Calcagno v. Emery

Decision Date21 May 2012
Docket NumberA11-1212
PartiesRobert Calcagno, as trustee for the next of kin of Claudia Calcagno, Respondent, v. Jennifer Barbara Emery, M. D., et al., Defendants, Monticello-Big Lake Community Hospital, Appellant.
CourtMinnesota Court of Appeals

This opinion will be unpublished and

may not be cited except as provided by

Minn. Stat. § 480A.08, subd. 3 (2010).

Affirmed

Kalitowski, Judge

Wright County District Court

File No. 86-CV-09-5000

Kathleen Flynn Peterson, Vincent J. Moccio, Brandon E. Thompson, Robins, Kaplan, Miller & Ciresi, L.L.P., Minneapolis, Minnesota (for respondent)

Diane B. Bratvold, Jessica J. Stomski, Briggs and Morgan, P.A., Minneapolis, Minnesota; and

Sally J. Ferguson, Paul E.D. Darsow, Arthur, Chapman, Kettering, Smetak & Pikala, P.A., Minneapolis, Minnesota (for appellant)

Considered and decided by Bjorkman, Presiding Judge; Kalitowski, Judge; and Schellhas, Judge.

UNPUBLISHED OPINION

KALITOWSKI, Judge

In this medical-negligence action, appellant Monticello-Big Lake Community Hospital appeals the district court's denial of its motions for a new trial, judgment as a matter of law (JMOL), and a new trial on damages or remittitur following a jury verdict in favor of respondent Robert Calcagno, as trustee for the next-of-kin of Claudia Calcagno. We affirm.

FACTS

Ms. Calcagno was admitted to Monticello-Big Lake Community Hospital on the evening of January 17, 2008, to be induced to give birth. After several hours of unsuccessful labor, Dr. Olson, Ms. Calcagno's obstetrician, decided to perform a cesarean section. Dr. Olson delivered a healthy baby boy on January 18, 2008, at 6:50 p.m. After the birth, Ms. Calcagno was stable, but her uterus was "suggestive of atony," a condition in which the uterus muscle does not contract and continues to bleed. Dr. Olson and hospital staff administered drugs and uterine massage to address the atony.

At approximately 8:50 p.m., Nurse Adams noticed that Ms. Calcagno was bleeding heavily and contacted Dr. Emery, the on-call obstetrician. Responding to a page by telephone while she was driving to the hospital, Dr. Emery ordered staff to "type and cross" Ms. Calcagno's blood to determine her blood type and compatibility and requested two units of blood "STAT." She also requested that the operating room be placed on standby. Around 9:10 p.m., Dr. Emery spoke with Nurse Adams a second time and ordered Nurse Adams to begin transfusing blood immediately.

When Dr. Emery arrived at the hospital at 9:18 p.m., she inquired why no blood was transfusing. Hospital staff told her that the lab was "working on" the request, and because the hospital did not stock A- blood, Ms. Calcagno's blood type, no A- blood was available. At 9:30, Dr. Emery ordered two units of trauma blood, referring to O- blood, which all patients can receive in an emergency. At 9:40 p.m., Dr. Emery ordered four units of red blood cells and four units of fresh frozen plasma for transfusion, and requested that two additional units be placed on hold. Dr. Emery then requested "all the trauma blood" that the hospital had available. Ms. Calcagno continued to bleed, and Dr. Emery performed an examination and further treated the atony with massage and drugs. Also around 9:30 p.m., Dr. Emery began planning to treat the bleeding with various surgical procedures, including a hysterectomy, and discussed the possibility of a hysterectomy with Ms. Calcagno. Staff provided two units of O- blood, which began transfusing at 9:41 p.m.

Dr. Emery informed Dr. Olson about Ms. Calcagno's condition. Dr. Olson arrived at the hospital around 10:00 p.m. and requested all the blood that could be given to Ms. Calcagno, but was told no blood was available. The physicians became concerned that Ms. Calcagno's blood loss was causing her blood not to clot. Ms. Calcagno signed a consent for surgery, including a hysterectomy. Around this time, Dr. Emery contacted North Memorial Hospital to inquire about transferring Ms. Calcagno because she believed appellant did not have an adequate blood supply, and because a radiation procedure could be performed at North Memorial.

