Expires 12/1/2019
Memorial Hermann Katy Hospital
Katy, 77494 (TSA-Q)
Expires 7/1/2018
Memorial Hermann Memorial City Medical Center
Houston, 77024 (TSA-Q)
Expires 8/1/2018
Memorial Hermann Northeast Hospital
Humble, 77338 (TSA-Q)
Expires 9/1/2018
Memorial Hermann Greater Heights Hospital
Houston, 77008 (TSA-Q)
Expires 7/1/2018
Memorial Hermann Southeast Hospital
Houston, 77089 (TSA-Q)
Expires 7/1/2018
Memorial Hermann Southwest Hospital
Houston, 77074 (TSA-Q)
Expires 7/1/2018
Memorial Hermann The Woodlands Hospital
The Woodlands, 77380 (TSA-Q)
Expires 7/1/2018
Methodist Charlton Medical Center
Dallas, TX 75237 (TSA-E)
Expires 5/1/2019
Methodist Dallas Medical Center
Dallas, 75265 (TSA-E)
Expires 2/1/2019
Methodist Mansfield Medical Center
Mansfield, 76063 (TSA-E)
Expires 9/1/2018
Methodist Richardson Medical Center
Richardson, 75080 (TSA-E)
Expires 8/1/2019
Methodist Stone Oak Hospital
San Antonio, 78258 (TSA-P)
Expires 3/1/2018
Metroplex Hospital
Killeen, Texas 76549
Expires 10/1/2019
Metropolitan Methodist Hospital
San Antonio, 78212 (TSA-P)
Expires 3/1/2018
Mission Trail Baptist Hospital
San Antonio, 78235 (TSA-P)
Expires 6/1/2018
Nacogdoches Memorial Hospital
Nacogdoches, 75961 (TSA-H)
Expires 12/1/2019
North Central Baptist Hospital
San Antonio, 78258 (TSA-P)
Expires 6/1/2018
North Cypress Medical Center
Cypress, 77429 (TSA-Q)
Expires 7/1/2018
Northeast Baptist Hospital
San Antonio, 78217-5440 (TSA-P)
Expires 6/1/2018
Northeast Methodist Hospital
Live Oak, 78233 (TSA-P)
Expires 3/1/2018
Northwest Texas Hospital
Amarillo, 79106 (TSA-A)
Expires 3/1/2019
Oakbend Medical Center- JS Main Campus
Richmond, 77469 (TSA-Q)
Expires 10/1/2018
Oakbend Medical Center- Williams Way Campus
Richmond, 77469 (TSA-Q)
Expires 10/1/2018
Odessa Regional Medical Center
Odessa, 79760 (TSA-J)
Expires 10/1/2019
Paris Regional Medical Center
Paris, 75460 (TSA F)
Expires 2/1/2019
Providence Health Center
Waco, 76712 (TSA-M)
Expires 3/1/2019
Scott and White Medical Center – Temple
Temple, 76508 (TSA-L)
Expires 5/1/2018
Seton Medical Center Hays
Kyle, 76840 (TSA-O)
Expires 6/1/2019
Seton Medical Center Williamson
Round Rock, 78665 (TSA-O)
Expires 7/1/2019
Southwest General Hospital
San Antonio, 78224 (TSA P)
Expires 1/1/2020
St. David's Georgetown Hospital
Georgetown, 78626 (TSA-O)
Expires 2/1/2020
St. David’s North Austin Medical Center
Austin, TX 78758 (TSA-O)
Expires 10/1/2018
St. David’s Round Rock Medical Center
Round Rock, 78681 (TSA-O)
Expires 6/1/2018
St. David's South Austin Medical Center
Austin, 78748 (TSA-O)
Expires 5/1/2019
St. Joseph Medical Center
Houston, 77002 (TSA-Q)
Expires 11/1/2018
Texas Health Arlington Memorial Hospital
Arlington, 76012 (TSA-E)
Expires 12/1/2018
Texas Health Harris Methodist Hospital Hurst - Euless-Bedford
Bedford, 76022 (TSA-E)
Expires 3/1/2018
Texas Health Huguley Hospital
