Defense Verdict in Pressure Wound Matter on Behalf of Hospital

Marshall L. Schwartz recently obtained a defense verdict on behalf of a hospital in a four-day jury trial in the Chester County Court of Common Pleas. The case involved allegations that the defendant hospital failed to rotate, turn and reposition the patient during his hospitalization, and as a result, the patient developed a stage IV pressure ulcer.

The case involved a patient that was admitted to the hospital with complaints of a headache, confusion, and weakness. Imaging identified masses on his brain, and the patient underwent several brain surgeries. The patient remained in critical condition at the hospital for approximately three months while he recovered. During this time, he developed several medical issues including the development of pressure ulcers.

The defense argued that although the patient developed pressure ulcers, it was not the result of any negligent action on behalf of the medical providers at the hospital but that it was unavoidable as a result of the patient’s critical, life threatening illness, multiple comorbidities and his past medical history.
After a brief deliberation, the jury returned a verdict, finding that the defendant hospital was not negligent.

Defense Verdict on Behalf of Urologist

Michael O. Pitt and paralegal Elizabeth Carson-Nave recently received a defense verdict on behalf of a urologist in the Chester County Court of Common Pleas. The matter involved a 60-year old male who underwent robotic-assisted radical prostatectomy for treatment of prostate cancer. There were no complications to the surgery. On the evening of the surgery, the patient lost consciousness briefly and this was attributed by a hospitalist as a likely vasovagal response. An EKG was obtained and was abnormal, but unchanged from a pre-operative EKG study. The patient was transferred from the medical-surgical floor to telemetry for closer monitoring.

Over the next two days, the patient had a distended abdomen along with several bouts of nausea and vomiting attributed to a post-operative ileus. Additionally, labs were drawn each morning and the patient’s hemoglobin level was observed to drop from 11.6 on the date of surgery, to 10.0 on post-op day one, and then to 8.8 on post-op day two. The patient’s pulse, blood pressure, oxygen saturations and urine output remained normal. After taking a walk around the unit in the early afternoon of post-op day two, the patient complained of indigestion, suddenly lost consciousness and coded. Resuscitative measures were unsuccessful. On autopsy, the medical examiner found 900 mL of blood in the patient’s retroperitoneum, as well as moderate to severe three-vessel coronary artery disease that was previously undiagnosed. Per the medical examiner, the patient’s cause of death was coronary artery disease in the setting of complications of prostatectomy.

The decedent’s spouse filed suit under the Pennsylvania Wrongful Death and Survival Acts. Plaintiff alleged that the urologist failed to recognize the falling hemoglobin levels as a sign of active internal bleeding that caused decreased oxygen carrying capacity to the heart and her husband’s untimely death. Plaintiff presented expert testimony by a urologist and a cardiologist who claimed that had the urologist ordered a cardiology consult, CT scan of the abdomen, and serial blood draws, the patient would have received a blood transfusion and lived.

The defense presented testimony by experts in urology and critical care. These experts established that the urologist acted within the standard of care, and more specifically, that a blood transfusion was not indicated in the patient because his vital signs were stable and his hemoglobin level never fell below 8.0. Additionally, evidence was presented that the patient’s death was not caused by reduced oxygen carrying capacity from blood loss, but rather, that the patient died from a sudden cardiac arrhythmia.
Following approximately 8 hours of deliberations, the jury returned a verdict in favor of the urologist.

Defense Verdict on Behalf of Pulmonologist

Tracie VizzaMary Kay Plyter and paralegal Lexi Romney recently received a defense verdict on behalf of a pulmonologist/critical care physician in Chester County. A 67 year old woman who had been treating with her pulmonologist for six years for a chronic and progressive lung illness was hospitalized and diagnosed with pneumonia in December 2011. She was discharged on oxygen, but was quickly readmitted less than two weeks later with increased complaints of weakness and shortness of breath. The patient continued to decline rapidly, became critically ill and was transferred to the intensive care unit where she was intubated. Twelve days later, imaging suggested that there was erosion in the trachea at the area of the cuff around the endotracheal tube. This erosion was confirmed on February 1, 2012. Conservative management of the tracheal erosion failed and the patient was transferred to another hospital to be placed on extracorpeal membrane oxygenation (ECMO) to allow the trachea to heal. The Patient died from a brain hemorrhage the next day.

Plaintiffs, the decedent’s husband and daughter, brought suit against several physicians who treated the patient in the hospital, as well as the hospital itself. Plaintiffs claimed that the intubation was performed negligently and caused a tear in the patient’s trachea at the time of injury, which eventually caused the patient’s death. The defense argued that the intubation was a “textbook” intubation; successfully performed on the first try, and that the patient’s presentation in the days after the intubation did not support an injury to the trachea at the time of intubation and, further, that plaintiffs could not explain how the intubation was performed negligently. The defense further asserted that the trachea was slowly eroded by the cuff on the endotracheal tube, and likely worsened as a result of the patient’s long time steroid use. After a two week trial, the jury found in favor of all of the defendants.

Defense Verdict on Behalf of Internal Medicine Physician in Chester County

Dan Ryan and Christine N. Dantonio recently obtained a defense verdict in favor of an internal medicine physician in the Court of Common Pleas of Chester County, Pennsylvania, in a case involving claims under the Wrongful Death and Survival Acts following the suicide death of the plaintiff’s wife. 

