Nacapuy v. Dacanay, No. 26836 (Hawaii 4/29/2008)
| Decision Date | 29 April 2008 |
| Docket Number | No. 26836.,26836. |
| Court | Hawaii Supreme Court |
| Parties | NATTIE NACAPUY and ADOLFO NACAPUY, Plaintiffs-Appellants, v. SAMUEL DACANAY, M.D.; CARDIOLOGY ASSOCIATES, INC., and ATSUSHI JIM TERAKUBO, M.D., Defendants-Appellees, and SCIMED LIFE SYSTEMS, INC.; BOSTON SCIENTIFIC CORPORATION, a Delaware corporation; BRETT BREDEN; LAKE REGION MANUFACTURING, INC.; JOHN DOES 1-10; JANE DOES 1-10; DOE CORPORATIONS 2-10; DOE PARTNERSHIPS 1-10; and DOE GOVERNMENTAL ENTITIES 1-10, Defendants. (CIV. NOS. 01-1-1009 and 01-1-2080) NATTIE SALES NACAPUY and ADOLFO RAMIREZ NACAPU Plaintiffs-Appellants, v. CARDIOLOGY ASSOCIATES, INC.; SAMUEL DACANAY, M.D., and ATSUSHI JIM TERAKUBO, M.D., Defendants-Appellees, and ST. FRANCIS MEDICAL CENTER; JOHN DOES 1-10; JANE DOES 1-10; DOE CORPORATIONS 1-10; DOE PARTNERSHIPS 1-10; and DOE ENTITIES 1-10, Defendants, and ST. FRANCIS MEDICAL CENTER, Third-Party Plaintiff, v. BOSTON SCIENTIFIC CORPORATION; SCIMED BUSINESS; SCIMED LIFE SYSTEMS, INC.; BOSTON SCIENTIFIC CORPORATION; JOHN DOES 1-50; JANE DOES 1-50; DOE PARTNERSHIPS 1-50; DOE "NON-PROFIT" CORPORATIONS 1-50; and DOE CORPORATIONS 1-50, Third-Party Defendants. (CIV. NO. 01-1-2080) |
APPEALS FROM THE FIRST CIRCUIT COURT (CIV. NOS. 01-1-1009 and 01-1-2080;).
On the briefs:
Ronald G.S. Au, and Ryan G.S. Au for plaintiffs-appellants, Nattie Nacapuy and Adolfo Nacapuy.
John S. Nishimoto and Steven L. Goto of Ayabe, Chong, Nishimoto, Sia & Nakamura for defendants-appellees Cardiology Associates, Inc. and Dr. Atsushi Jim Terakubo.
Thomas E. Cook and Bradford F.K. Bliss of Lyons, Brandt, Cook & Hiramatsu for defendant-appellee, Dr. Samuel Dacanay.
Plaintiffs-Appellants, Nattie Nacapuy ("Mrs. Nacapuy") and Adolfo Nacapuy (collectively referred to as "the Nacapuys"), appeal from the first circuit court's1 August 24, 2004 judgment in favor of all defendants, Cardiology Associates, Inc. ("Cardiology Associates"), Samuel Dacanay, M.D. ("Dr Dacanay" and Atsushi Jim Terakubo, M.D. ("D Terakubo").
Two cases, which have been consolidated, arose after Mrs. Nacapuy underwent a percutaneous transluminal coronary angioplasty ("angioplast") with stent procedure at St. Francis Medical Center that was followed by rapid restenosis and a bypass operation six weeks later. The Nacapuy complaint against St. Francis Medical Center, Dr. Terakubo, and Dr. Dacanay asserted, inter alia, claims of negligence and lack of informed consent. This case was consolidated with a gproducts liability case (Civil No. 01-1-1009) in which the Nacapuys filed a complaint against the manufacturer and distributors of a medical instrument that fractured during the angioplasty. The claims against the defendants of the products liability case and St. Francis Medical Center were dismissed by stipulation of the parties. The claims against Dr. Dacanay and Dr. Terakubo were resolved in their favor by summary judgment and jury verdict.
On appeal, the Nacapuys argue that: (1) the circuit court erred by granting Dr. Dacanay and Dr. Terakubo's motion for summary judgment on the issue of informed consent where (a) Dr. Dacanay retained control over Mrs. Nacapuy's procedure, (b) Mrs. Nacapuy would not have undergone the angioplasty with stent procedure if she was aware of its risks and the alternative bypass operation, and (c) Mrs. Nacapuy did not provide her informed consent for her reballooning procedure; (2) the circuit court erred by precluding any evidence on the issue of informed consent for the reballooning procedure against Dr. Dacanay based on its prior summary judgment ruling on informed consent, inasmuch as the Nacapuys had not previously claimed that Dr. Dacanay failed to obtain informed consent for the reballooning procedure; (3) the circuit court erred by precluding evidence of the Instruction Booklet of the Trooper Floppy Guide Wire ("package insert") where the Nacapuys offered it in conjunction with their expert witness, Dr. Stephen Hubbard ("Dr. Hubbard"), who was prepared to testify that it was relevant to the medical standard of care; (4) the circuit court erred by allowing Dr. Robert Chesne ("Dr. Chesne") to testify on a new opinion that he had not previously disclosed through discovery; (5) the circuit court erred by denying the Nacapuys' motion for partial summary judgment on the matter of res ipsa loquitur regarding Dr. Terakubo fracturing the guide wire during the angioplasty with stent procedure because the three elements of this doctrine were met; and (6) the circuit court erred by denying the Nacapuys' jury instructions on negligence and thereby requiring expert testimony to establish the medical standard of care, even though the removal of the guide wire was within the jury's "common knowledge."
