Medical Malpractice

May 26, 2011

Case Illustrates the Issues Surrounding Medical Malpractice Exceptions

In a recent medical malpractice case, the Second Circuit Court of Appeal for the State of Louisiana found Dr. Donovan Bailey not liable for medical malpractice. His patient, Mrs. Mary Prine, died at the age of 58 a mere two months after being diagnosed with colon cancer. Her surviving spouse and two children sued and claimed that Dr. Bailey’s medical negligence caused Mrs. Prine’s wrongful death.

In order to prove that Dr. Bailey was medically negligent, the plaintiffs had to prove: 1) a duty of care owed by the health care provider to the plaintiff; 2) breach of that duty by failure to abide by the appropriate standard of care; 3) a causal connection between the breach and the patient’s injury or death; and 4) damages.

Both sides essentially agreed that since 1997, colorectal cancer screening should be recommended to patients 50 years of age or older, and that Dr. Bailey had not done so even though he had been caring for Mrs. Prine since 1997. The only pivotal issue in this case was whether Dr. Bailey was Mrs. Prine’s primary health care physician. If he was not, then he could not be liable for medical malpractice because he would owe her no special duty, which is an element for the medical negligence cause of action.

May 24, 2011

The Impoverished Plaintiff and the Assessment of Court Costs

by Berniard Law Firm

The Louisiana Code of Civil Procedure generally affords the trial court wide discretion in assessing the costs of litigation to one or more of the parties. “Except as otherwise provided by law, the court may render judgment for costs, or any part thereof, against

any party, as it may consider equitable.” La. C.C.P. Art. 1920. The expenses that the court can tax as costs include the fees of the court clerk or sheriff, witness’ fees, costs of taking depositions, and the cost of photocopies of laws, regulations, medical reports, and hospital records used during the trial. So great is the trial court’s discretion, in fact, that the trial court’s assessment can be overturned only upon a showing of abuse of discretion.

As mentioned, though, there are limitations in the law to the trial court’s authority. For instance, special provisions exist for allocating costs in workers’ compensation cases as well as those involving a plaintiff who proceeds in forma pauperis (through a pauper’s action). The recent case of Curry v. HealthSouth Rehabilitation Hospital illustrates that one path to reversible error on the part of the trial judge is running afoul of the special rules for impoverished plaintiffs.

May 22, 2011

Court Vacates Jury’s Award in Rapides Parish Lost Chance of Survival Case

by Berniard Law Firm

As we have explored in numerous prior posts, a doctor or other healthcare provider owes his or her patient a duty to meet the standard of care applicable to the patient’s situation. The failure to follow the standard of care points to the doctor’s negligence which, in the case of the death of the patient, can give rise to a claim of “lost chance of survival” for the spouse or children of the deceased. In a lost chance of survival action, the plaintiff “does not have to shoulder the unreasonable burden of proving that the patient would have lived had proper treatment been

given.” Rather, the plaintiff must establish by a preponderance of the evidence that the doctor’s negligent conduct “denied the patient a chance of survival.” In other words, a lost chance of survival claim will not be successful if the patient would have died anyway due to causes unrelated to the doctor’s actions; the plaintiff must tie the doctor’s negligence to the death of the decedent. Whether a plaintiff carries this burden is a question of fact reserved for the jury.

Third Circuit Court of Appeal recently reviewed a jury verdict on this question in the case of Skinner v. Christus St. Francis Cabrini Hospital. Robert Skinner was admitted to Christus Hospital in Alexandria on August 17, 2000 for an elective hemorrhoidectomy and partial sphincterotomy. He died the following morning after spending the night in the hospital. His wife, Pamela Skinner, filed suit against the hospital and Stephen Ford, the nurse who had charge of Mr. Skinner from 7:00 PM to 7:00 AM during the night of his stay. At the trial, various witnesses from the hospital explained that the surgery had gone well. The only reason Mr. Skinner stayed overnight was because of his high level of anxiety over the procedure. Mr. Skinner had a history of mental and physical problems, and was taking numerous prescription medications to address his depression, high blood pressure, high cholesterol, and heart burn. Several members of the hospital staff reviewed Mr. Skinner’s medication list on separate occasions, and each time he neglected to mention that he had taken a particular antidepressant prior to coming to the hospital. In fact, the toxicology screening that was conducted as part of an autopsy revealed dangerously high levels of the drug in his system–a concentration which the medical experts in the case agreed was “known to kill.” Nevertheless, the jury found that the evidence supported the conclusion that the hospital and Nurse Ford failed to properly monitor Mr. Skinner after the surgery, Therefore, the defendants “deviated from the appropriate standard of care in the medical treatment of Mr. Skinner,” causing a lost chance of survival. The jury awarded Mrs. Skinner $250,000 in general damages. The defendants appealed, arguing that the jury erred in finding the plaintiff had carried her burden.

