On March 21, 2013, the Court of Special Appeals of Maryland (“Court of Special Appeals”), Maryland’s intermediate appellate court, reinstated a Maryland medical malpractice jury’s verdict in the amount of $1,123,000 for a man who the jury found would have been admitted into a local Baltimore hospital where his symptoms consistent with a stroke would have been properly diagnosed and treated had an emergency room doctor and a nurse complied with the required standard of care.
The Underlying Facts
The man went to see his primary care physician on January 26, 2005 because he was experiencing weakness in his right hand grip, numbness, and tingling in his right arm. His physician was concerned that the man was having a transient ischemic attack (mini-stroke) or was in the beginning phases of a stroke and therefore called the patient’s wife to immediately drive him to the hospital, even providing them with a written note ordering a “stroke work up” to be given to the hospital’s registration personnel upon arrival at the hospital.
When he arrived at the hospital, the man was seen by the “quick look nurse,” who was shown the physician’s note, and who determined that the man should be a priority number one (the highest priority, meaning that the patient’s condition was life threatening). The quick look nurse noted on the hospital form that the man “had a weak right grip, tingling in the right hand, a numb right side, and that he had been seen by his primary care doctor.” She attached the physician’s note to the hospital form and directed the man to the emergency room.
The man was next seen by the triage nurse who claimed that she did not see the physician’s note. She allegedly changed the quick look nurse’s note from “numb right side” to “numb right hand” and changed the man’s priority from one to four, directing the man to the urgent care department that treats less serious conditions instead of the emergency room.
In the urgent care department, the man was seen by an emergency medicine physician who allegedly did not see the physician’s note ordering a stroke work up but testified that had he seen the note, he would have brought the man to the emergency department for the stroke work up. The emergency medicine physician instead ordered a wrist x-ray, diagnosed the man with carpel tunnel syndrome, gave him pain medication, prescribed an anti-inflammatory medication, and told him to follow up with a hand surgeon.
As the man was leaving the hospital, the quick look nurse saw him in the parking lot and felt that he had not been there long enough to have a stroke work up. She looked at the man’s assessment form and saw that he did not receive the stroke work up. She advised the charge nurse who then called the man’s physician, who instructed her to call the man and have him return to the emergency room. The charge nurse left a message on the man’s home answering machine.
Upon returning to the hospital about two hours later, the man received at least a partial stroke work up. The emergency room physician who examined the man ruled out a hemorrhagic stroke based on the CAT scan. After a few other tests, the emergency room physician concluded that the man needed to be admitted for further evaluation. However, the man’s health insurance was through Kaiser Permanente, which required a Kaiser Permanente hospitalist to admit the man. The only Kaiser Permanente hospitalist on duty that evening was called by the emergency room physician who requested that the hospitalist come to the hospital to evaluate and admit the man. Despite stating that he would come to the hospital as soon as possible, he never arrived.
The man became tired of waiting and wanted to go home. The emergency room physician advised the man to follow up with his own physician in the morning and discharged him.
The next day, the man called his physician and told him about what occurred at the hospital. The physician planned for the man to have an MRI, a doppler study of his neck, and an echocardiogram within one week, and to see a neurologist in four days. However, when the man’s wife returned home from work, she found that the man had suffered a stroke sometime after she had left for work earlier that day.
The man and his wife filed a Maryland medical malpractice case against the hospital, the emergency medicine physician in the urgent care department, his employer, and the emergency room physician who treated the man when he returned to the emergency room the same evening as the initial visit. The jury found the emergency room physician to not be liable but found the other medical malpractice defendants liable for $200,000 for loss of household services, $73,000 for future medical expenses, $750,000 in non-economic damages, and $50,000 for loss of consortium.
The trial judge subsequently granted the defendants’ motion for judgment notwithstanding the verdict (“JNOV”) based on the alleged insufficient causation evidence presented at trial, finding that the plaintiffs’ expert’s “testimony on causation lacked foundation, did not provide legally sufficient testimony for the jury to find that as a result of the violation of the standard of care by [the triage nurse] and [the emergency medicine physician], that [the man] had a stroke and that if they had complied with the standard of care, that his stroke was preventable.” The plaintiffs appealed that decision.
The Court Of Special Appeals Decision
The Court of Special Appeals determined that assuming the truth of the plaintiffs’ evidence and all reasonable inferences drawn therefrom, the jury could have concluded that the triage nurse downgraded the man’s priority and that this did contribute to his injury. The jury could have reasonably found that because she downgraded the priority and sent the man to urgent care, neither the emergency medicine physician in the urgent care department nor any other doctor was put on notice of the severity of the man’s condition. The jury could have reasonably found that had the nurse sent the man to the emergency department with the highest priority, he could have been admitted during his first visit to the hospital and undergone a full stroke work up. The jury also could have concluded that the man did not receive the same treatment he would have received during the first hospital visit on the second visit because he was not admitted during the second visit so his stroke work-up could not be completed.
The Court of Special Appeals concluded that there was sufficient evidence to create a jury question on whether the man would have been admitted to the hospital and received the appropriate tests if they had complied with the standard of care. Because the Court of Special Appeals is not permitted to substitute its evaluation of the evidence for the jury’s evaluation, it concluded that the plaintiffs produced sufficient evidence of causation, and the trial court erred in granting a JNOV. Therefore, the Court of Special Appeals exercised its power to reinstate the jury’s verdict.
Source: David A. Barnes, et al. v. Greater Baltimore Medical Center, et al., September Term, 2011, No. 0789.
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