About an hour ago
Michael Hromanik had a difficult childhood.
His mother died of lung cancer when he was 7.
His uncle moved in with him and his dad. Five years later, their house in the Renton neighborhood of Plum burned , killing his uncle and his dog.
Still, Hromanik was the first in the family to go to college. He became an orthopedic surgeon at age 39.
“He had a lot of tragedy as a kid,” said his wife, Angela Hromanik. “It makes it more amazing how he grew.”
On Jan. 1, 2019, with his career in full swing and a happy life with a wife and three kids, Hromanik developed a terrible headache.
He knew almost immediately that he was having a hypertensive crisis, his wife said.
She drove him the few blocks from their Aspinwall home to UPMC St. Margaret.
Michael Hromanik told the emergency room physician what he thought was happening, his wife said.
The doctor dismissed the symptoms as a migraine, according to a lawsuit she filed Aug. 5 in Allegheny County Common Pleas Court on her husband’s behalf.
An hour and 20 minutes later, the lawsuit said, the treating physician noted the left side of Michael’s face beginning to droop.
A CT scan revealed hemorrhaging in his brain. He was having a stroke.
Now, nearly two years later, Michael, 49, resides in an assisted living facility in New Orleans — no longer a doctor.
No longer the caring husband and father who attended all the kids’ sporting events in his scrubs.
No longer the man he used to be.
Angela Hromanik sued UPMC St. Margaret alleging negligence. She hopes that by raising awareness of what happened to her husband, it may prevent another family from going through what hers has.
“Michael’s situation is the epitome of tragic consequences that can occur when doctors ignore patients,” said the family’s attorney, Jason Matzus. “He knew he was having a hypertensive crisis.
“He was right. They were wrong, and now Michael and his family are paying one hell of a price for that.”
Gloria Kreps, a spokeswoman for UPMC, said, ”We are saddened that the patient suffered this event. However, our emergency department care was high quality and we intend to vigorously defend the suit.”
After graduating from the University of Pittsburgh in philosophy, Michael Hromanik attended physical therapy school there. He worked as a physical therapist for about a year and a half before attending medical school at the Mayo Clinic College of Medicine and Science in Rochester, Minn.
He graduated in 2006 and moved to New Orleans to begin his orthopedic surgery residency.
There, he met Angela at the hospital’s gym.
They wed six months later during the week between his first and second year of residency.
At the time, Angela was working as the state operations manager for Cox Communications. Because Michael was working all the time, he would sometimes visit her at her office and sleep on the floor just to be near her.
“The cleaning lady would vacuum around him,” she said.
Eventually, Angela quit her job to stay home with their kids, George, now 10, and Natalya, now 9. She also has an older daughter from a previous marriage, Ashley, who is 23.
As their children were young, and Michael put in long hours, Angela often brought them to have meals with him at work.
“The babies basically grew up at the hospital,” she said. “We love hospital food.”
They settled in to a comfortable life.
“All he did was work and come home to be with us,” Angela said. “That’s it.”
Michael’s career took them from New Orleans to Northern Maine, where they stayed for a year, with the St. John River in their backyard, and Canada on the other side.
Although they enjoyed the scenery — Angela said there were moose and fox everywhere — it was eight hours to the closest Wal-Mart. There were just 11 people in her oldest daughter’s high school class.
It was difficult to travel out of the area, and after a year, Michael took a job in Arkansas.
They stayed there three years before deciding they wanted to return to Michael’s hometown in Pittsburgh. They found a home in Aspinwall.
He began a fellowship at Allegheny General Hospital, and after completing it, went to work in 2018 at Trinity Health System in Steubenville.
Michael was able to balance work with his home life, while staying fit.
George plays soccer, baseball and hockey, and his dad would cheer from the sidelines in his scrubs. With Natalya, the two of them loved going to the community flea market early on Sunday mornings, and to painting classes.
Michael would take Ashley, now at Pitt with plans to go to medical school, with him to the hospital. She watched his surgeries.
Even in teaching the kids lessons, Angela said, “Everything had a story.
“He was a deep thinker. Nothing was a quick analysis. He applied strict logic to everything.”
Jan. 1, 2019, was George’s birthday. Michael made some calls for work that day, went to the gym, and then they celebrated their little boy turning 10.
Angela described it as a “lazy, celebrate George day.”
About 10 p.m., she and Michael were lying in bed. She was watching television, when he said, “‘I have such a horrible headache.’”
He got up and started pacing around their room. He laid down again, felt nauseous and clammy, Angela said. Then he threw up.
“‘Bring me to the hospital,’” Michael told her. “’I’m having a hypertensive crisis.’”
She and her oldest daughter struggled to get him down from the third floor of the house. Then Angela got him in the car and started driving.
She asked him if he thought she should take him to a larger hospital.
“‘No, I don’t have time,’” he responded. “‘I’m going to have a stroke.’”
Michael kept telling her, “‘Faster, faster.’”
They arrived at the emergency department at 10:39 p.m., according to the lawsuit.
Michael told Dr. Dylan Morris, who was treating him, that he was actively taking an MAOI, or anti-depressant, caffeine pills and Lunesta, a sleep aid, according to the lawsuit.
The lawsuit noted that a hypertensive emergency is a known side effect of MAOI use. Michael told the St. Margaret staff what he believed was occurring.
“Dr. Hromanik’s concerns about him suffering an acute hypertensive emergency were summarily dismissed and/or ignored by Dr. Dylan Morris and other of defendant’s medical personnel,” the lawsuit said.