May 18, 2011

Caddo Parish Jury Finds Doctors Not Liable in Medical Malpractice Case; Verdict Upheld

by Berniard Law Firm

The plaintiffs in this case are the family of Cody Ebarb, a 12-year-old boy who suffered a stroke and subsequently died after receiving care from various doctors at Willis Knighton Medical Center in Shreveport-Bossier City, Louisiana. Cody suffered from several pre-existing medical problems, including a viral chronic fatigue syndrome, suspected disease of the connective tissue, and herpes virus of the eye. He had spent much time in medical treatment and was, sadly, a very sick child for much of his life.

On the morning of November 5, while on his way to the pediatrician, Cody suddenly said that he couldn’t see and fell to the floor, moaning. He was transported by EMTs to Willis-Knighton South, and they noted only that he was having seizures. It turned out that he had actually had a stroke due to a small tear in his basilar artery (which is surrounded by the spine).

Dr. Felty, an emergency room physician, performed a basic emergency exam and ran a batter of standard tests. He did not perform a full neurological exam because Cody could not communicate and was moving involuntarily. He also did not order an MRI because subspecialists, not ER physicians, normally do so. While at the hospital, Cody could not open his eyes or speak, but at some point was aware of his surroundings. Eventually, at approximately 2 pm, a pediatrician arrived, ordered Ativan (a widely used sedative and anticonvulsant) and left. Between the hours of 2 pm and 6:30 pm, several doctors examined Cody, who by then had deteriorated and was unable to move his arms or communicate. He was then transferred into the Intensive Care Unit (ICU). During his night in the ICU, Cody went into cardiac arrest and was placed on life support. While on life support, an MRI was taken that showed a very rare torn basilar artery, which resulted in a stroke.

May 17, 2011

Product Safety a Concern? Check Out This Government Website

by Berniard Law Firm

For those wishing to be kept abreast of the latest products to receive governmental warnings regarding the safety surrounding their use, feel free to check out SaferProducts.gov. With a list of incident reports from other consumers, this effort by the government hopefully will help enable people to make conscious decisions regarding the products they put in their homes.

May 4, 2011

On Prematurity and a Plaintiff’s Case for Damages

by Berniard Law Firm

According to the Louisiana Code of Civil Procedure, a defendant can file an “exception of prematurity” to challenge whether the plaintiff’s cause of action has “matured to

the point where it is ripe for judicial determination.” A classic (mis)application of the exception is found in the 1999 case, Steed v. St. Paul’s United Methodist Church. In that case, the church’s choir director sued the minister for sexual harassment. The minister filed a counter-claim for defamation, arguing that the choir director’s false allegations damaged his reputation in the Monroe community. Before the appellate court, the choir director asserted that the minister’s defamation claim was premature because the trial court had not yet entered a judgment declaring that her harassment allegations were false (truth being an absolute defense to defamation). However, because the choir director never filed an exception of prematurity in the trial court, she could not raise the issue on appeal. This is because, as a “dilatory” exception, it is waived if not specifically pled and a court cannot “supply an exception of prematurity on its own motion.”

