Pfiffner v. Correa

• Decision Date: 17 October 1994
• Parties: 94-0924 La
• Court: Louisiana Supreme Court

Page 1228

643 So.2d 1228

94-0924 La. 10/17/94, 94-0963 La. 10/17/94,

94-0992 La. 10/17/94

Yevon M. PFIFFNER, et al. v. Amilcar J.E. CORREA, M.D., et al.

Nos. 94-C-0924, 94-C-0963, and 94-C-0992.

Supreme Court of Louisiana.

Oct. 17, 1994.

Rehearing Denied Dec. 8, 1994.

Edward J. Rice, Jr., L. Thomas Styron, Arthur F. Hickham, Jr., Adams & Reese, New Orleans, for applicant (94-C-0924).

Stewart E. Niles, Jr., Bruce J. Toppin, Patricia A. Bethancourt, Jones, Walker, Waechter, Poitevent, Carrere & Denegre, New Orleans, for respondent (94-C-0924).

Bruce J. Toppin, Jones, Walker, Waechter, Poitevent, Carrere & Denegre, New Orleans, for applicant (94-C-0963).

Darryl J. Tschirn, Metairie, Jones, Walker, Waechter, Poitevent, Carrere & Denegre, Stewart E. Niles, Patricia Bethancourt, Adams & Reese, Edward J. Rice, Jr., L. Thomas Styron, Arthur F. Hickham, Jr., New Orleans, for respondent (94-C-0963).

Stewart E. Niles, Patricia Bethancourt, Jones, Walker, Waechter, Poitevent, Carrere & Denegre, New Orleans, for applicant (94-C-0992).

Darryl J. Tschirn, Metairie, Edward J. Rice, Jr., L. Thomas Styron, Arthur F. Hickham, Jr., Adams & Reese, Bruce J. Toppin, Jones, Walker, Waechter, Poitevent, Carrere & Denegre, New Orleans, for respondent (94-C-992).

[94-0992 La. 1] CALOGERO, Chief Justice. ^*

We granted plaintiff's writ application to determine whether a plaintiff can prevail in a medical malpractice action when she does not introduce an expert witness to testify--as to the applicable standard of care, its breach, and causation. As a general rule, a plaintiff can prevail under such circumstances when [94-0992 La. 2] a defendant/physician or a defense expert testifies regarding the standard of care, and the objective evidence at trial is such that a lay jury can infer negligence from the facts. Accordingly, the court of appeal was in error when it stated that the absence of expert testimony by a plaintiff regarding a breach of the standard of care precludes success in a medical malpractice action.

A plaintiff must also establish, with adequate evidence, however, a causal connection between a defendant's negligence and the plaintiff's injuries. In applying this rule to the case before us, even if this Court were to assume that the defendants, Dr. Fontenelle and Dr. Correa, through their own testimony, had established the applicable standard of care, and there can be inferred by the lay jury from facts and/or the defendant/physicians' testimony a breach of that standard, plaintiff fails in this lawsuit because there is no evidence to support a finding that the purported breach of the standard of care was the cause of Pfiffner's death, or his loss of a chance of survival. ¹ The jury was clearly wrong in finding that fault of Dr. Fontenelle and Dr. Correa contributed to Pfiffner's death.

This case involves a medical malpractice claim arising from the death of Mr. James A. Pfiffner. On April 12, 1983, Pfiffner, a longshoreman, received a blow to the head while assisting in off-loading cargo and dunnage from a ship at the Port of New Orleans. He did not lose consciousness immediately after the incident, but six days later, on April 18, 1993, he went to the emergency room at St. Claude General Hospital complaining of nausea, dizziness, severe headaches, and blurred vision. His diagnosis was "neck pains." The emergency room doctor telephoned Pfiffner's family physician, Dr. I.L. Fontenelle, to advise him of the patient's [94-0992 La. 3] condition.

The next day, the Pfiffners went to see Dr. Fontenelle, a general medical practitioner, at his St. Claude Street office in New Orleans' 9th Ward near St. Claude General Hospital. Dr. Fontenelle examined Pfiffner and discovered that his condition had changed from the night before, as had then been reported to him by the emergency room attending physician. Dr. Fontenelle found nuchal rigidity (neck stiffness) and pupil dilation, symptoms which indicated a potentially serious neurological disorder. Dr. Fontenelle requested a neurological consultation and called Dr. Amilcar J.E. Correa, a neurologist board certified in neuroimagery and neurological surgery. ²

The Pfiffners went to see Dr. Correa that same day, April 19. There is a dispute as to what time this visit occurred. At trial, Mrs. Pfiffner testified to the following sequence of events. On the morning of April 19, 1983, Dr. Fontenelle called the Pfiffners and asked them to come to his office immediately. Pfiffner was examined by Dr. Fontenelle at around 8:00 a.m. Based on this examination, Dr. Fontenelle recommended a neurological consult and spoke with Dr. Correa at his office at around 8:30 a.m. The Pfiffners then proceeded to Dr. Correa's office and arrived there at about 9:00 or 9:15 a.m. They waited approximately five hours, or until around 2:00 p.m., before Dr. Correa examined Pfiffner.

