Healthcare Underwriters Grp., Inc. v. Sanford
Decision Date | 30 March 2022 |
Docket Number | s. 4D20-2023,4D20-2026 |
Citation | 337 So.3d 32 |
Parties | HEALTHCARE UNDERWRITERS GROUP, INC., Amarnath Vedere, M.D., and Cardiology Partners, P.l., Appellants, v. Deborah SANFORD, as Personal Representative of the Estate of Gerald L. Sanford, deceased, Appellee. |
Court | Florida District Court of Appeals |
Mark D. Tinker of Cole, Scott & Kissane, P.A., Tampa, and Adrianna de la Cruz-Munoz of Cole, Scott & Kissane, Plantation, for appellant Healthcare Underwriters Group, Inc.
Mark Hicks and Dinah Stein of Hicks, Porter, Ebenfeld & Stein, P.A., Miami, and Keith J. Puya and Hector R. Buigas of the Law Offices of Keith J. Puya, P.A., Palm Beach Gardens, for appellants Amarnath Vedere, M.D. and Cardiology Partners, P.L.
William Zoeller and Michael Baxter of Schuler, Halvorson, Weisser, Zoeller & Overbeck, P.A., West Palm Beach, and Andrew A. Harris and Grace Mackey Streicher of Harris Appeals, P.A., Palm Beach Gardens, for appellee.
Dr. Amarnath Vedere, Cardiology Partners, P.L., and Healthcare Underwriters Group, Inc. (collectively referred to as "Dr. Vedere") appeal a final judgment following a jury verdict in favor of Plaintiff Deborah Sanford, as personal representative of the Estate of Gerald L. Sanford, in a medical malpractice wrongful death suit. Dr. Vedere raises multiple issues: 1) the trial was tainted by the improper inclusion on the verdict form of a former settling defendant; 2) a new trial is required because of the admission of prejudicial "financial motive" testimony and argument; 3) improper argument regarding the survivor's life expectancy resulted in a grossly excessive award of non-economic damages to decedent's daughter; and 4) the court erred in awarding prejudgment interest on the entire amount of the verdict. We conclude that issues one, two, and four do not merit reversal, but that the closing argument requires a new trial on the issue of the surviving daughter's non-economic damages. We address each issue.
The Estate brought a wrongful death action for medical malpractice against Dr. Vedere and Palm Beach Gardens Medical Center1 ("PBGMC"), alleging that Dr. Vedere negligently performed a percutaneous coronary intervention
(PCI) on the decedent, causing him to go into cardiogenic shock and respiratory arrest, leading to his death a month later. The Estate claimed that PBGMC was responsible for Dr. Vedere's negligence on multiple grounds, including that PBGMC and Dr. Vedere were acting in a joint venture while treating the decedent. PBGMC settled with the Estate and was dismissed by court order prior to trial. The Estate's medical negligence claim against Dr. Vedere proceeded to jury trial.
At trial, evidence revealed that the decedent had heart issues and was seen by a surgeon, who recommended a mitral valve repair. Not wanting surgery, the decedent sought out another cardiologist who concluded that he did not need surgery.
A year later, the decedent sought out the opinion of Dr. Vedere, a board-certified interventional cardiologist, on the mitral valve repair. After several tests, the doctor recommended continued medical therapy.
Nine months later, the decedent returned to Dr. Vedere with complaints of heart palpitations. After conducting several tests, Dr. Vedere recommended performing a right and left diagnostic heart catheterization
. That procedure was performed and revealed severe calcified stenosis and narrowing of the left anterior descending artery, the most dominant and important coronary artery. Because of the high risk for heart attack or death, Dr. Vedere recommended a PCI procedure to open the blockage and implant a stent. A PCI is a nonsurgical intervention (going through a hole in the skin) to open the heart arteries and keep them open. Dr. Vedere anticipated it would be a complex procedure due to the calcification and tortuosity of the artery, but he had performed approximately 5,000 PCIs in a twenty-two-year period. Because of the decedent's age, Dr. Vedere told him that medications would not work to lessen the blockage. The decedent agreed to an elective PCI procedure, and it was scheduled for the following week.
The procedure went ahead as scheduled. Dr. Vedere intended to first insert a guide catheter to open the artery and let tools in, and then use an atherectomy device
to shave off the plaque inside the artery, before opening the artery with a balloon and placing a stent. During the first hour and a half of the PCI procedure, Dr. Vedere made fourteen insertions, removals, and exchanges of guide catheters and wires in an unsuccessful attempt to use the atherectomy device. After the fourteenth attempt, the decedent's blood pressure suddenly dropped, and he went into cardiogenic shock and respiratory arrest.