A similar failure to plead the exception plagued the plaintiff in the more recent case of Moreno v. Entergy Corp.. Daniel Moreno was badly shocked while working around overhead power lines in Jefferson Parish. Moreno sued Entergy Corporation, the owner of the power lines. Entergy filed a cross-claim against Moreno’s employer, Stewart Interior Contractors, LLC. Entergy argued that, if it were found liable for Moreno’s injuries, the Act would create a right of indemnity against Stewart because the contractor violated the Overhead Power Line Safety Act (the “Act”) by working near the power lines without first contacting the owner of the lines (Entergy) and making the necessary safety arrangements. The trial court ruled against Entergy, finding that the Act “does not create an independent right of indemnity for damages incurred as a result of injuries suffered by third parties.” When Entergy appealed this judgment, the Fifth Circuit Court of Appeal affirmed on the grounds of prematurity, though the exception had not been raised by any party. The Fifth Circuit declared that because no fault had yet been allocated to any party, no cause of action for indemnity had been created. The court entered an “exception of no cause of action on the basis of prematurity,” a judgment which had not been seen previously in Louisiana jurisprudence. Upon review, the Louisiana Supreme Court found that the Fifth Circuit erred as a matter of law in supplying the exception to prematurity on its own motion. “Although the court of appeal claimed it was entering an exception of no cause of action, the judgment was not truly based on the legal insufficiency of the allegations [for which it was permitted to raise an exception on its own accord]. It is clear that the court based its ruling solely on the theory that Entergy’s indemnity claim was not ripe for adjudication, which is properly raised only via dilatory exception.” Accordingly, the court reversed the Fifth Circuit and remanded the case.

April 28, 2011

Medical Malpractice and the Patient Compensation Fund

by Berniard Law Firm

A person’s worst fear when undergoing an invasive surgery, is for something to go wrong. For one patient, this fear came true when his doctor operated on the wrong knee. This severe error was not disputed by the Doctor, who admitted he erroneously operated on the plaintiff’s right knee when he intended to treat the plaintiff patient’s left knee with arthoscopic surgery. What was at issue in this recent Louisiana Second Circuit Court of Appeals decision, is whether or not the injured plaintiff was awarded an appropriate amount in damages. Numerous factors are weighed when determining damages. However, in Louisiana, as well as numerous other states, there is a cap on how much a person may recover in a medical malpractice suit. Patients who have been injured face a litany of complicated issues and standards that are difficult to understand, thus, obtaining legal representation as soon as possible is highly recommended in order to protect legal rights throughout the process.

In a recent Louisiana Second Circuit Court of Appeals decision, the court explored the amount of damages a patient was initially awarded for damages they sustained from an erroneously performed surgical procedure. The plaintiff patient complained on appeal that the trial court abused its discretion in awarding inadequate damages for past lost wages, past medical expenses, as well as pain and suffering. Additionally, the victim contended that the trial court erred in failing to award future lost wages and future medical expenses for the patient plaintiff and loss of consortium for his wife. The appellate court affirmed the trial courts damages award for numerous reasons, many based on statutory limits that are in place restricting the amount a patient may obtain. Yet, the decision is in large part held by the jury. The jury has the duty to hear the evidence and determine a price that may “make the plaintiff whole again.” In this case, the jury decided that the patient plaintiff had $40,000 in pain and suffering and $10,000 in loss of income. It may seem a harsh factor in the legal process, that despite the severity of a patients injuries, the numerical value given such injuries is designed to “fix” such issues. The plaintiff in this case felt that the jury’s damages award did not adequately resolve any of the issues he was experiencing after having the botched surgical procedure. Since the accident, the victim of this botched surgery had been experiencing serious issues in almost every part of his life, including that the knee which was erroneously operated on was in constant pain, decreased his range of motion, his sense of instability caused him to limp, insomnia, impaired ability to work, back pain induced by the limp which resulted in a herniated disk, and loss of consortium with his wife. Thus, the problems went deeper then the categorical terms such as “pain and suffering and loss of income.” The court however, explains and supports their decision by exploring the governing statutes at issue.