At 10:35 p.m., the physicians decided to initiate surgical procedures in attempt to stop the bleeding and transferred Ms. Calcagno to the operating room. Drs. Emery and Olson considered performing a hysterectomy, but determined that a hysterectomy could not safely be performed without more blood than they believed was available. The physicians performed an exam and inserted a balloon tamponade in Ms. Calcagno's uterus. After determining that the balloon had slowed the bleeding, the physicians decided to transport Ms. Calcagno to North Memorial. Ms. Calcagno was transported by helicopter at approximately 11:30 p.m. Her condition deteriorated during the transfer. North Memorial physicians transfused blood to Ms. Calcagno and performed an emergency hysterectomy. Shortly after her arrival, Ms. Calcagno suffered fatal cardiac arrest due to the excessive blood loss.

Respondent filed a complaint against appellant, Buffalo Clinic, and Drs. Emery and Olson alleging that each was "negligent in the care and treatment provided to Claudia Calcagno." Just prior to trial, respondent settled with Drs. Emery and Olson and Buffalo Clinic and all claims against them were dismissed.

Respondent's claims against appellant were tried to a jury in October 2010. The evidence presented at trial established that at 5:50 p.m. on January 18, 2008, a nurse signed the hospital's standing order for a cesarean section, which included an order to "type and screen" Ms. Calcagno's blood and obtain two units of type-specific blood in anticipation of surgery. The type and screen was not performed and two units of A-blood were not obtained. Evidence established that if the type and screen had been performed when ordered, two units of A- blood would have been available by at least8:30 p.m. The evidence also established that there were four units each of A+ and O+ blood in the hospital blood bank, all of which could have been safely transfused to Ms. Calcagno. It was undisputed that the hospital's non-type-specific-blood policy provided that a person with A- blood could receive A+ and O+ blood in an emergency. Respondent also provided evidence that hospital staff failed to comply with appellant's established emergency procedures for obtaining additional blood from other hospitals and the Red Cross.

Dr. Olson testified that he and Dr. Emery believed that no blood was available when they were assessing how to treat Ms. Calcagno. He testified that if they knew blood was available, "our thought process would have been very different and very likely the hysterectomy would have been performed in Monticello." Dr. Olson testified that a hysterectomy will "stop bleeding in all situations." Additionally, Dr. Olson testified that when physicians request or order blood, they expect that hospital staff will deliver it. He stated that lab staff is responsible for informing the physicians of available suitable blood for a patient. Likewise, Dr. Emery testified that she relied on the nurses and lab staff to supply available blood. Dr. Emery asked for "all the trauma blood available" and was told by staff that the hospital had "no blood . . . that [she] [could] give the patient right now."

Respondent's expert witness Dr. Sacher testified that appellant's blood stock did not meet accepted standards of medical practice because appellant did not stock A- blood. Dr. Sacher opined that accepted medical practice would have required Nurse Adams to begin transfusing blood as soon as Dr. Emery ordered it, and stated that if the bloodtransfusions were started before Dr. Emery's arrival at 9:18 p.m., it would have made a difference in Ms. Calcagno's outcome. He also testified that a person with A- blood can receive, in addition to type-specific blood, A+, O+, and O- blood and when asked whether this information is "basic knowledge for any laboratory technologist," he replied, "absolutely." Dr. Sacher opined that, under accepted standards of medical practice, "[i]f a doctor requests all available blood in a situation like this, then it is the blood bank's responsibility to provide compatible blood that is available." He opined that the hospital staff's failures to comply with accepted medical practice and its own type-and-screen and non-type-specific blood policies played a substantial part in bringing about Ms. Calcagno's death, explaining "[t]he blood that was provided by the blood bank and the lack of communication and the lack of following procedures all contributed to too little, too late."

Respondent also presented expert testimony from Dr. Landers. Dr. Landers testified that it is critical for a patient who is hemorrhaging to receive blood as soon as possible. He opined that if the hospital had followed its type-and-screen and emergency blood policies, sufficient blood would have been offered to the physicians, Drs. Emery and Olson would have performed a hysterectomy and Ms. Calcagno would not have died.

The director of the hospital lab testified that lab staff members are expected to understand and follow the hospital policies and procedures, including type-and-screen orders and non-type-specific blood. She also stated that if a physician or nurse asks for all available blood, the lab staff is responsible for communicating all blood that could be used for the patient in accordance with the non-type-specific blood policy.

Appellant presented evidence from an expert witness who testified that Drs. Emery and Olson departed from standards of accepted medical practice by not performing a hysterectomy or other procedures, and that this failure caused Ms. Calcagno's death. Appellant also presented testimony from Nurse Adams and other hospital staff who testified that Drs. Emery and Olson did not request all available blood and Dr. Emery did not order transfusions before 9:30 p.m.

The parties submitted proposed jury instructions. Appellant objected...

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