Based upon the following analysis, we vacate the circuit court's August 24, 2004 judgment and remand the case for a new trial.
On June 13, 2000, Mrs. Nacapuy, who was at the time, fifty-nine-years old with a several day history of chest pain, was recommended for admission to St. Francis Medical Center by her physician, Furtonato Elizaga, M.D., after her twelve-lead electrocardiogram (EKG) showed anterior ischemic changes. Mrs. Nacapuy was admitted to St. Francis Medical Center under the care of Dr. Dacanay.
On June 15, 2000, Dr. Dacanay performed several diagnostic tests on Mrs. Nacapuy including an angiogram,2 a medical imaging technique that takes x-rays of blood vessels. Mrs. Nacapuy's angiogram indicated "blockage in the left anterior descending artery" and "single-vessel coronary disease with highgrade proximal stenosis."
Dr. Dacanay believed that Mrs. Nacapuy was stable on medications but that she needed to undergo an angioplasty with stent procedure to unclog and open up her narrowed heart artery. "In a[n angioplasty with stent] procedure, a guide wire is advanced from the groin area to the left anterior descending artery, where the artery is narrowed or clogged by plaque and the stent is deployed with a balloon to open the narrowed artery."3
Because Dr. Dacanay was unavailable to perform the procedure and he believed that Mrs. Nacapuy required an angioplasty with stent procedure as soon as possible, he asked Dr. Terakubo to perform Mrs. Nacapuy's angioplasty with stent procedure on the following day, June 16, 2000. On the morning of June 16, 2000, Dr. Terakubo met with Mrs. Nacapuy and, according to Mrs. Nacapuy, Dr. Terakubo told her Mrs. Nacapuy claims that Dr. Terakubo did not further explain the procedure. However, Dr. Terakubo claims that during this meeting, he advised Mrs. Nacapuy of the attendant risks and complications associated with the procedure and of the treatment alternatives. It is undisputed that Mrs. Nacapuy signed a written informed consent for the angioplasty with stent procedure which included the following clause: "I recognize that, during the course of the operation, post operative care, medical treatment, anesthesia, or other procedure, unforeseen conditions may necessitate my above-named physician and his or her assistants, to perform such surgical or other procedures as are necessary to preserve my life or bodily functions."
At around 5:10 p.m. on June 16, 2000, Dr. Terakubo performed the angioplasty with stent procedure using the Boston Scientific Floppy guide wire and its new NIR Royal stent. Brandon Shibuya, a catheter technologist, Wes Ige, a technician, and nurse Karen Keala, R.N., assisted Dr. Terakubo. This was the first time Dr. Terakubo used the NIR Royal stent, however, he testified that it is "the next generation stent of the NIR stent," and that he used it because he is "very familiar with this particular brand and type of stent."
To begin the procedure, Dr. Terakubo made a small incision in the patient's right groin, using a femoral sheath (an approximately five inch plastic tube which allows access to the arteries) to maintain the opening at the artery and skin. He then inserted a guide catheter up to the left anterior descending artery, followed by the guide wire. While Dr. Terakubo advanced the catheter and wire to Mrs. Nacapuy's area of the blockage, he used the flouroscope, a tool that helped him see what was happening in her body to ensure that they moved in the right direction. After the guide wire and the guide catheter were in place, Dr. Terakubo pushed a balloon catheter over the guide wire until it reached the area of the artery to be repaired. Once at the site of the blockage, the deflated balloon was slowly inflated to compress plaque in the artery up against the sides and open up the artery. During the inflation of the stent and balloon, Dr. Terakubo took thirty-two pictures of the procedure. He thereafter deflated and withdrew the balloon.
As Dr. Terakubo subsequently withdrew the guide wire, he did not use a fluoroscope because "[i]t's standard procedures [sic] we don't look when we withdraw the wire." He testified that he felt He testified that he did not turn the fluoroscope on after he felt resistance in the pull because he
pay[s] attention to little detail about the patient conditions. There's a monitor to monitor the blood pressures, heart rate. There was live E.K.G. The patient was right next to me. She was in sound condition. Patient was hemodynamically stable, is not [sic] complain about any chest discomfort. There's no E.K.G changes. I didn't have any issue that suspect something was going on.
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