The decedent was immediately intubated and stabilized by the code team. Dr. Vedere was then able to insert and inflate a balloon to compress fifty to sixty percent of the blockage, but was unable to deploy a stent
due to the calcification. Dr. Vedere called a cardiovascular surgeon, and after conferring with him, resumed the procedure. He then inserted an Impella device (a device that assists with pumping blood in the heart) to stabilize the decedent. Later, the decedent was transported to the ICU where he stayed for several more weeks, remaining intubated and minimally responsive. After his health deteriorated further, his wife and daughter decided to remove him from life-support.
The Estate later filed suit for medical malpractice and wrongful death, claiming the PCI was not medically indicated nor was it properly performed. Dr. Vedere defended contending that the procedure was proper, and that the decedent died of other complications.
During the trial, the Estate's expert, a board-certified cardiologist, testified that the PCI procedure which Dr. Vedere performed was not justified and was below the standard of care, because the decedent was asymptomatic, and his condition was non-life threatening. Specifically, the expert opined that the decedent had no symptoms to improve, and the procedure would not reduce his mortality. According to the Estate's expert, the decedent's palpitations and atrial fibrillation
stemmed from his mitral valve problems and not from the coronary blockage, because the decedent did not have symptoms of coronary artery disease
.
Dr. Vedere disagreed. He and his expert testified that the PCI procedure was medically indicated. They concluded that the mitral valve did not need to be replaced, and coronary bypass
surgery was inappropriate and carried a much higher risk.
As to the standard of care, the Estate's expert testified that he had performed over 2,000 PCI procedures during his career and the greatest number of attempts he had ever made to insert a guide catheter was five. He opined Dr. Vedere may have had trouble inserting the guide catheters because he had failed to notice during the diagnostic heart catheterization
that the decedent had an unusual anatomic feature: he had an absent left main artery and instead had "dual ostia," a bifurcation that causes two small openings as opposed to one large opening from a left main artery, which was highly unusual and would make the insertion of the catheter much more difficult. The expert testified that the prudent thing for Dr. Vedere to have done when he was having trouble inserting the guide catheters was to "stop" and "back off" before "do[ing] more harm than good."
Conversely, Dr. Vedere and his expert testified that the decedent had a short, but not absent, left main artery. They also testified that the number of catheters used in the PCI procedure was not below the standard of care, even if the decedent's anatomy made it more challenging and ultimately led to the unsuccessful advancement of the atherectomy device
and stent.
As for causation, the Estate's expert testified that the cardiogenic shock
and respiratory arrest resulted from Dr. Vedere's use of fourteen catheters, which was excessive under the circumstances and caused an impairment of blood flow. Dr. Vedere and his expert testified that the decedent's coronary artery disease and atrial fibrillation were the cause of death. Dr. Vedere also noted that the sedation was a possible cause.
The Estate advanced a theory that Dr. Vedere's negligent performance stemmed from financial motivation. The Estate contended that Dr. Vedere performed an unnecessary procedure and made multiple attempts to insert the catheters, because he wanted to be able to use a new atherectomy device
on the market, called the Diamondback Orbital 360 which was manufactured by a company called CSI. Dr. Vedere admitted he received compensation from CSI to train technologists on how to use the device, but he did not receive compensation for using the device itself. Only a single payment of $2,000 was ever identified.
On the subject of damages, the Estate's expert testified that, had the decedent survived the procedure, his life expectancy would have been ten years. Near the end of trial, the Estate read the mortality tables for decedent (12.9 years), his surviving wife (21.9 years), and his surviving daughter (59.7 years) into evidence. Dr. Vedere objected and moved to strike the testimony as to the survivors on the basis that it misled the jury because recovery for pain and suffering would be limited to their joint life expectancy with the decedent. The court overruled the objection and ruled that Dr. Vedere could clarify any misconceptions during closing argument. But in closing argument, the Estate's counsel argued to the jury, over objection, that the daughter would have a long life expectancy and the jury should consider how much longer she would live and have time to think about the years she lost with her dad.
Prior to trial, the parties drafted a verdict form. After noticing that the Estate's draft included PBGMC in the caption, defense counsel removed it. The parties agreed on the form except for the language in one question, and defense counsel agreed...
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