Fort Worth, 76115 (TSA-E)
Expires 3/1/2019
Texas Health Presbyterian Hospital Denton
Denton, TX 76201 (TSA-E)
Expires 12/1/2019
Texas Health Presbyterian Hospital Plano
Plano, 75093 (TSA-E)
Expires 5/1/2018
Texoma Medical Center
Denison, 75021 (TSA-E)
Expires 10/1/2018
The Hospitals of Providence East Campus
El Paso, 79938 (TSA I)
Expires 11/1/2019
The Hospitals of Providence Memorial Campus
El Paso, 79902 (TSA-I)
Expires 12/1/2019
The Medical Center of Southeast Texas
Port Arthur, 77640 (TSA-R)
Expires 4/1/2019
Titus Regional Medical Center
Mount Pleasant, 75455 (TSA F)
Expires 10/1/2018
United Regional Healthcare System
Wichita Falls, 76301 (TSA-C)
Expires 3/1/2020
University Medical Center
Lubbock, 79415 (TSA-B)
Expires 5/1/2019
University Medical Center El Paso
El Paso, 79905 (TSA-I)
Expires 6/1/2018
University of Texas Medical Branch
Galveston, 77555 (TSA-R)
Expires 2/1/2020
Valley Baptist Medical Center - Brownsville
Brownsville, 78520 (TSA-V)
Expires 8/1/2019
Valley Baptist Medical Center – Harlingen
Harlingen, 78550 (TSA-V)
Expires 9/1/2018
Valley Regional Medical Center
Brownsville, 78526 (TSA-V)
Expires 12/1/2018
Wadley Regional Medical Center
Texarkana, 75501 (TSA-F)
Expires 8/1/2019
West Houston Medical Center
Houston, 77082 (TSA-Q)
Expires 5/1/2018
Wilson N. Jones Regional Medical Center
Sherman, TX 75091 (TSA-E)
Expires 11/1/2019
Wise Regional Health System
Decatur, 76234 (TSA-E)
Expires 12/1/2019
Texas Support (Level III) Stroke Facilities
Baylor Scott & White Medical Center – Brenham
Brenham, 77833 (TSA-N)
Expires 7/1/2018
Bellville St. Joseph Health Center
Bellville, 77418 (TSA-Q)
Expires 1/1/2019
CHI St. Joseph Health Burleson Hospital
Caldwell, 77386 (TSA-N)
Expires 12/1/2019
CHI St. Joseph Health Grimes Hospital
Navasota, 77868 (TSA-N)
Expires 3/1/2020
CHI St. Joseph Health Madison Hospital
Madisonville, 77864 (TSA-N)
Expires 10/1/2019
Connally Memorial Medical Center
Floresville, 78114 (TSA-P)
Expires 7/1/2019
CHRISTUS St. Michael Hospital
Atlanta, 75551 (TSA F)
Expire 5/1/2018
East Texas Medical Center – Athens
Athens, 75751 (TSA G)
Expires 10/1/2018
East Texas Medical Center – Henderson
Henderson, 75652 (TSA G)
Expires 10/1/2018
East Texas Medical Center – Pittsburg
Pittsburg, 75686 (TSA-G)
Expires 7/1/2019
East Texas Medical Center – Quitman
Quitman, 75783 (TSA G)
Expires 1/1/2019
North Texas Medical Center
Gainesville, TX 76240 (TSA-E)
Expires 12/1/2017 (Extended 1/1/2018)
Texas Health Harris Methodist Hospital Azle
Azle, 76020 (TSA-E)
Expires 9/1/2019
Texas Health Presbyterian Hospital of Kaufman
Kaufman, 75142 (TSA-E)
Expires 11/1/2019
TMC Bonham Hospital
Bonham, 75418 (TSA-E)
Expires 12/1/2018
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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical malpractice and wrongful death lawsuits.
