Greenstein v. Meister

• Decision Date: 01 February 1977
• Docket Number: No. 85,85
• Citation: 368 A.2d 451,279 Md. 275
• Parties: George H. GREENSTEIN et al. v. Ruth MEISTER, Administratrix of the Estate of Nathan Meister, et al.
• Court: Maryland Court of Appeals

Page 275

279 Md. 275

368 A.2d 451

George H. GREENSTEIN et al. v. Ruth MEISTER, Administratrix of the Estate of Nathan Meister, et al.

No. 85.

Court of Appeals of Maryland.

Feb. 1, 1977.

John F. King, Baltimore (Anderson, Coe & King, Baltimore, on the brief), for George Greenstein; by Robert E. Scott, Jr. and John H. Mudd, Baltimore (Semmes, Bowen & Semmes, Baltimore, on the brief) for Sinai Hospital of Baltimore, Inc., for appellants.

Marvin Ellin, Baltimore (Jonathan Schochor, Baltimore, on the brief), for appellee.

Argued before SINGLEY, SMITH, DIGGES, LEVINE, ELDRIDGE and ORTH, JJ.

LEVINE, Judge.

This appeal deals mainly with questions of admissibility and sufficiency of evidence in a medical malpractice case. Appellees recovered judgments totaling approximately $214,500 against appellants, George Greenstein, an orthopedic surgeon, and Sinai Hospital of Baltimore, Inc., in the Superior Court of Baltimore City (Murphy, J.). Appellants then noted appeals to the Court of Special Appeals, but we granted certiorari prior to consideration of the case by that court. We affirm.

Although the events culminating in this appeal originated with the performance of a spinal operation, the engligence charged to the two surgeons who performed it and to Sinai Hospital occurred not during surgery, but in the postoperative stage that followed. ¹ The entire episode began on the morning of Sunday March 9, 1969, when the decedent, Nathan Meister, then 49 years of age and employed as a parttime television repairman, entered Sinai Hospital for the purpose of undergoing elective surgery to be performed on the following day by Doctor Greenstein and Doctor Neal Aronson, a neurosurgeon. Mr. Meister, otherwise in good health, had for the past few years suffered from instability of the low back, which had necessitated three prior surgical procedures including one disc removal and three spinal fusions. The third operation had been performed only 18 months earlier. Since it had afforded him no relief, a fourth fusion was to be performed on the following day, Monday March 10th. Because his own blood was known to contain a characteristic described as Duffy Antigen, Mr. Meister had been tested at the Sinai blood bank a week earlier to insure the availability of an adequate supply of compatible blood during the surgery. After the blood was crossmatched, seven pints were set aside for the surgery.

On Monday March 10, Mr. Meister underwent a four-hour operation. At the outset, Doctor Aronson performed his neurosurgical procedures, which consisted essentially of explorations to ascertain the possible presence of nerve root compression. Since he found no evidence of a protruded disc, it was unnecessary for him to perform a neurosurgical operation. The services which he did render consumed about thirty minutes, whereupon he left the operating room. Doctor Greenstein then took over and performed an extensive spinal-fusion operation at the levels of L-4 to S-1. To accomplish this, a bone graft from the right hip was necessary. The combined efforts by the two surgeons were themselves uneventful and technically successful. At midnight, Mr. Meister was removed from the recovery room to his own semi-private room in satisfactory condition.

Shortly after 9:00 a. m. on the following morning, Tuesday March 11, Doctor Aronson visited Mr. Meister in his room. He found the patient lying on his side and complaining of acute pain at the donor site. Although he regarded the pain as a normal consequence of the particular surgery which had been performed, he observed that the donor site was swollen 'more than what one would ordinarily expect. . . . (T)he hip seemed much more prominent to (him) than an ordinary hematoma.' While he no longer considered Mr. Meister to be his patient, he was sufficiently concerned by what he had seen to telephone Doctor Greenstein, in whose care the patient had remained. Doctor Greenstein was not available, but one of his partners recommended to Doctor Aronson that an ice pack be applied. After seeing to this and prescribing a pain medication, Doctor Aronson departed.

Although Doctor Greenstein testified that he visited the patient about midnight on the 11th, and his associate, Doctor Arthur Baitch, testified to having visited 60 minutes earlier, the hospital records failed to reveal any such visits until 10:00 a. m. on the 12th, when another orthopedic associate, Doctor Melvin Friedman, arrived. Mr. Meister, however, was seen twice on the 11th by a house physician, once at 6:00 a. m. and again at 1:15 p. m. He was, of course, also seen a number of times by nurses.

