Koelling v. Mercy Hosps. E. Cmtys.
| Decision Date | 21 August 2018 |
| Docket Number | No. ED 105839,ED 105839 |
| Citation | 558 S.W.3d 543 |
| Parties | Joan KOELLING, Appellant, v. MERCY HOSPITALS EAST COMMUNITIES d/b/a Mercy Hospital Washington, Mercy Clinic Surgical Specialists LLC, Thomas B. Riechers, M.D. and Mercy Clinic East Communities, Respondents. |
| Court | Missouri Court of Appeals |
558 S.W.3d 543
Joan KOELLING, Appellant,
v.
MERCY HOSPITALS EAST COMMUNITIES d/b/a Mercy Hospital Washington, Mercy Clinic Surgical Specialists LLC, Thomas B. Riechers, M.D. and Mercy Clinic East Communities, Respondents.
No. ED 105839
Missouri Court of Appeals, Eastern District, DIVISION TWO.
FILED: August 21, 2018
ATTORNEY FOR APPELLANT: Gregory G. Fenlon, David Alan Perney, Co-Counsel, 601 S. Lindberg, St. Louis, MO 63131, BURTON NEWMAN P.C.
ATTORNEY FOR RESPONDENT: Philip Louis Willman, David Martin Perron, Co-Counsel, Teresa Michelle Young, Co-Counsel, 800 Market Street, Suite 1100, St. Louis, MO 63101, BROWN & JAMES, P.C.
OPINION
Honorable Mary K. Hoff
Joan Koelling ("Koelling") appeals from the Judgment following a jury verdict in favor of Mercy Hospitals East Communities d/b/a Mercy Hospital Washington, Mercy Clinic Surgical Specialists, L.L.C., Mercy Clinic East Communities (collectively, "Mercy"), and Thomas B. Riechers, M.D. ("Dr. Riechers") on her medical malpractice claims against Mercy and Dr. Riechers. We reverse and remand.
Statement of Facts
On February 10, 2012, Koelling presented to Dr. Riechers complaining of pain in her left lower abdomen. Upon examination, Dr. Riechers believed that Koelling’s pain was likely caused either by adhesions—the adherence of inflamed bowels causing scarring—or
by diverticulitis—an inflammatory condition whereby diverticula, or outpouchings of the colon that occur when blood vessels penetrate the muscle of the colon wall, become infected. Dr. Riechers ordered a CAT scan to investigate the cause of Koelling’s pain and to determine whether a sigmoid colectomy, the removal of the sigmoid colon, should be considered.
On April 20, 2012, Koelling returned to Dr. Riechers for reassessment, and they reviewed the results of the CAT scan. The results showed that Koelling had diverticulosis, an underlying condition that predisposes an individual to diverticulitis. To more concretely determine the cause of Koelling’s pain and correct it, Dr. Riechers developed a plan for exploratory surgery. Dr. Riechers informed Koelling of the risks associated with such a surgery, including the possibility that a second surgery might be required to correct any occurrence of fascial dehiscence.1 Koelling elected to undergo the procedure.
On June 5, 2012, Dr. Riechers performed the surgery on Koelling, discovering extensive abdominal adhesions, adhesions between her right ovary and cecum, and adhesions to her sigmoid colon. Dr. Riechers treated these conditions by separating the abdominal adhesions and removing Koelling’s right ovary and her sigmoid colon. After the surgery, Koelling remained at the hospital for two days, and Dr. Riechers discharged her after her condition improved.
On June 27, 2012, however, Koelling returned to Dr. Riechers after having developed a cough and increased abdominal pain. Dr. Riechers ordered a blood test, which was negative for infection, and Koelling requested a CAT scan. Dr. Riechers refused the CAT scan, explaining to Koelling that there was no reason yet, based upon the clinical findings, to pursue one. Dr. Riechers noted that, instead, he would wait to receive laboratory findings, and if they showed an intraabdominal or intra-pelvic problem, he would then order a scan. Dr. Riechers observed no clinical indications of fascial dehiscence.
On July 2, 2012, Koelling returned to Dr. Riechers to report that her cough had not resolved, that she continued to feel abdominal pain, and that she now experienced a "feeling that things are falling out near [her] rectum." Dr. Riechers conducted abdominal and rectal examinations, finding that Koelling’s incision looked normal and showed no signs of infection. Dr. Riechers believed that Koelling’s pain could be due to pelvic relaxation whereby, due to weakened pelvic muscles, the bladder falls when abdominal muscles are tightened, such as during a cough. Dr. Riechers again found no indication that Koelling developed a fascial dehiscence and ordered no CAT scan.
