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Minn. officials consider lawsuit settlement over medics allegedly misdiagnosing stroke

The lawsuit highlighted St. Paul medics reporting manifestations of Parkinson鈥檚 disease and obtaining a refusal from a patient who can鈥檛 read or speak English

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The back of a St. Paul Fire Department ambulance photographed Tuesday, April 15, 2014.

Pioneer Press: John Autey/TNS

By Mara H. Gottfried
Pioneer Press

ST. PAUL, Minn. 鈥 After a man sued the city of St. Paul and firefighters he says disregarded 鈥渙bvious signs鈥 that he鈥檇 had a stroke and told him the emergency room was full, the city is poised to settle his lawsuit for $295,000.

Ahmed Ali, who was 84 when the lawsuit was filed, previously lived independently but now requires 24-hour care, according to his lawsuit against the city鈥檚 paramedics and emergency medical technicians who responded to his family鈥檚 911 call in 2022.

The St. Paul City Council is due to vote on the settlement Wednesday, an agenda posted Thursday shows.

鈥淭his was a sad event for Ali, his family, and the city,鈥 said J. Ashwin Madia, one of Ali鈥檚 attorneys. 鈥淗e鈥檚 grateful to have this matter resolved, and hopes that his case will help motivate St. Paul to update its training and procedures for responding to emergency calls of suspected stroke.鈥


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This webinar covers stroke assessment, recognition and timely decision-making as to where to transport a patient for intervention

There was an internal investigation, which was closed with no discipline, according to St. Paul City Attorney Lyndsay Olson.

鈥淲hile the actions of our EMS and firefighters followed policy and protocol, we entered into a settlement with the plaintiff to avoid the expense and uncertainty of continued litigation,鈥 Olson said.

Ali filed the lawsuit in Ramsey County District Court in April 2023 and the city sought to dismiss it. After a hearing in March, Judge Stephen Smith ruled in June that the portion of Ali鈥檚 lawsuit alleging medical malpractice could move forward. He wrote there were factual disputes between information from Ali鈥檚 lawsuit and from the city.

Smith dismissed the lawsuit鈥檚 assertion that Ali had been discriminated against on the basis of race and national origin, writing that he found 鈥渋nsufficient factual allegations鈥 to support the claim.

The lawsuit

The lawsuit filed by attorneys Madia, Zane Umsted and Charlie Alden provided the following information:

Ali took a walk with his son, Hassan, on Nov. 2, 2022. At about about 9 p.m., Ali 鈥渂egins to exhibit classic signs of stroke.鈥 He had weakness in his right arm and leg, his right leg was dragging, his right arm was shaking, and his neck and head drooped to one side.

Hassan got Ali back to his apartment, monitored his father鈥檚 condition and called 911 at 10:42 p.m. The St. Paul Fire Department provides emergency medical care in St. Paul, and all its firefighters are paramedics or EMTs (the lawsuit and other court documents refer to all of the responders as paramedics).

Paramedics arrived to Ali鈥檚 apartment at 10:51 p.m. Hassan also called his cousin, Dr. Mohamed Abdihalim, who is a neuroradiologist in St. Paul and works with stroke patients daily. He explained Ali鈥檚 condition to Abdihalim, who was 鈥渦nequivocal and adamant鈥 and told the paramedics that his uncle was having a stroke and needed to be taken to the emergency room.


Reframe your thinking to get patients with atypical neurologic emergency symptoms immediate care

Paramedics asked about Ali鈥檚 medical history. Abdihalim told them his uncle was diagnosed with Parkinson鈥檚 disease a year earlier and had high blood pressure. 鈥淗e explains that notwithstanding his Parkinson鈥檚 diagnosis, Ali has never exhibited neurological symptoms like this from Parkinson鈥檚,鈥 the lawsuit said.

Paramedics checked Ali鈥檚 blood pressure and blood sugar levels, and conducted an electrocardiogram, Judge Smith wrote in a summary. They concluded 鈥渢he results all fell within normal ranges.鈥

Ali said in his lawsuit that the paramedics tried to have him walk and squeeze their fingers, but he was unable to do either. Paramedics said his symptoms were 鈥渕anifestations of his Parkinson鈥檚 disease,鈥 but his son repeated what Abdihalim had stated about the problems only arising that night.

Dispute over stroke test

Ali鈥檚 lawsuit says paramedics didn鈥檛 conduct all the tests required by a pre-hospital stroke scale 鈥渁nd/or ignored the positive results,鈥 Smith wrote in his summary.

The city, however, wrote in a court document that firefighters performed the stroke test and that 鈥渨here the discretion lies is in interpreting the results.鈥

Ali also said his family insisted that paramedics take him to the hospital and they 鈥渞efused 鈥 intimating 鈥 it would be a long time before he would see a doctor because the emergency room was full of Covid patients,鈥 the judge鈥檚 summary said. Paramedics, meanwhile, said Ali decided not to go to the ER because of concerns about COVID and a lengthy waiting time, the summary continued.

Ali鈥檚 lawsuit said the paramedics asked him to mark their form to indicate he 鈥渞efused鈥 transport to the emergency room, though his suit emphasizes that he is a Somali immigrant who can鈥檛 read or speak English. The paramedics left his apartment 10 minutes after making contact with him.


The UCSF physician team discusses how to best treat our stoke patients in the pre-hospital setting

Hasan stayed with his father through the night and took him to the hospital in the morning. An MRI showed dozens of strokes throughout Ali鈥檚 left part of his brain. Because of the amount of time that had passed since Ali鈥檚 stroke symptoms started, medical providers couldn鈥檛 provide him with a 鈥渃lot-busting鈥 drug, the lawsuit said.

鈥淭he paramedics鈥 failure to get Ali to the emergency room, where (the medication) could be administered, resulted in permanent damage to Ali鈥檚 brain and body,鈥 the lawsuit alleged. 鈥淭he stroke spread through his brain and resulted in permanent right-side impairment (and) weakness.鈥

Hassan quit his job to care for his father full-time.

A review of Ali鈥檚 claims in the lawsuit by the Minnesota Emergency Medical Services Regulatory Board鈥檚 complaint review panel didn鈥檛 鈥渞esult in any adverse findings that (the workers鈥) actions fell below the standard of care,鈥 the city wrote in a court document.

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