Dalbey v. Heartland Reg'l Med. Ctr.
| Decision Date | 06 April 2021 |
| Docket Number | WD 83602 |
| Parties | Roy DALBEY, Appellant, v. HEARTLAND REGIONAL MEDICAL CENTER and Ashok Gokhale, M.D., Respondents. |
| Court | Missouri Court of Appeals |
H. William (Bill) McIntosh, Kansas City for appellant.
Michael Rudd, Kansas City; Jeffrey L. Dunn, Timothy C. Sansone, St. Louis; Brian L. Burge, Jana Von Richards, Overland Park, KS for respondents.
Before Division One: Alok Ahuja, P.J., and Thomas H. Newton and Thomas N. Chapman, JJ.
Roy Dalbey sued Dr. Ashok Gokhale and Heartland Regional Medical Center in the Circuit Court of Buchanan County. Dalbey claimed that he suffered personal injuries as a result of medical negligence by Dr. Gokhale, and that Heartland was vicariously liable for Dr. Gokhale's actions. Following a nine-day trial, a jury returned a verdict in favor of Dr. Gokhale and Heartland. Dalbey appeals. We affirm.
In the early morning on November 6, 2011, Roy Dalbey arrived at Heartland's Emergency Department in St. Joseph, accompanied by his roommate, David Rosenbaum, and a neighbor, Kathy Hoffman. Rosenbaum had found Dalbey unconscious and unresponsive in the bathroom of their apartment. Dalbey regained some level of consciousness five to twenty minutes after Rosenbaum found him. Hoffman and Rosenbaum drove Dalbey to the hospital.
A critical question – and perhaps the critical question – in this case is what Heartland staff were told about Dalbey's condition during his November 6, 2011 hospital visit. Dalbey's medical records indicate that he told the emergency room triage nurse that he had passed out after vomiting up blood approximately half-an-hour earlier (around 2:30 a.m.). Dalbey stated that he had drank some alcohol earlier that night. One of his friends told the nurse that when they found him, Dalbey had "fixed pupils" and had been briefly unresponsive. The triage nurse did not note any abnormalities based on her initial physical examination. The medical records indicate that Dalbey was alert and oriented with no signs of acute distress. Dalbey reported to the nurse that he was not in any pain, and in fact reported a pain level of zero out of ten.
Dr. Gokhale was working in Heartland's Emergency Department when Dalbey arrived. Dr. Gokhale examined Dalbey. According to Dr. Gokhale's notes, Dalbey complained of nausea and a decreased appetite, and stated that he had vomited blood. Dr. Gokhale found Dalbey to be neurologically normal – he was alert, fully oriented, and lucid, was able to carry on a normal conversation, and did not slur his speech. Dr. Gokhale concluded that Dalbey had "almost certainly" fainted as the result of a vasovagal episode, triggered when he saw his own blood after vomiting. Dr. Gokhale ordered numerous tests related to gastrointestinal bleeds
, as well as an electrocardiogram (or "EKG") that would look for potential cardiac issues. Dr. Gokhale diagnosed Dalbey with gastritis versus peptic ulcer disease. He prescribed Prilosec, a medication used to decrease gastric acid secretion. Dalbey was discharged with literature relating to gastrointestinal bleeds, and with the recommendation that he obtain a follow-up endoscopy.
When he was discharged, the medical record indicates that Dalbey was ambulatory and was discharged walking (rather than assisted in a wheelchair) to a private vehicle, accompanied by his friends.
Although we view the evidence in the light most favorable to the jury's verdict in favor of Dr. Gokhale and Heartland, we note that Dalbey's companions, Rosenbaum and Hoffman, provided radically different testimony concerning how Dalbey presented at the hospital, and what they and Dalbey told Heartland personnel on the morning of November 6, 2011. While we presume under our standard of review that the jury disbelieved this testimony, it provides important background to the issues Dalbey raises on appeal.
According to Rosenbaum and Hoffman, Dalbey needed their physical assistance both to enter and to leave the Heartland Emergency Department. They testified that Dalbey could not remember what had happened earlier that night, his speech was slurred, and he had difficulty communicating with Heartland staff. Rosenbaum and Hoffman claimed that they told the triage nurse that Dalbey had lost bowel and bladder control during his syncopal episode. They testified that they told both the triage nurse and Dr. Gokhale that Dalbey had complained of severe headaches, and that Dalbey stated that his headache was so severe that he "felt like his head was going to blow off," and that it was a ten out of ten on a pain scale. Hoffman testified that she told a nurse that Dalbey needed to have his head X-rayed. In addition, Hoffman and Rosenbaum claimed that they, and Dalbey, all asked Dr. Gokhale to order an X-ray or computerized tomography
(or "CT") of Dalbey's head. They testified that their requests were "blown off," and that Dr. Gokhale concluded that an X-ray or CT scan was unnecessary. None of the circumstances and events which Rosenbaum and Hoffman described were documented in Dalbey's medical records, or corroborated by the testimony of Heartland personnel.
