Pittman v. Virgina Mason Health Sys.
| Decision Date | 21 April 2022 |
| Docket Number | 38054-8-III |
| Parties | DAVID and PENNY PITTMAN, Personal Representatives of the ESTATE OF JAYNE ALAZNE PITTMAN; and DAVID PITTMAN and PENNY PITTMAN, Individually and as Parents of JAYNE ALAZNE PITTMAN, Appellants, v. VIRGINA MASON HEALTH SYSTEM, a Washington corporation, doing business as VIRGINIA MASON MEMORIAL; and MARK LIVINGSTON, M.D., Defendants, YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION, Respondent. |
| Court | Court of Appeals of Washington |
UNPUBLISHED OPINION
David and Penny Pittman appeal the summary judgment dismissal of their claims against Yakima Valley Memorial Hospital Association (YVM) for medical negligence arising out of the death of their two-year-old daughter, Jayne Alazne Pittman. We reverse and remand for further proceedings.
Jayne Alazne Pittman[1], daughter of Penny and David Pittman, was a two-year-old girl who suffered from cystic fibrosis and chronic pseudomonas. In May 2015, Jayne began experiencing intermittent moderate abdominal pain. On May 26, 2015, Ms Pittman brought Jayne to the emergency room at YVM where a doctor ordered x-rays with two views of Jayne's abdomen. After reviewing the films himself, the doctor diagnosed Jayne with constipation, prescribed a laxative, and sent the child home with her mother.
About a week later on June 3, Jayne's parents again brought Jayne to YVM, this time because of abdominal pain, abdominal distension, abdominal cramping, vomiting, and diarrhea. The Pittmans arrived at the hospital at close to midnight. The attending emergency room physician, Mark Livingston, M.D. conducted a physical examination of Jayne and ordered an x-ray. Dr. Livingston interpreted the x-ray and determined Jayne had "[d]ilated loops of bowel filled with stool and gas, similar to [the] x-ray performed [on] May 26. Clerk's Papers (CP) at 307. Dr. Livingston diagnosed Jayne with "acute vomiting likely viral syndrome" and prescribed an anti-nausea medication. Id.
Dr. Livingston discussed his interpretation of the x-ray and his diagnosis with Jayne's parents, and the Pittmans returned home early the next morning around 1:30 a.m. According to the autopsy report, Jayne and Ms. Pittman fell asleep around 2:30 a.m., with Jayne falling asleep on her mother's chest. When Ms. Pittman awoke about 6:00 a.m Jayne was no longer breathing and unresponsive.
Later that morning, Joseph Gouveia, M.D., a radiologist with staff privileges at YVM, reviewed Jayne's x-ray from the night before, unaware that Jayne had since died. In his written report, Dr. Gouveia described "rather notable obstipation," bowel distension, and "a small amount of bowel dilation." Id. at 310. This interpretation was very similar to that of Dr. Livingston.
A subsequent autopsy performed by forensic pathologist Jeffrey Reynolds, M.D., identified the cause of Jayne's death as "[s]evere malabsorption syndrome secondary to cystic fibrosis" and concluded the mechanism of death was "[a]cute cardiac pump failure secondary to right heart air embolism." Id. at 442. In addition, Dr Reynolds indicated that Jayne had suffered "torsion of the omentum," leading to "avascular necrosis of [a] considerable portion of [the] small bowel." Id. at 445. Jayne's necrotic small bowel was found to be grossly dilated, extending from the mid-jejunum to the mid-ileum area. The compromised, distended, and air-filled bowel was the source of the "[d]issection of gas into the submucosal venous and lymphatic system" with eventual venous air embolus to [the] right heart," due to the omentum torsion, leading to "acute cardiac pump failure." Id. at 315, 442. Put simply, due to Jayne's severe bowel condition, air was able to escape from her bowels and eventually reach her heart, causing an air embolism in the right portion of the heart.
The Pittmans sued YVM and Dr. Livingston for medical negligence. The case proceeded through discovery and the claims against Dr. Livingston were resolved. YVM then moved for summary judgment on the remaining claims and the parties presented competing expert witness opinion testimony regarding whether a violation of the standard of care by YVM contributed to Jayne's death.
YVM retained Daniel von Allmen, M.D., a professor of surgery at the University of Cincinnati College of Medicine and surgeon-in-chief of Cincinnati Children's Hospital Medical Center. Dr. von Allmen, who is board certified as a medical examiner, surgeon, pediatric surgeon and advanced trauma life support provider, opined that at the time Jayne arrived at YVM on June 3, segments of her bowel "were essentially dead." Id. at 268. According to Dr. von Allmen, "while emergency resection surgery could have potentially revived some of the bowel, the extent of damage was likely too great, and combined with [Jayne's] additional extensive health complications, her chance of having survived the surgery would have been slim." Id. Dr. von Allmen was also of the opinion that it would have been necessary to transfer Jayne to a more advanced care facility, such as Seattle Children's Hospital, to receive the necessary surgery, with the transit time involved in moving Jayne between the two facilities further decreasing her chances of survival. It was Dr. von Allmen opinion that there was nothing YVM could have done on June 3 to prevent Jayne's death.
The Livingstons countered with expert witnesses Gary Stimac, Ph.D., M.D., and Richard Cummins, M.D.
Dr. Stimac is a physician and board certified radiologist, with specialized training in neuroradiology. He reviewed Jayne's x-rays from May 26 and June 3 and concluded they showed significant abnormalities, particularly when comparing the later x-ray to the earlier films. According to Dr. Stimac, the films showed serious bowel complications, consistent with Jayne's diagnosis of cystic fibrosis. Dr. Stimac explained that those findings from the x-rays suggested a need for emergent medical or surgical attention. He opined that Dr. Gouveia's interpretation, after Jayne's death, of the June 3 x-ray was inadequate and also fell below the standard of care.
Dr. Cummins is a physician who is board certified in both internal medicine and emergency medicine. He is a professor of medicine at the University of Washington and has been an attending physician at the University of Washington Medical Center since 1982. Dr. Cummins opined that the standard of care in the state of Washington is to have a radiologist review an x-ray prior to discharging a patient. Dr. Cummins explained YVM breached this standard of care when Jayne's x-rays were reviewed only by the attending physician. According to Dr. Cummins, a competent radiologist would have recognized the severity of Jayne's condition. This would have led to remedial steps such as rehydration, monitoring, and transfer for surgery. Dr. Cummins opined, on a more likely than not basis, that Jayne would have survived if she had been timely diagnosed and treated.
Dr Cummins based his standard of care conclusion on his training, practice, and teaching of emergency medicine, on statements and guidelines published by the American College of Emergency Physicians and the American College of Radiology, hospital certification requirements, and his knowledge of the reasonably prudent practice of emergency medicine in emergency departments. He based his opinions regarding Jayne's condition and the survivability of that condition on his professional training, clinical experience, and knowledge of her condition obtained from a review of the treatment records and x-rays, and the autopsy report...
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