Defense Verdict on behalf of Podiatrist in Philadelphia County

Heather Hansen and paralegal Beth Carson recently obtained a defense verdict on behalf of a podiatrist in a case involving allegations of failure to timely diagnose melanoma.  The plaintiff brought suit against two podiatrists, his primary care physician, and a vascular surgeon/wound care physician.  The case proceeded to trial against the two podiatrists and the primary care physician, only.

The plaintiff initially presented to his primary care physician with complaints of a pigmented lesion on his right great toe.  He was referred to podiatrist A for further evaluation. Podiatrist A diagnosed a pinched callus which he debrided.  At a follow-up visit, Podiatrist A told the patient that he had a bone spur (seen on x-ray) that was likely contributing to the callus formation.  The patient never returned to Podiatrist A.  For about seven months, plaintiff performed self-care to his wound and kept it covered with a band aid.  He then returned to his PCP because his toe was not healing.  A wound culture was performed and plaintiff was prescribed oral and topical antibiotics.  He was also referred to podiatrist B. 

When plaintiff presented to podiatrist B, he advised that his toe had not healed since being debrided by Podiatrist A and that he had increased pain with elevation.  Podiatrist B examined the toe and described a non-pigmented ulceration.  A MRI was ordered to rule out a possible bone infection and returned negative.  Based on the complaint of pain on elevation, Podiatrist B referred plaintiff to a vascular surgeon to rule out other potential causes of poor wound healing.  Plaintiff never returned to podiatrist B.  Several months later, plaintiff was diagnosed with amelanotic melanoma.

At trial, plaintiff presented expert testimony from specialists in podiatry, family medicine, and oncology.  He argued that each defendant was negligent in failing to perform a biopsy to rule out malignancy or ensure that a biopsy was performed. 

Following a seven-day trial, and over 15 hours of deliberations, the jury returned a verdict finding Podiatrist A 25% negligent, the PCP 25% negligent, and Podiatrist B not negligent.  The jury assessed 50% comparative negligence against plaintiff. 

Defense Verdict on Behalf of Two Cardiologists in Philadelphia County

Marshall L. Schwartz recently obtained a defense verdict on behalf of two cardiologists in a nine-day jury trial involving allegations of a failure to properly monitor a patient’s Coumadin usage following a cardiac catherization, as well as an alleged failure to recognize neurologic signs and symptoms prior to the patient suffering a hemorrhagic stroke.

This case involved a patient who had a longstanding medical history of coronary artery disease, hypertension, diabetes, deep vein thrombosis and pulmonary embolism, and who had undergone gastric bypass surgery multiple times for morbid obesity. He also had been taking Coumadin for several years due to his risk factors for stroke. The patient presented to his cardiologist with symptoms of shortness of breath, and was advised to have a cardiac catherization which was scheduled to take place a few days later. The patient was also instructed to stop taking his Coumadin prior to the procedure. The cardiac catherization was performed without incident, and the patient was instructed to resume taking his Coumadin, follow up with the cardiology practice in a week, and have his Coumadin levels monitored by his primary care provider.

About a week after the patient was discharged from the hospital, he was seen for a follow up appointment with a practitioner at the cardiology practice. The practitioner found that he was neurologically intact. Two days later, he followed up with his primary care provider who historically monitored his Coumadin levels. His blood levels were in range, and he was instructed to continue the same Coumadin dosage that he had been taking since the procedure. Then, about ten later, the patient began to experience symptoms of stroke. His primary care provider ordered an MRI of the brain that revealed a left temporal hemorrhage. Ultimately, the patient was diagnosed with a stroke, however, no surgical intervention was necessary.

The defense successfully argued that although the patient suffered a stroke, it was not the result of any action, or inaction on behalf of anyone in the cardiology practice. In support of this argument, an expert cardiologist and nurse practitioner were called to testify and supported this defense.

After deliberation, the jury returned a unanimous verdict, finding that the defendant physicians’ care and treatment of the plaintiff 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 Orthopaedic Surgeon

Heather Hansen and paralegal Lexi Romney recently received a defense verdict on behalf of an orthopaedic surgeon in Philadelphia County. A 65-year-old woman presented to the orthopaedic surgeon with knee pain. MRI demonstrated a non-displaced occult fracture of the distal femur. The patient was prescribed a long leg brace, instructed to remain non-weightbearing, and told to follow up with her primary care physician for purposes of anticoagulation to help prevent deep vein thrombosis. The orthopaedic surgeon contacted the patient’s primary care physician about his recommendations. Later the same day, the patient’s primary care physician contacted her on the telephone and discussed the options of using Coumadin or increasing her Aspirin dose from 81mg daily to 325mg daily. The patient chose to increase her dose of Aspirin.

Thereafter, the patient continued to follow up with the orthopaedic surgeon who noted that she was on anticoagulation per her primary care physician. The patient continued to go to work, but despite receiving a walker, she found it too difficult and preferred to use a wheelchair obtained by her husband. She did not tell the orthopaedic surgeon or her primary care physician that she was not using the walker.

Several weeks after her diagnosis, the patient started having nausea, vomiting, diarrhea, sweating and shortness of breath. Eventually, an ambulance was called to her home. After being loaded in the ambulance, the patient became unresponsive and coded. Resuscitative measures were unsuccessful. An autopsy reported the cause of death as pulmonary embolism, deep venous thrombosis, and immobility following femur fracture.

The patient’s husband brought suit against the orthopaedic surgeon and the primary care physician alleging that they were negligent by failing to ensure that adequate anticoagulation and deep vein thrombosis prophylaxis was provided. At trial, plaintiff presented expert witness testimony that Aspirin, an antiplatelet medication, was not standard of care and that an anticoagulant, such as Coumadin, should have been prescribed to the patient. The defense also presented expert witnesses who testified that the use of Aspirin was acceptable for this patient under the guidelines for anticoagulation set forth by the American College of Chest Physicians and the American Academy of Orthopaedic Surgeons. After a seven day trial, the jury found in favor of the defendants.

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 Hand Surgeon

Dan RyanCarolyn Bohmueller and paralegal Stacy Jaeger received a defense verdict on behalf of a hand surgeon in Philadelphia Court of Common Pleas. Plaintiff-father and his 11 year old son were involved in a rollover motor vehicle accident, in which the child’s right thumb was partially amputated. The minor was brought to the hospital via helicopter, where his thumb was examined. Following discussions with the parents, and specifically with the child’s father, who was a plastic surgeon, the child was taken to the operating room to address the injury. Plaintiff-father claimed that he did not give consent for a “completion amputation” of the tip of the thumb. At trial, plaintiffs did not pursue their claim that the surgery was improperly performed, and rather only proceeded on a claim of lack of consent. It was established during trial that the distal portion (or end) of the thumb including the first joint had been amputated and injured beyond repair during the accident, and that the plaintiff-father agreed to the surgical procedure performed. After a three day trial, the jury found consent was given for the surgical procedure and returned a verdict in favor of the surgeon.