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ARTICLE ID 186414

$________ – MEDICAL MALPRACTICE – HOSPITAL NEGLIGENCE – FAILURE OF NURSE TO ACT UPON FIXED AND DILATED PUPIL – BRAIN ABSCESS – BRAIN HERNIATION – DEATH OF 24-YEAR-OLD ACCOUNTANT – SURVIVAL ACTION – DAMAGES ONLY.

Allegheny County, PA

This medical malpractice action arose from the death of a 24-year-old accountant in the defendant hospital. The defendants included the hospital, on both a corporate liability theory and for the vicarious negligence of one of its nurses, as well as an attending neurosurgeon and the doctor’s professional practice group. The plaintiff alleged that the defendant doctor and nurse failed to recognize the significance of a fixed and dilated pupil and failed to timely treat the decedent’s worsening brain abscess; thereby resulting in the brain herniation which caused the decedent’s death. The plaintiff also contended that the defendant hospital failed to provide adequate training and supervision of its personnel and failed to formulate policies adequate to avoid the breakdown of care which allegedly resulted in the decedent’s death. The defendant’s hospital nurse and the defendant neurosurgeon presented conflicting testimony regarding the extent of the information relayed by the nurse to the doctor in a telephone conversation. Each denied negligence.

A previous jury trial in ________ resulted in a finding of ________% negligence against the defendant hospital with a damage award of $2.5 million on the wrongful death claim; but no damages on the plaintiff’s survival action. The plaintiff was granted this new trial limited to damages on the survival claim only. The previous $2.5 million award for wrongful death damages, as well as the court’s granting of a new trial on survival act damages only, was affirmed by the Pennsylvania Superior Court in Rettger v. UPMC Shadyside, ________ A.2d ________ (________). The defendant hospital paid $3.2 million to satisfy the verdict plus delay damages and post judgment interest.

The decedent initially presented to a hospital in West Virginia, where he was on a work assignment, with complaints of severe headaches. Diagnostic imaging showed a mass in the left side of the decedent’s brain which was diagnosed as glioblastoma multiforme, an aggressive type of brain tumor, with a differential diagnosis of brain abscess. The decedent was transferred to the defendant hospital on November 15, ________, and came under the care of the defendant neurosurgeon on November 17, ________. The defendant concurred in the earlier diagnosis and a surgical procedure was scheduled for 7:30 a.m., Wednesday, November 19, ________.

Pending surgery, the decedent was placed in a neurosurgical unit at the defendant hospital and was assigned to the defendant’s nurse who had completed her nurse’s training in May ________. The plaintiff showed that the policies of the defendant hospital included the imperative that a nurse invoke the nursing chain of command to obtain proper care for a patient if the attending physician failed to render such care or to call a “Condition C” to obtain immediate critical care for a patient whose condition appeared emergent.

On November 18th, the day prior to the scheduled surgery, evidence showed that the decedent displayed uneven pupil size and experienced substantial pain, for which he received narcotic pain medications and an anti-seizure medication. On November 19, shortly after 1:00 a.m., the defendant’s nurse documented on the decedent’s chart that the pupil of his left eye was fixed and dilated; a finding which the plaintiff’s experts testified indicated escalating pressure on the brain which, if not treated on an emergency basis, could lead to brain herniation and, ultimately, death.

The nurse’s notes also indicated that she telephoned the defendant neurosurgeon at home to report the decedent’s condition. However, the nurse’s account of the telephone conversation differs sharply from that of the defendant neurosurgeon. The nurse testified that she told the doctor that the decedent’s pupil was fixed and dilated. The defendant doctor, on the other hand, maintained that the nurse told him only that the decedent’s pupils were uneven, essentially indicating that his condition was unchanged. The defendant neurosurgeon testified that the nurse reported a sluggish pupil and that, if he had been informed that it was a fixed and dilated pupil, he would have come to the hospital immediately.

The defendant neurosurgeon did not report to the hospital nor order emergency treatment, and the nurse did not invoke the nursing chain of command or call a “Condition C.” Thereafter, the plaintiff showed that the decedent was not seen by any doctor until about 6:30 a.m. when he was taken to the surgical holding area. In the surgical holding area, the decedent lost consciousness and was rushed into surgery. The defendant neurosurgeon arrived at the hospital and looked at an MRI of the decedent’s brain which had been performed at 5:30 p.m. the day before. When the defendant neurosurgeon saw size of the mass on the MRI he knew immediately that the mass was an abscess, not a tumor. The defendant performed two emergency procedures to relieve pressure on the brain, including a partial lobectomy, but the decedent never regained consciousness and was pronounced dead at 9:30 a.m. on November 20, ________.

The plaintiff’s doctors testified that, as a result of the lack of medical attention to his worsening condition, the decedent suffered brain herniation, which caused his death. The plaintiff’s expert neurosurgeon also testified that had the decedent been treated properly after he developed the fixed and dilated pupil at 1:00 a.m. he could have returned to work as an accountant.

At the new trial on survival act damages only, the evidence showed that the plaintiff had graduated from college Cum Laude, had obtained employment with one of the Big Four accounting firms and that he was earned $________ per year as a senior accountant at the time of his death. The plaintiff’s accounting expert testified to the most likely career paths the plaintiff would have taken, and opined that the total compensation after deduction of maintenance and reduction to present value was in the range of $4.3 million to $18.3 million. The defendant presented no witnesses.The jury awarded the plaintiff $________ in damages on the survival claim. Delay damages of $2.6 million have been added to the verdict. When added to the previous $3.2 million already paid by the defendant hospital on the wrongful death claim, the plaintiff’s total recovery is increased to $15.8 million. The defendant hospital has filed post-trial motions which are currently pending before the trial court.

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