Juries factual finding decisions are highly regarded, and under Louisiana law such decisions may not be set aside unless the appellate court finds that it is manifestly erroneous or clearly wrong. The appellate court will review the witnesses testimony at trial in order to determine whether or not their may have been an erroneous decision. Here, the plaintiff alleged he had to undergo four surgeries due to the Doctor operating on the wrong knee plus a discogram of his back. To support the additional damages that were a result of the erroneous surgical procedure performed by the defendant doctor, the plaintiff offered the testimony of a doctor who contended that the plaintiff would need two back and neck surgeries and would have pain in his right knee for the rest of his life. Further, the plaintiff would have to get a total knee replacement at some point in his life. In consequence to the erroneous surgery, the plaintiff was declared disabled by Social Security and began receiving Social Security Income payments. Additionally, the plaintiff was unable to perform the part time work he was previously able to and the couple eventually went bankrupt. Despite these very sad consequences, the court has to abide by the regulations and statutes that are in place and govern medical malpractice issues.

April 24, 2011

Court Clarifies Procedure for Medical Panel’s Review of New Claims

by Berniard Law Firm

As we have explored in several prior posts on this blog, claims brought against healthcare providers under the Louisiana Medical Malpractice Act must be examined by medical review panel before proceeding to court. Just over a year ago, the First Circuit Court of Appeal issued guidance to plaintiffs on the procedure they must follow if they should uncover new claims of negligence after the medical panel has completed its review of the original claims and issued an opinion.

On September 14, 1998 Doris Abel underwent surgery at the North Oaks Medical Center (“NOMC”) in Hammond. She died a short time later from complications arising from the surgery. Her family (the “Plaintiffs”) submitted a malpractice complaint against NOMC to the medical review panel in September of 2003, which rendered a decision in favor of NOMC. Plaintiffs then filed suit against NOMC that led to a protracted period of pre-trial discovery. During that time, Plaintiffs discovered new claims of negligence against NOMC and petitioned the court to amend their complaint to include these claims. NOMC objected on the grounds that the medical review panel had not examined these new claims and requested a new trial. The trial court denied NOMC’s request and instead remanded the matter to the original medical review panel for the sole purpose of reviewing Plaintiffs’ new allegations. NOMC sought review by the First Circuit, urging that the there is no procedure in the Louisiana Medical Malpractice Act (the “Act”) for remanding a case back to a review panel once it has rendered its opinion and a suit has been filed.

The First Circuit began its analysis by noting that the Act’s language “must be strictly construed.” The court, in reiterating that the Act requires that “all malpractice claims against health care providers covered under the Act shall be reviewed by a medical review panel,” concluded that the “use of the term ‘shall’ in these statutory provisions indicates that these procedures are mandatory.” And, although the Act does not specifically address late-discovered claims, the court concluded that “the procedures the legislature mandates for filing a request for review by a medical review panel also encompass malpractice claims that are discovered after the panel has rendered an opinion and suit has been filed.” The court found additional support for this conclusion in the statutory language that describes the review panel’s duty to “express its expert opinion as to whether or not the evidence supports the conclusion that the defendant or defendants acted or failed to act within the appropriate standards of care.” The panel must be presented with all evidence in order to discharge this duty. Further, the court decreed that once a panel renders an opinion, its duty has been discharged. “Therefore, if additional malpractice claims are discovered… these new claims must be presented for review by a new medical review panel.” Accordingly, the court found that the trial court erred by remanding the matter back to the original medical review panel. It reversed the judgment and remanded the case back to the trial court so it could arrange for a new panel to review the Plaintiffs’ late-discovered claims before trial.

April 10, 2011

Prescription Drug Overdose Leads Court to Review Pharmacist’s Standard of Care

by Berniard Law Firm

On March 13, 2008, Sarah Hollier visited Dr. Gregory Green for treatment of bronchitis. Dr. Green wrote Hollier a prescription, which she took to the Super One Pharmacy in Monroe to have filled. The pharmacist on duty, Katy Buntyn, was not familiar with the particular form of the drug that Dr. Green prescribed because it had been discontinued some four years prior. Buntyn directed her pharmacy technician to phone Dr. Green’s office for clarification on how to fill the order. Ultimately, after further confusion over the form of the drug and the dose, Buntyn mistakenly filled the prescription at a dosage which was at more than 2.5 times the “top end” dose indicated on the drug’s literature and eight times the dose intended by Dr. Green. When Hollier began taking the medication, she experienced high energy levels, sleeplessness, increased heart rate, and nausea.