On the other hand, the testimony of Dr. Fontenelle, Dr. Correa, and Dr. Correa's receptionist, as well as documentary evidence and Mrs. Pfiffner's pre-trial deposition conflict with Mrs. Pfiffner's testimony at trial. During her deposition, when asked how long she and Mr. Pfiffner waited at Dr. Correa's office before being seen by him, Mrs. Pfiffner replied that it had been about thirty five to forty minutes. Moreover, Dr. Fontenelle testified that he did not examine Pfiffner until the afternoon of April 19. While the Pfiffners were in his office, he spoke to Dr. [94-0992 La. 4] Correa about Pfiffner's change of symptoms and need for a neurological examination. The Pfiffners were then sent to Dr. Correa's office and arrived there around 4:00 p.m. A transfer note written by Dr. Fontenelle indicating the date and the time of his examining the patient (3:00 p.m.) supports this testimony. Moreover, Lilian Castillo, Dr. Correa's receptionist, and Dr. Correa both testified that Dr. Correa received a phone call from Dr. Fontenelle on April 19 at around 3:00 p.m. and the Pfiffners arrived at Dr. Correa's office around 4:00 p.m. Finally, the defendants' chronology of events is also supported by the fact that Dr. Correa's Prytania Street clinic across from Touro Infirmary did not open until 2:00 p.m.

As indicated at the outset of this opinion, plaintiff has the burden of proving the applicable standard of care, its breach, and causation. Because plaintiff clearly did not prove that the delay in treatment caused her husband's death or loss of a chance of survival, plaintiff cannot prevail. We, therefore, need not decide whether the jury was wrong in finding that plaintiff did prove the standard of care and breach thereof. By this means of resolving this case, we therefore concede that the jury was correct in finding Dr. Correa had delayed treating Pfiffner for five hours, and that by such delay, Dr. Correa breached the standard of care he owed to Pfiffner. We also concede for present purposes that plaintiff established the standard of care by testimony from Dr. Correa that seriously ill patients must be quickly diagnosed and treated. Although the only expert to testify was Dr. Correa and he testified that he did not breach this standard, we do not conclude that the jury was wrong in this decision. Nonetheless, we find that Dr. Correa must prevail in this action because there is no support for the jury's finding that this breach contributed, in whole or in part, to Pfiffner's death. Assuming the jury reasonably concluded that Dr. Correa was at fault, it cannot conclude, since there is no evidence of the same, that such fault caused Pfiffner's death, or loss of a chance of survival.

In making the same concession regarding the defendant Dr. [94-0992 La. 5] Fontenelle, we note that Dr. Fontenelle must likewise prevail because here, too, no evidence demonstrates any causal nexus between Dr. Fontenelle's alleged negligence and Pfiffner's demise. ³

Upon examining Pfiffner, Dr. Correa discovered that he was suffering from marked stiffness of the neck. Dr. Correa also observed pupil constriction but did not find papilledema (swelling of the head or optic nerve). The optic nerve did not indicate any increased intracranial pressure. Dr. Correa's differential diagnosis was that Pfiffner was suffering from meningitis or subarachnoid hemorrhage. After a lumbar puncture and CT scans, Pfiffner was sent to Chalmette General Hospital. The CT scans revealed cerebritis (an inflammation of the brain) and a "space occupying lesion consistent with intracerebral abscess in the posterior parietal area on the right hemisphere." Dr. Correa's diagnosis, based on the clinical findings, the CT scan, and the spinal fluid test, was non-infectious intracerebral abscess causing a meningeal syndrome and possible aseptic ventriculitis. Surgery offered no hope for patient improvement because the lesion had not encapsulated and, additionally in Dr. Correa's opinion, Pfiffner's medical condition was too poor to tolerate surgery. ⁴ Upon admittance to the hospital, Pfiffner had a general seizure and remained in a semi-comatose state for the remainder of his hospitalization. Four days later, on April 23, 1983, Pfiffner died. The cause of death was respiratory arrest due to increased [94-0992 La. 6] intracranial pressure as a result of the inoperable cerebral mass lesion.

On April 13, 1984, Mrs. Pfiffner filed a complaint against Dr. Fontenelle and Dr. Correa with the Commissioner of Insurance. Three days later, on April 16, 1984, she brought suit "individually and on behalf of her deceased husband and his estate" against Dr. Fontenelle, Dr. Correa, Diagnostic Services, and St. Claude General Hospital. Dr. Fontenelle filed an exception of prematurity which was maintained. The suit against Dr. Fontenelle was thereupon dismissed without prejudice. Diagnostic Services was dismissed because plaintiff failed to amend her petition after its exception of no cause of action was maintained.

Thereafter, the complaint filed with the Commissioner of Insurance against Drs. Fontenelle...