In the early morning hours of December 2, 2011, less than one month later, Dalbey again arrived at Heartland's Emergency Department, this time by ambulance. Rosenbaum testified that he had noticed Dalbey acting strangely in the bathroom of their apartment, scrubbing the sink with no running water, and that Dalbey had said he had a "tremendous horrible headache." Rosenbaum called 9-1-1 when he observed that Dalbey could not move his left side.
Dalbey presented at Heartland's Emergency Department with an "altered mental status," was confused and had decreased responsiveness. Emergency medical personnel reported to Heartland staff that Dalbey's family had found him on the floor in the bathroom confused and disoriented about one hour prior to arriving at the hospital, and that when emergency personnel arrived at his home, Dalbey was unresponsive. While the Emergency Department nurse was conducting her initial examination, Dalbey began experiencing an active seizure.
Dr. Gokhale was again on duty in the emergency room. He ordered a non-contrast CT scan
. The CT scan indicated an intracerebral hemorrhage with acute subarachnoid hemorrhage as well as intraventricular hemorrhage, possibly from a ruptured intracranial aneurysm. At approximately 3:13 a.m., Dr. Gokhale consulted with the on-call neurosurgeon at Heartland. The neurosurgeon recommended that Dalbey be transferred to another hospital because Heartland could not treat the massive brain hemorrhage which the CT scan indicated Dalbey had suffered. At approximately 3:33 a.m., Dr. Gokhale contacted the on-call neurosurgeon at the University of Kansas Medical Center, and established plans to transfer Dalbey there for further treatment. Dalbey was life-flighted to the University of Kansas Medical Center at approximately 3:45 a.m.
Dalbey's medical treatment revealed that he had an aneurysm
in his right pericollosal artery, which had ruptured on the night of December 1-2, 2011. Dalbey suffered intraparenchymal hemorrhage (bleeding in the brain ), as well as subarachnoid bleeding (blood leaking into the fluid surrounding the brain). As a result, Dalbey suffered substantial and permanent brain damage leading to lasting disability, and requires substantial on-going care and treatment.
Dalbey originally filed suit against Heartland and Dr. Gokhale in the circuit court on November 5, 2013. That case was voluntarily dismissed in April 2015, and Dalbey then filed the present lawsuit on August 19, 2015. Dr. Gokhale passed away in 2016, and his widow Rhonda Gokhale was substituted as defendant ad litem. Dr. Gokhale's testimony was presented to the jury in the form of his videotaped deposition, which was taken in October 2015.
A nine-day jury trial began on September 30, 2019. Although Dalbey had alleged in his pleadings that Dr. Gokhale was negligent in multiple respects, he submitted only a single claim to the jury: that Dr. Gokhale was negligent for failing to order a CT scan
of Dalbey's head when Dalbey first visited Heartland's emergency room on November 6, 2011. Dalbey contended that, if a CT scan had been ordered at that time, it would have revealed his brain aneurysm, and/or a small "sentinel bleed" from the aneurysm which was a harbinger of its later rupture. Dalbey claimed that the findings of a CT scan would have led to further medical treatment before the aneurysm ruptured, and would have prevented him from suffering massive hemorrhaging and brain damage on December 1-2, 2011. Dalbey submitted a claim of liability against Heartland based solely on its vicarious liability for Dr. Gokhale's negligence.
The defense presented expert testimony indicating that the aneurysm rupture
on December 2 was an acute event, which was not preceded by a sentinel leak or bleed. Defense expert Dr. Franz Wippold emphasized that the most common presentation for aneurysm or sentinel leak is an intense or "thunderclap" headache, which was not documented in the records of Dalbey's November 6, 2011 hospital visit. Dr. Fernando Goldenberg, a neurocritical care specialist, testified for the defense that Dalbey's presentation on November 6 (with a history of syncope and vomiting blood, a normal neurological examination, and no report of pain) was not consistent with a subarachnoid hemorrhage.
The jury returned a verdict in favor of Dr. Gokhale and Heartland. The circuit court entered judgment for defendants on October 23, 2019, and overruled Dalbey's motion for a new trial on February 18, 2020.
Dalbey appeals.
Dalbey raises four Points on appeal. In Points I and II, he argues that the circuit court erred in quashing a trial subpoena duces tecum which he had served on Heartland, and by "preemptively denying" Dalbey's effort to serve a trial subpoena on Heartland's Risk Manager and corporate representative. In Point III, Dalbey argues that the...
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