Arthur Roeca assisted by April Luira, Roeca Luria Hiraoka LLC (Honolulu, Hawaii) obtained defense verdicts in favor of his clients.
The first was a 2 week jury trial on Maui. It involved the alleged wrongful death of a patient for alleged nursing malpractice. Mr. Roeca’s client was the traveling registered nurses who was working at the Maui community hospital. The hospital settled out prior to trial for a nominal sum. The decedent had been admitted with what proved to be severe, refractory immune thrombocytopenia purpura (ITP). The attending physicians ordered the nurses to conduct regular “neuro checks” and to notify attending MD of any neuro changes STAT and to administer platelets and initiate head CT scan as prophylaxis for presumed intracranial bleed. Throughout the hospital admission the patient’s platelet count remained in the 3-4,00 range, whereas the normal range was 150-450,000. It was agreed by all that any patient with platelets as low as this was at risk to have a spontaneous bleed with most problematic bleeds being intracranial. Thus MD orders for neuro periodic neuro checks were intended to detect early onset of hemmorrhagic stroke and to initiate emergency treatment. Progress notes, including those by nurses, documented patient’s course over a 12 day admission. On the 12th evening patient’s family reportedly observed abnormal behavior, some of which was documented by the defendant nurse, who elected to monitor and record vitals but neither notified the attending MD nor initiated the plan as set forth in the MD orders. Patient’s vitals as documented were baseline and testimony conflicted as to whether patient was alert & oriented during the shift. The patient was found unresponsive 9 hours later and at autopsy his death was determined to be secondary to intracranial hemmorrhage.
The jury was presented with issues of nursing standard of care and causation. The Plaintiffs’ experts opined that the physician’s orders established the nursing standard of care, i.e., conduct 4 hour neuro checks and, if changes noted, initiate the “plan”. The defense, via the treating MDs, who were not defendants, argued that nursing assessments were properly conducted and that neuro checks for nurses do not mandate the more exhaustive neurological assessments described in the Lippincott text on Nursing. Plaintiffs’ experts opined that timely diagnosis would have lead to neurosurgical evacuation of the hemmorrhage which was necessary to save patient’s life. The defense called multiple experts on causation in the following specialties: neurovascular medicine; hematology; neurosurgery—the thrust of the causation defense was that the patient’s ITP was refractory to all therapy, including recent administration of platelets, and his platelets were too low to allow any safe surgical intervention, including neurosurgery consisting of either ventriculostomy or craniotomy. In short, no neurosurgeon would have been willing to offer this patient surgery given the severely low platelet count. The jury found that there was no breach of nursing standard of care thus did not get to the causation question on the verdict form.
Two weeks later the Oahu jury trial commenced. It involved a patient who was on long-term hemodialysis for end-stage renal failure and who suffered a series of access site complications. He was a complex patient with DM Type 1, retinopathy of diabetes and an assorment of other chronic conditions that rendered him disabled. Plaintiffs sued the dialysis center, the nephrologist and Mr. Roeca’s client, the vascular surgeon. During cross-examination, the vascular surgeon admitted that he did not explain any alternative approaches to the patient prior to placing a “spare tire” right groin IV graft that he recommended to the patient should his present functioning left groin IV graft site fail in the future. Patient subsequently developed an access site infection at the left groin IV graft that required surgical removal and 4 months hospitalization and ICU care; his right groin IV access site was also determined to be nonfunctional due to unusually deep placement necessitating revision and eventual abandonment.
The plaintiffs’ theories were that the negligence of the defendants needlessly compromised the patient’s last remaining vascular access site, that there was a failure to inform the patient of alternative treatment options; and that the vascular surgeon should have recommended and performed venous mapping to study the anatomy in an effort to avoid unnecessary surgery which, they opined, resulted in the loss of the final virgin vascular access site for this patient. Plaintiffs settled with the dialysis center prior to trial and proceeded against the 2 physician-defendants. Plaintiffs called experts in nephrology and vascular surgey, both of whom opined that the standard of care was breached by the 2 defendant physicians. The defendants called experts in the same fields, countering Plaintiffs’ theories by pointing out that the patient had been on hemodialysis for 10 years, was noncompliant and required multiple interventions to keep his vascular access sites patent. After 4 weeks of trial the jury was asked to consider liability theories of breach of standard of care and lack of informed consent. The jury returned defense verdicts in favor of both physicians on all issues.