E. The Facts:

The patient is a 47 year old male with a history of GERD, cholelithiasis, diabetes mellitus, hypertension, hypercholesterolemia and a family history of cardiac disease. He presented to the Central City ED on 7-4-08 for acute onset of midepigastric pain radiating to the chest while eating at a 4th of July picnic. According to the Respondent's note, the patient felt the pain was similar to previous GERD symptoms. The Respondent ordered a "GI cocktail," chest X-Ray, a blood cell count, and liver enzymes. No EKG or cardiac enzymes were ordered or noted. The patient's pain diminished, but was not entirely abated. The Respondent's note stated that the patient "felt better" and "wished to go home." He was discharged with GERD instructions and instructed to double his use of Prilosec for 10 days. (Tab 06, pages 2-5, 7-12)

Shortly after the patient returned to the picnic, he collapsed and was non-responsive. He received brief bystander CPR and became progressively more responsive. 911 was called and EMS arrived on scene. The patient was transported back to the Central City ED, where a 12 lead EKG was performed demonstrating an acute anterior MI with lateral extension. The patient was emergently taken to the catheterization lab in moderate cardiogenic shock. A complete RCA occlusion was noted after some effort, then successfully opened and stented. The patient required intra-aortic balloon pump therapy. After a fairly stormy post-procedure course, the patient made a successful recovery with minimal sequelae. He was discharged on 7-11-08. (Tab 07, pages 39, 61-67, 4-8)