Late in the morning of the 11th, Mrs. Meister received a telephone call from her husband's roommate at the hospital, Francis C. Jackson, a Baltimore County police detective. He called at the request of Mr. Meister, whom he described as suffering from severe pain in the right hip and complaining that he was hot. Earlier that morning, he had begun to notice 'a yellowish cast' over Mr. Meister's face. When Mrs. Meister arrived shortly after receiving the telephone call, she found her husband with a 'slightly yellowish cast on his skin,' in great pain and feverish to touch.

With the exception of a brief absence to pick up their 17-year old daughter at school, Mrs. Meister remained with her husband continuously until 9:00 p. m. on the evening of the 11th. During her stay, she testified, no physician examined Mr. Meister. The yellowish cast appeared to her 'to deepen' as the day wore on. At the same time, his pain and restlessness increased, 'and his face was contorted more.' By the time she left at 9:00 p. m., 'the yellow (color) had really deepened and he was very feverish.' Some time during the evening, a nurse, at Mrs. Meister's request, took his temperature and found 'it was more elevated.' On learning this, Mrs. Meister asked the nurse 'to call the doctor.' After waiting for some time, she was called to the nurse's station at 7:45 p. m., where she was met by a physician whom she understood to be an employee of the hospital. She described to him her husband's condition and requested that the doctor make an examination. He did not do so during her stay, but assured her that he would make one immediately after her departure.

On the next morning, March 12, when she again responded to a telephone call from Mr. Jackson, Mrs. Meister found her husband 'very, very yellow, (a) deep color yellow' with one eye 'back in the side of his head and the other one . . . going up and down.' By then he was unable to speak. Mr. Jackson also detected a worsening of Mr. Meister's condition on the 12th when he observed the patient to be as 'yellow as a banana.'

Not surprisingly, therefore, the degree of attention accorded Mr. Meister increased dramatically following the arrival of Doctor Friedman on the morning of the 12th. At that time, he found the patient 'grossly jaundiced.' According to the hospital records, he formed the opinion, which came to be shared by virtually every other physician who saw Mr. Meister on the 12th, that the patient's condition had resulted from a blood transfusion reaction. Various remedial measures were taken by the hospital staff after 12:30 p. m. when the patient was 'in shock.' Among the steps initiated was the insertion of a tube to empty the stomach of fluids and gas. This procedure apparently alleviated the shock condition. Still later, he became even more jaundiced and experienced gross hemolysis-a breakdown of the red blood cells. The family physician then had him transferred to the intensive care unit where the patient was seen by a hematologist. He, too, concluded that the most likely explanation for Mr. Meister's condition was 'transfusion incompatibility.' Early that evening, Doctor Aronson, on being informed by a telephone call from Doctor Greenstein that the patient was 'doing very badly,' went immediately to the hospital and, on seeing the patient, recognized that 'it was a hopeless situation.' Mr. Meister died at 10:30 p. m. on the 12th.

Two death certificates were prepared. The first, executed on the 12th, listed the cause of death as 'massive introvascular hemolysis' (destruction of the red blood cells) as a consequence of blood transfusion reaction. The second certificate, dated the 13th, listed the underlying cause as 'CLOSTRIDIAL SEPSIS,' AN INFECTION OF THe bloodstream, apparently of undetermined origin. This change of opinion resulted from tests conducted before and after Mr. Meister's death, which had excluded the possibility of blood transfusion reaction or contamination.

The various expert witnesses called by appellees, however, were of the further opinion-to the extent that we can state it concisely-that beneath the airtight covering at the donor site, the hematoma (accumulation of blood), a normal consequence of such an incision, had resulted in dead tissue. This served as fertile ground for the growth of the anaerobic (non-oxygen consuming) organism, clostridia perfringens, which produced a toxin resulting in gas gangrene and thus destruction of the red blood cells. This destructive process which overtook the red blood cells released two components, one in particular, a pigment called bilirubin that caused the jaundiced appearance of the skin. The depth of the yellowish color was directly related to the amount of blood cell destruction.

Following her husband's death, Mrs. Meister and her daughter brought suit against Sinai and Doctors Greenstein and Aronson. The jury, after a trial that covered a span of some 25 days and produced a transcript of almost 2500 pages, returned verdicts in favor of Doctor Aronson, but against Sinai and Doctor Greenstein in favor of Mrs. Meister, as administratrix of her husband's estate, in the sum of $152,209; in her favor individually in the sum of $56,600; and in favor of the daughter in the sum of $5,660. Appellants attack the judgments that followed on numerous grounds. Some...