MDLinx$70.8M Awarded in Neuro Misdiagnosis—How Aggressively Do You Work Up a Headache?

$70.8 million awarded after 38-year-old woman discharged from Tampa General ER with “worst headache of her life” received only labs and medication—no imaging or neurology consult. Patient suffered cerebral venous sinus thrombosis within 30 hours, resulting in permanent blindness, paralysis, and cognitive impairment.

⚖️ PROFESSIONAL IMPACT

• Jury found nurse practitioner negligent for failing to obtain neuroimaging despite textbook red flag presentation—”worst headache ever” by ambulance
• Verdict establishes liability for missing CVST when standard red flag criteria (SNOOP, Ottawa SAH Rule) weren’t applied to high-risk presentation
• 2024 ACEP policy and AHA guidelines recommend immediate imaging (CT/CTA/CTV) plus low threshold for neurology consult when red flags present
• TeamHealth contractor model creates vicarious liability risk for health systems when protocols aren’t followed by mid-level providers

🎯 ACTION ITEMS

• Document SNOOP criteria assessment for every severe or atypical headache presentation in medical record
• Establish protocol requiring CT/CTA or neurology consult for “worst headache ever” or thunderclap presentations
• Train all ER staff on red flags: sudden onset, exertional, focal deficits, pregnancy/postpartum, anticoagulation use
• Review current imaging criteria against 2024 ACEP/AHA guidelines for subarachnoid hemorrhage and cerebral venous thrombosis

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