Hollier’s husband, himself a pharmacist, recognized her symptoms and discovered the erroneous dose after inspecting the prescription bottle. The Holliers reported the problem to the pharmacy and, later, filed suit against the pharmacy and Buntyn. In Louisiana, pharmacists are not subject to the state’s Medical Malpractice Act, so the matter was heard in Monroe City Court on September 21, 2009. The trial court entered a judgment for Hollier and awarded her $7,500 in general damages and $827.08 for medical expenses. The defendants appealed, refuting liability.

The Second Circuit first reviewed the elements of general negligence, but then noted that a “pharmacist has a duty to fill a prescription correctly and to warn the patient or to notify the prescribing physician of an excessive dosage or of obvious inadequacies on the face of the prescription which create a substantial risk of harm to the patient.” Buntyn argued that she met this duty by calling Dr. Green’s office to inquire about the prescription. But the court disagreed that this action was sufficient to discharge her duty; instead, “the fact that the package insert lists the top end of an initial daily dosage of [the drug] at 9 mg should have aroused Ms. Buntyn’s suspicions that a 24 mg initial daily dosage was excessive.” At that point, reasoned the court, Buntyn “should have inquired further.” Thus, the court could not find that trial court committed manifest error in finding that Buntyn breached her duty to Hollier by supplying the extremely high dose of the drug, and affirmed the judgment.

April 4, 2011

Ouachita Parish Case Examines the Applicability of the Louisiana Medical Malpractice Act to Intentional Torts

by Berniard Law Firm

Previously on this blog, we have discussed the Louisiana Medical Malpractice Act (“LMMA”) and its requirement that “all claims against healthcare providers be reviewed or ‘filtered’ through a medical review panel before proceeding to any other court.” A plaintiff who fails to do this is subject to the defendant’s “exception of prematurity,” which is a procedural mechanism by which the defendant can petition the court to dismiss the plaintiff’s claim until the medical review panel has properly conducted its review. The defendants in the case of Heacock v. Cook attempted to invoke the exception in a case that involved a sexual relationship between a doctor and his patient.

In December of 2005, Margaret Heacock was admitted to the Palmetto Addiction Recovery Center (“Palmetto”) in Rayville for an inpatient substance abuse treatment program. After being discharged in May of 2006, she underwent outpatient treatment which continued through January of 2008. In 2009, Heacock filed two lawsuits against Palmetto and her treating physician, Dr. Douglas Cook. Both suits alleged essentially the same facts: that Dr. Cook “entered into an inappropriate, sexual relationship” with Heacock during the time she was his patient; one suit’s theory of recovery was based on intentional tort, the other on negligence. Dr. Cook and Palmetto filed exceptions of prematurity, seeking to have all claims dismissed in the trial court and instead brought before the medical review panel. After a hearing, the trial court determined that Heacock’s claims sounded primarily in medical malpractice and therefore required a review by the medical panel. Thus, the trial court dismissed Heacock’s suits without prejudice. Heacock appealed, arguing that it was error for the trial court to require the panel’s review given that her allegations gave rise to a general tort claim, and not a medical malpractice claim.

The Second Circuit Court of Appeal noted that the LMMA applies only to “malpractice” as defined by the statute, while other tort liability on the part of a health care provider is governed by general tort law. Further, Louisiana statute provides separate and distinct definitions for “malpractice” and “tort,” the former extending only to unintentional actions. Thus, “by definition, ‘malpractice’ does not include the intentional acts of the health care provider.” Noting that “Dr. Cook took deliberate action as a physician by becoming involved in a sexual relationship with his patient,” the court reasoned that Heacock’s claim of intentional tort against Dr. Cook was not “malpractice” as defined by the LMMA. Instead, “this type of deliberate action, a sexual relationship, has been deemed to be an intentional tort, and, as such, not considered a malpractice claim.” The court, concluding that the trial court erred in granting Dr. Cook’s exception of prematurity for Heacock’s claim of intentional tort, reversed the trial court’s judgment as to the intentional tort action and affirmed the trial court’s judgment as to the negligence claim.