Martin v. East Jefferson General Hosp.

• Decision Date: 21 June 1991
• Docket Number: No. 91-C-0393,91-C-0393
• Citation: 582 So.2d 1272
• Parties: Georgia Wells Martin, Wife of, and Roger MARTIN v. EAST JEFFERSON GENERAL HOSPITAL, Employees of East Jefferson General Hospital, Saeed Ahmed, M.D., and Jesse James Wells, Sr., and Other Joint Tortfeasors and Health Care Providers.
• Court: Louisiana Supreme Court

Page 1272

582 So.2d 1272

Georgia Wells Martin, Wife of, and Roger MARTIN v. EAST JEFFERSON GENERAL HOSPITAL, Employees of East Jefferson General Hospital, Saeed Ahmed, M.D., and Jesse James Wells, Sr., and Other Joint Tortfeasors and Health Care Providers.

No. 91-C-0393.

Supreme Court of Louisiana.

June 21, 1991.

Russ M. Herman, Mark B. Wolfe, John B. Loweb, Charles O. Taylor, Herman, Herman, Katz & Cotlar, New Orleans, for plaintiff-applicant.

Steven A. Adams, Carruth, Cooper and Adams, Baton Rouge, Edward Rice, Adams & Reese, New Orleans, for defendant-respondent.

CALOGERO, Chief Justice.

A writ was granted in this medical malpractice action to determine whether the court of appeal, which reversed the district court's judgment in favor of the plaintiff, afforded the proper deference to the district court's findings of fact.

This action arose out of the death of a twenty-one year old woman named Joyce ¹ Marie Wells. The immediate cause of her death was cardiac arrest due to myocarditis, an inflammation of the muscular wall of the heart. Ms. Wells' mother, Georgia Wells Martin, brought this lawsuit against the treating physician, Dr. Saeed Ahmed, and several other health care providers, contending that Dr. Ahmed's treatment of Ms. Wells fell below the standard of care ordinarily practiced by doctors of internal medicine. The plaintiff claimed that the myocarditis was likely the result of undiagnosed systemic lupus erythematosus (lupus), a collagen vascular disease which can be treated with steroid drugs. Dr. Ahmed defended on the theory that the myocarditis was caused by a viral infection, which is an untreatable condition.

After a bench trial, the district court entered judgment in favor of the plaintiff in the amount of $150,000.00, later clarifying the judgment to assess $100,000.00 against Dr. Ahmed and $50,000 against the Commissioner of Insurance and the Louisiana Patient's Compensation Fund. In written reasons for judgment, the district judge determined that Ms. Wells probably had lupus, and that the doctor's failure to rule out lupus as the cause of Ms. Wells' chronic illness lessened the patient's chances of survival. Both the doctor and the Fund appealed the judgment to the court of appeal.

The court of appeal reversed, holding that the plaintiff "failed to show by a preponderance of the evidence that, more probably than not, her chances of survival were reduced by defendant's failure to rule out lupus as a possible cause of her last illness." Martin v. East Jefferson General Hospital, 571 So.2d 895, 897 (La.App. 5th Cir.1990). The court of appeal stated that the district judge erred as a matter of law because, in its view, the record did not support a finding that the doctor's treatment, even if it fell below the standard of care, was more likely than not a cause of the patient's death. The court of appeal concluded that "on the evidence presented it is equally plausible that the death resulted from a viral infection as diagnosed by Dr. Ahmed, as it is that she died of complications of lupus." 571 So.2d at 897.

The court of appeal thus reversed the district court upon determining that the plaintiff failed to prove causation. After reviewing the record, we conclude that the court of appeal improperly substituted its own factual findings for that of the district court, thereby misapplying the manifest error/clearly wrong standard of review. Accordingly, we reverse the judgment of the court of appeal and reinstate the judgment of the district court.

The facts of this case show that Ms. Wells was a twenty-one year old woman who prior to the following events had no medical history of chronic illness. On August 18, 1980, she experienced severe pelvic and abdominal pain and was taken to the emergency room of East Jefferson General Hospital where she was treated and released. Five weeks later, on September 24, 1980, Ms. Wells returned to the emergency room suffering from abdominal discomfort, vomiting, neck pains, lethargy, and a red, itchy rash on her arms and thighs. The emergency room physician diagnosed "viral illness," prescribed aspirin, pain and nausea medication, and released Ms. Wells to return home.

Four days later, on September 28, 1980, Ms. Wells had one, possibly two, grand mal seizures and was again brought to the East Jefferson emergency room. She was found to have fever, lethargy, headache and was "hot to the touch." The emergency room physician made a preliminary diagnosis of viral encephalitis. Ms. Wells was referred by the emergency room to Dr. Saeed Ahmed, the defendant. Dr. Ahmed practiced internal medicine and nephrology but was not board certified in either specialty. He saw Ms. Wells after she had been stabilized, and admitted her to East Jefferson General Hospital. Dr. Ahmed did not obtain a complete medical, social and family history at the time of Ms. Wells' admission, nor at any time during her initial five day stay at the hospital. Dr. Ahmed also failed to review Ms. Wells' records from her August 18th and September 24th visits to East Jefferson General Hospital. Based on her symptoms and her lab tests, Dr. Ahmed concluded that Ms. Wells was suffering from either viral encephalitis or viral meningitis. He prescribed Vibramycin, an antibiotic.

