Medical Malpractice Case Highlights Evidentiary Elements of Tragic Incident

In a semi-recent Third Circuit Court of Appeal decision, the Louisiana Medical Malpractice Act was explored in order to determine whether the lower Vernon Parish District Court’s decision was appropriate. Despite the sad facts of the case, the appellate court may only overturn a trial court’s decision if there was clearly an error in the record. The appellate court analyzed the necessary requirements of the Louisiana Medical Malpractice Act in order to decide whether or not a doctor’s actions met the standard of care in treating a seriously injured young man. Medical Malpractice requires numerous steps for claimants to take before even reaching the court room. For instance, a person with a claim against a doctor, hospital staff, or the hospital itself has to first submit the claim to a medical review panel. This medical review panel was the primary focus for the appellate court, who had to establish whether or not the panel’s ultimate decision regarding a surgeon’s actions lived up the the applicable standard of care.

The underlying facts giving rise to the case occurred on August 11, 2002, when a young man entered the emergency room at Byrd regional Hospital in Leesville, Louisiana, after suffering a two and one-half centimeter knife wound to the left side of his chest. The emergency room staff noticed that the young man appeared alert despite his labored breathing and low blood pressure. The emergency room physician on duty suspected that the young man was suffering from the presence of air between the lung and the wall of the chest. A chest x-ray, an electrocardiogram (EKG) lab work, and an IV infusion of saline were ordered, and as such procedures were being performed on the young man, the emergency room doctor decided to telephone a general surgeon in private practice in Leesville, asking for his assistance. The general surgeon arrived at the emergency room and ordered a second x-ray in order to determine if there was any other issues involved with the young man’s condition. Throughout this time period, the young man’s blood pressure continued to decrease and his condition worsened. Over one hour later, the general surgeon determined that a large amount of blood had collected in the young man’s chest cavity, but he failed to confirm the emergency room doctor’s determination of a cardiac injury because the young man’s heart sounds were still normal and there was no swelling in the neck vein. The general surgeon then decided that the young man had to undergo surgery to repair what appeared to be a large hole in the left ventricle of the young man’s heart. However, at this point, the young man’s blood pressure plummeted, despite the doctor’s attempts at ordering blood transfusions. Within ten minutes after the young man’s third blood transfusion, the general surgeon made an incision into the left side of the chest cavity, he attempted to repair the laceration with sutures, but the young man continued to bleed at the point of injury. The young man went into ventricular fibrillation and as a result, passed away on the operating table. The young man’s parents sued the general surgeon, asserting that his failure to transfer their son to a hospital with a heart bypass capabilities and staffed with a cardiovascular surgeon constituted malpractice. Following the bench trial, the trial court ruled in favor of the general surgeon, relying on the Louisiana Medical Malpractice Act in order to support their decision.

The Medical Malpractice Act requires a number of steps to be followed in order for a claim to move forward for trial. Importantly, when exploring a medical malpractice issue, La. R.S. 40:1299 states, “[a]ny report of the expert opinion reached by the medical review panel shall be admissible as evidence in any action subsequently brought by the claimant in a court of law.” Thus, the first argument the plaintiff’s allege as error on the trial court’s part may have been in vain. They alleged that the trial court erred in admitting the medical review panel opinion into evidence and that this error requires the appellate court to undergo a new factual finding of the trial court’s decision. Following the Louisiana statute’s language, the opinions of medical review panels may be utilized by the trial court in handling a medical malpractice case. In fact, medical review panels are designed to review the evidence after any examination of the panel and conclude that either:

(1.) The evidence supports the conclusion that the defendant(s) failed to comply with the appropriate standard of care,
(2.) The evidence did not support the conclusion that the defendant(s) failed to meet the applicable standard of care,
(3.) That there is a material issue of fact, not requiring expert opinion, or lastly,
(4.) If the defendant(s) is found to have failed to comply with the standard of care whether or not the plaintiff suffered any disability, extent of such disability, and if any permanent impairment and the percentage of such impairment exists.

The medical review panel in this case determined that the doctor had not failed to abide by the appropriate standard of care when treating the injured young man. The reasons provided by the panel included each of the medical steps and precautions taken by the hospital staff that were used to evaluate, treat, and attempt to save the young man’s life. Further, they maintained that any attempted transfer of the young man would not have been feasible, as his condition was too poor to survive any transfer to any other facility. In order for the plaintiff’s to overcome the medical review panel’s findings, they would have had to prove by a preponderance of the evidence that the standard of care applicable to the general surgeon applied to him, that he breached such standard, and that there was a causal link between the breach of care and the resulting injury/death of their son. In order to satisfy each element, the plaintiff’s had numerous Doctor’s give their expert testimony regarding their son’s situation. Each expert provided testimony which declared that had the young man been at the appropriate facility that handled such serious coronary issues, he would have likely survived. One of the experts even pointed out the fact that the young man could have been transferred at the time when his blood level was relatively stable, yet, the hospital failed to move on any transferral, missing the opportunity.

The ultimate conflict revolves around whether or not the doctor should have transferred the young man or not, and since he ultimately did not transfer him, was he responsible for the end result? The conclusion by the trial court as well as the appellate court is no. Applying the Louisiana Medical Malpractice Act, the court’s both found that the medical review panel made the appropriate determination considering the circumstances and that the standard of care was not breached by the general surgeon. The evidence demonstrated that the young man’s blood pressure was never stabile at any given moment, but rather, was in a constant influx and that transferring him would have been instantly detrimental to survival. Thus, despite the difficult facts and the sad outcome, the medical review panel made their determination after weighing the actions of the hospital and doctor’s and the eventual consequences of such actions in order to decide that under the Louisiana Medical Malpractice Act, their decision was that no breach of care had been committed. Their decision was used by the trial court, which cannot be overturned without a showing of manifest error, as such, there is no evidence that the analysis and review by the medical review panel nor the trial court was in error. Thus, the appellate court affirmed the initial decision finding that the doctor had not breached his standard of care.