The decedent, a Certified Registered Nurse Practitioner, knew the defendant physician from working with him in the past.  In January, 2010, she sustained multiple fractures to her pelvis from a fall in her home.  Following admission to the hospital, the decedent was transferred to a skilled nursing facility where she requested that the defendant physician treat her.  She made good progress and was discharged from the skilled nursing facility in early March.  Thereafter, the decedent began to experience incapacitating pain in her left buttock and groin areas.  She was subsequently diagnosed by her gynecologist as having pudendal neuralgia, a painful neuropathic condition that is caused by inflammation of the pudendal nerve.  When she returned to the defendant physician in April, the medication Neurontin was prescribed to help with the decedent’s pain, and this medication was slowly titrated up.  In early May, the decedent complained of some depression secondary to her pain, in response to which the defendant physician prescribed the anti-depressant Lexapro.  Subsequently, another physician recommended that the Lexapro be increased and that the pain medication Ultram be added.  The defendant physician agreed and made the necessary adjustment to the decedent’s medications.  However, the decedent developed the side effect of hand tremors, and therefore, the doses of Lexapro and Ultram were decreased.  Plaintiff’s pain continued, eventually requiring the Ultram to be discontinued in favor of a narcotic pain medication.  During this time period, the decedent had no obvious signs or symptoms of severe depression or suicidal thoughts.  Tragically, she took her own life on May 27, 2010.

It was alleged that the defendant physician negligently increased the risk of harm to the decedent by failing to warn her and her husband of the potential side effects of Neurontin; significantly, its association with an increased risk of suicidal ideation and behavior.  Plaintiff further alleged that the defendant physician deviated from the standard of care when he failed to discontinue Neurontin following the decedent’s complaints of depression and hand tremors, failed to send the decedent for a psychiatric evaluation, failed to refer the decedent to a pain management specialist, and by prescribing a “dangerous mix” of medications. 

Defendants presented expert testimony that the use of Neurontin was appropriate, as was its combined use with Lexapro, Ultram, and Vicodin to treat the incapacitating nerve condition suffered by the decedent.  The jury was also presented with evidence that the decedent was proactive in her own care and was seeking out specialists all over the country for treatment of her condition.  However, the decedent quickly learned that even with aggressive therapy and/or surgery, there was no guarantee of a cure.  Given the lack of severe depression or suicidal thoughts by the decedent, it was argued that the decedent’s tragic demise was the result of her realization that she would never be able to return to her prior life as a Certified Registered Nurse Practitioner, wife, and mother. 

The jury deliberated for approximately two hours and returned an 11-1 verdict in defendant’s favor, finding that the defendant physician’s treatment of the decedent did not deviate from the standard of care, and therefore, he was not negligent.

Defense Verdict in Fraud and Breach of Fiduciary Duty Action in Chester County

Paul E. Peel and Brett M. Littman obtained a defense verdict in a bench trial at the Chester County Court of Common Pleas in a corporate liability action, which included allegations of fraud and breach of fiduciary duty. Mr. Peel and Mr. Littman represented the president of an emergency medicine practice who was being sued by a former officer of the group.

In 2003, several emergency physicians at a local hospital made the decision to form an independent group who would share equally in profits obtained from their practice and have autonomy over the day-to-day operations of their practice. During the same time period, this group was approached by an existing group who operated at another hospital with a plan to combine the two practices, which would afford them certain benefits, including a discount from vendors and an increase in reimbursements from insurance companies for medical services rendered.

After initial discussions, the groups sought legal counsel and determined that the only way to obtain these benefits would be for the existing group to have a 100% ownership interest in the new group. All involved in the fledgling group agreed that the benefits of being owned greatly outweighed the need for complete autonomy, particularly when they would still control the day-to-day functioning of the practice. The members of the group voted, by a four-to-one count, to go forward with the plan. The dissenting voter nonetheless acquiesced to the plan, and the new group signed a contract to provide emergency services.

This dissenting voter became increasingly dissatisfied with the operation of the business and was demoted from his position as a corporate officer and co-owner of the new practice. He was ultimately terminated, and he brought a lawsuit against the president of the new group, the group itself, the group that held the ownership interest, and the group’s attorney. Plaintiff’s claims included allegations that the president of his group defrauded him and breached a fiduciary duty by concealing the fact that the new group would be owned by the existing practice, to his detriment.

By introducing corporate minutes, corporate start-up documentation, and the testimony of all involved, the defense presented extensive evidence that all parties were aware of the ownership structure before it went into effect, and that all members of the new group knew that they were to be owned by another group. After hearing the evidence and argument of the parties, the Honorable Edward Griffith rendered a defense verdict.

In the same action, Mr. Peel and Mr. Littman also represented the group’s healthcare attorney, as the plaintiff alleged that the attorney placed the interests of the group ahead of his personal interests, which represented a legal conflict and constituted legal malpractice. This action was dismissed pursuant to successful preliminary objections prior to trial.

Mr. Peel and Mr. Littman also represented the fledgling group and the group that held the ownership interest. Claims against these parties were also dismissed pursuant to successful preliminary objections prior to trial.