Although Ms. Wells had never before suffered from grand mal seizures, Dr. Ahmed did not consult with a neurologist to investigate the cause of the seizures. Additionally, when Dr. Ahmed received Ms. Wells' lab studies on admission, he failed to repeat any of these tests even though the results revealed significantly elevated levels in the liver and heart enzymes, spinal fluids, blood tests, urinalysis and chemistry profile. The one abnormal study Dr. Ahmed repeated was the EKG showing a first degree AV (atrial ventricular) block. Ms. Wells' subsequent EKG showed a tachycardia (rapid pulse rate) of 135.

During this initial hospitalization, Ms. Wells again broke out in a generalized rash, which Dr. Ahmed assumed to be an adverse reaction to the Vibramycin. Dr. Ahmed did no further investigation or consultation to determine if the rash was related to the one Ms. Wells had when seen at the emergency room on September 24, 1980. Dr. Ahmed replaced the Vibramycin with Erythromycin, and gave Ms. Wells Calamine lotion and Benadryl for the rash.

On October 2, 1980, Ms. Wells was released from the hospital, although the only lab results Dr. Ahmed had were abnormal. She returned to Dr. Ahmed's office the next day complaining that the rash had gotten worse. Dr. Ahmed gave Ms. Wells an injection of Benadryl and increased her dosage of Benadryl capsules. Dr. Ahmed noted that Ms. Wells had a swollen face and a swollen lymph node behind her ear, but ordered no further lab studies. Ms. Wells again returned to Dr. Ahmed on October 5th, 6th, 13th and 27th. On none of these visits did Dr. Ahmed choose to rerun any of the laboratory studies, which had earlier shown abnormal results, to determine the cause of Ms. Wells' illness.

On October 5, 1980, when Ms. Wells returned to the East Jefferson Hospital because the rash had still not gotten any better, she was seen by a doctor in the emergency room who started her on high doses of Prednisone, a steroid (which is used to treat lupus). When Ms. Wells saw Dr. Ahmed in his office the next day, October 6, 1980, she was feeling some relief from her symptoms, so Dr. Ahmed continued her on Prednisone and Benadryl. From October 6th through November 7th, 1980, Ms. Wells was treated with steroids and she showed improvement.

On November 10, 1980, after Dr. Ahmed had discontinued the steroids, Ms. Wells returned to the doctor with complaints of chest pain. Dr. Ahmed testified that he had discontinued the steroids because, in his opinion, Ms. Wells was in no apparent need of the drug. Despite the chest pain, Dr. Ahmed ran no EKG or any other lab studies, but instead continued her on Benadryl. Two days later, on November 12, 1980, Ms. Wells returned to Dr. Ahmed's office and saw his associate because Dr. Ahmed was not in the office. The associate noted his impression of Ms. Wells' condition to be "collagen vascular disease Lupus E," and spoke to Dr. Ahmed on the phone about Ms. Wells. Although Dr. Ahmed still chose not to rerun any lab tests or EKG's, the associate doctor ran a complete blood count and instructed Ms. Wells to return the next day.

When Ms. Wells returned on November 13, 1980, Dr. Ahmed decided that she still had a viral infection and again started her on Vibramycin, the antibiotic that Dr. Ahmed had previously considered to be the cause of Ms. Wells' rash. ² Although Ms. Wells' condition on that day was characterized by labored breathing, lethargy and chest pains, Dr. Ahmed sent her home without running any tests. That same afternoon, Ms. Wells' condition became so severe that her mother contacted Dr. Ahmed. Dr. Ahmed admitted Ms. Wells to the hospital, whereupon her lab tests showed abnormally high results. In addition, Ms. Wells had fever, severe chest pain, tender abdomen, and an enlarged liver. Her heart was enlarged and was surrounded by fluid. The lab values taken upon her admission to the hospital indicated severe organ failure and tissue death.

Dr. Ahmed again prescribed Vibramycin without checking her medical record, and failed to reorder the steroid drug, Prednisone, even though he noted the possibility of collagen vascular disease on the physician's physical examination sheet. Dr. Ahmed did not come to the hospital that evening of November 13th to assess Ms. Wells' condition for himself. When Dr. Ahmed arrived at the hospital the next day, November 14, 1980, Ms. Wells' condition had worsened to such an extent that Dr. Ahmed was forced to consult with a cardiologist. The cardiologist ordered tests for lupus ³, and strongly recommended the institution of steroid therapy because he suspected collagen vascular disease.

Although the cardiologist recommended steroid treatment...