On July 11, 2012, Dr. Riechers saw Koelling once more, who reported continuing abdominal pain and a sensation of her bladder "falling." Dr. Riechers performed abdominal and rectal examinations, which still showed that the incision was healing normally, and he found no clinical indication of fascial dehiscence. Thus, Dr. Riechers again determined that a CAT scan was unnecessary.
Thereafter, Koelling’s condition began worsening, and on July 18, 2012, Koelling presented to the Mercy Hospital Washington Emergency Room where a CAT scan was undertaken before she was, ultimately, sent home.
By July 20, 2012, Koelling’s condition had so deteriorated that she was in great discomfort and was not coherent, and she presented to the emergency room at Missouri Baptist Hospital where Dr. Omar Guerra ("Dr. Guerra") undertook her care. Upon reviewing the results of a CAT scan taken that evening, Dr. Guerra found that Koelling had a perforated intestine, low blood pressure, sepsis, and fascial dehiscence. Dr. Guerra performed an emergency operation, stitching the perforated areas before transferring Koelling to intensive care.
Dr. Guerra treated Koelling through the date of trial, which entailed a second surgery on July 21, 2012 to correct certain repairs that had not held, a third surgery three months later, and a diagnosis of fascial dehiscence. Koelling was eventually discharged on August 22, 2012, but required assistance for activities like eating and ambulating, and she continued to feel pain through trial.
On June 13, 2014, Koelling filed her petition alleging medical malpractice against Mercy and Dr. Riechers. On March 6, 2017, Mercy and Dr. Riechers disclosed their intent to call Dr. Kurt Kralovich ("Dr. Kralovich") to testify as to, inter alia , the applicable standard of care. Dr. Kralovich was deposed on April 3, 2017, and he testified that the standard of care did not require Dr. Riechers to perform an abdominal CAT scan to investigate Koelling’s symptoms on July 2, 2012. He explained that a physical examination was a more appropriate "first-line test for detecting ... a fascial dehiscence" because a CAT scan with IV contrast exposes patients to risks of anaphylaxis, renal failure, and radiation. Likewise, Dr. Kralovich testified that the standard of care did not require Dr. Riechers to order a CAT scan on July 11, 2012 because Koelling’s "vague or persistent" symptoms were reported only five weeks from surgery. Dr. Kralovich explained that, without more, such as an accompanying fever, Koelling’s complaints did not "create a scenario where there is a complication from the surgery that you would go in and repair."
During cross-examination of Dr. Kralovich’s deposition testimony, Koelling’s counsel asked Dr. Kralovich several questions about his involvement as a defendant in prior medical malpractice cases. On that subject, the following exchange occurred:
Q. How many times have you been a defendant in a case?
A. I've been named in a suit, I would estimate, 10 to 12 times.
Q. How did that make you feel being named that many times?
...
A. Like any human being, there are a variety of emotions that come with being sued, from frustration, to sadness, to anger. It’s not a pleasant feeling for anyone.
Q. And did that make you angry toward medical malpractice cases?
A. I guess at times you have feelings toward the system, if you will ... When you are named in a lawsuit, obviously it is someone saying something bad about you. It hurts your feelings and makes you feel bad. If you don't think you did anything wrong, I think humans tend to initially become somewhat defensive.
Q. And that made you feel badly about the system itself; correct?
A. I believe it can at times.
Q. For you; correct?...
A. I think at times you feel if there was a different way to resolve things.
Q. In the 10 to 12 times you were sued twice for common duct injuries; correct?
A. I have been named twice for common duct injuries.
Q. And in this case, the Deidre Gray-Taylor case, there was a verdict against you; correct?
A. There was.
Q. Did that also make you angry against the system?
A. That one, I'd say initially you're angered. Initially you're frustrated, then there is eventually an acceptance.
Q. Did you think it was fair?
A. To this day I do not believe that that was an appropriate conclusion.
Q. And did that make you then mad at the system?
...
A. After an initial sort of emotion that every human has, I think everyone comes to realize that there has to be a set of rules, that no rules are perfect, and that we have to be a nation of laws, and we follow the laws, and if I have a problem, it’s my job to make the laws better. I don't think you have long, deep-seated anger against the society we all live in.
Q. But you were angry at the system and wanted to change it; right?
A. I thought that there is—I think that there is an initial anger that’s a human response. I think then logic takes over. I don't have a grudge, a bias, or longstanding change. I'm not going to be a judicial activist. I've gotten over it. Brian Kean and I sit next to each other at our daughters' hockey games now. We can speak cordially. It’s not something that affects my objectivity.
Q. Since that date of this verdict, or since 2013, have you ever
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