According to St. Margaret’s medical records for Michael that night, his blood pressure was severely elevated, with a systolic reading above 200, the lawsuit said. A normal blood pressure reading for systolic pressure is generally less than 120.
The staff administered a CT scan on Michael at 11:13 p.m., the lawsuit said, which revealed no acute bleeding or stroke, and Dr. Morris diagnosed him with an “‘atypical [headache,] migraine.’”
But 37 minutes later, Dr. Morris saw that Michael was “’more confused, distressed,” and that his face had started to droop on the left.
It was then that Dr. Morris expressed concern that Michael’s medications may have interacted to cause a hypertensive emergency, the lawsuit said.
“Although it should have been apparent as of the time of Dr. Hromanik’s initial presentation … that Dr. Hromanik was suffering from an acute hypertensive emergency, his condition was not timely diagnosed and/or treated until it was too late to prevent the occurrence of, among other things, a stroke and/or intracranial bleed and/or decrease the likelihood of these conditions occurring,” the complaint said.
At 12:19 a.m., a second CT was done, revealing a large hemorrhage in Michael’s brain “‘extending to the frontal and temporal lobe,’” the lawsuit said.
At that point, Michael was put on a ventilator and a decision was made to transfer him to UPMC Presbyterian.
Because of inclement weather, that transfer didn’t happen until nearly two hours later.
At UPMC Presbyterian, a CT scan showed the bleeding was worse, and he was taken to surgery.
He was released to stroke rehabilitation at UPMC Mercy 11 days later.
‘The worst nightmare’
The lawsuit calls what happened to Michael “a profound brain injury that has caused permanent and irreversible brain damage,” which led to “major neurocognitive disorder with associated mood and behavior disturbance.”
Angela called it “the worst nightmare ever.”
Hromanik doesn’t have use of his left side; he falls a lot; he has a flat affect and visual impairment — for example, he could see a potted plant and believe it to be a person.
“His memory is getting worse,” she said.
He has trouble remembering the last five years, his wife continued, but “he can talk for hours about medicine, surgery and philosophy.
“The simple stuff escapes him,” she said.
It’s hard to talk about day-to-day life, she continued, because it reminds Michael of what he no longer has.
“Every single day is a struggle for him. He’s so overwhelmed with the loss that he has regressed inside of himself.”
Early in his recovery, Angela took Michael home, having aides come to care for him.
But he became aggressive — throwing things, yelling at people and cursing at them, she said.
For a while, he was going to physical therapy four times each week.
“Then, all of a sudden, it just tanked,” Angela said.
Michael would just sit, staring off into the distance, and not respond to anything.
It turned out, she said, he was having tiny seizures.
Although doctors got them under control, the therapies were no longer effective.
“He lost that flame to recover,” she said.
Michael realized, Angela continued, that he was never going to be able to be a surgeon again, or to throw a ball with his son. He thinks, “‘What’s the point?’”
“The emotional toll has taken over,” she said. “He has no hope at all, no hope in the future.
“It’s really gone to a very dark place.”
She had to move Michael to a care facility and because of the pandemic, they were unable to see him for four months.
Then, in mid-August, Angela had Michael moved to a care facility in New Orleans. She and the kids moved back there, too, to be near her family.
Now, Angela said, Michael has worked to distance himself from them, not wanting to talk on the phone or FaceTime because he doesn’t want to see himself on the screen.
“That’s something that’s very difficult for me to explain to the kids,” she said. “To be around us is another stab at ‘I’m never going to have the kind of life I had before.’”
For Angela Hromanik, dealing with that has been the worst part.
“This is not my husband,” she said . “He’s not coming back. There’s no repair for the damage that’s been done.
“There’s no bright prognosis.”
‘I miss the old daddy’
Had the staff at UPMC St. Margaret recognized Hromanik’s symptoms more quickly — and treated him with the anti-hypertensive medication, Labetalol — the lawsuit contends, he may never have suffered the long-term consequences he now faces.
Matzus listed 24 failures of the treating physicians and staff at UPMC St. Margaret that led to Hromanik’s injuries, including not properly recognizing his symptoms; not having adequate training to diagnose them; and not recognizing the risk factors of MAOI interaction that could lead to a hypertensive emergency.
In an interview, the attorney said that what happened to Hromanik — a physician not listening to his patient — is rampant in the practice of medicine.
“The doctor clung to the diagnosis of a migraine headache and wouldn’t accept anything else,” Matzus said.
Caitlin Donovan, a senior director at the National Patient Advocate Foundation in Washington, D.C., said the most common complaint they receive is “‘How do I get my doctor to listen to me?’”
“So much of medical discourse is asking patients to trust their doctors, but it has to go the other way, too,” Donovan said. “Having doctors trust their patients.”
In their organization, they urge patients to “Say it first, say it twice,” which means they should tell their doctor the most important thing immediately and repeat it.
If the doctor provides a diagnosis that the patient doesn’t agree with, Donovan said, the patient should push the issue and ask, “What’s your second guess?”
Donovan’s organization also urges patients to have a person with them that can help advocate.
Angela Hromanik hopes their story can help someone else.
“My son will say, ‘I miss the old daddy.’
“He was such a strong voice in our family,” she said. “He always had the right answers.”
Paula Reed Ward is a Tribune-Review staff writer. You can contact Paula by email at firstname.lastname@example.org or via Twitter .
Allegheny | Local | Top Stories