A family claiming that a woman died of a heart attack has reached a confidential settlement in a Jasper County lawsuit against an emergency room doctor and nurse. The woman died five days after being discharged from the ER with a prescription for heartburn medication. The 55 year old patient went to a rural hospital late in the evening complaining of mid-upper epigastric pain with a history of hiatal hernia. Small community hospitals such as this can be found in small towns all over mid-Missouri, including Boonville, Marshall, Sedalia, Moberly, Mexico, and Osage Beach. After 20 minutes the patient then was complaining of chest pain radiating to both arms. As required the chest pain protocol was initiated. That protocol uses two diagnostic tests to rule out heart attack – an EKG and a blood test for the cardiac enzyme Troponin I. Both tests were performed and the results were arguably within normal limits. After reviewing the tests, the ER doctor ordered the patient to be discharged with medication for heart burn. Five days later the patient was found dead and her body was cremated before an autopsy was performed. The decedent’s husband and daughter filed a lawsuit about two years later alleging that the defendants had missed the heart attack. About a week before trial the parties reached a settlement agreement. This case presented substantial difficulties as a final medical diagnosis for the decedent’s cause of death was never definitively established.