Richardson v. Holmes

• Decision Date: 12 June 1975
• Docket Number: No. 7672,7672
• Citation: Richardson v. Holmes, 525 S.W.2d 293 (Tex. Ct. App. 1975)
• Parties: A. J. RICHARDSON et al., Appellants, v. Hugh D. HOLMES, Appellee.
• Court: Texas Civil Court of Appeals

Page 293

525 S.W.2d 293

A. J. RICHARDSON et al., Appellants, v. Hugh D. HOLMES, Appellee.

No. 7672.

Court of Civil Appeals of Texas Beaumont.

June 12, 1975.

As Amended on Denial of Rehearing July 10, 1975.

Ralph M. Zeleskey, Lufkin, Adams & Adams, Jasper, for appellants.

Jim M. Perdue, Houston, Forse, Forse & Hilliard, Newton, for appellee.

DIES, Chief Justice.

This is a medical malpractice suit. Judgment was given for plaintiff (deceased's surviving husband-appellee) on the following jury findings:

1. The defendants (physician-appellant) delayed in transferring Mrs. Rhoda Holmes to another physician longer than a doctor of ordinary prudence would acting under the same or similar circumstances, engaged in the practice of medicine in this or similar communities.

2. That such delay was a proximate cause of Rhoda Holmes' death.

3. That defendants failed to obtain such consultations with specialists in the field of diagnosing and healing abdominal conditions and complications as would have been obtained by a physician of ordinary prudence, engaged in the practice of medicine in this or similar communities during the time Rhoda Holmes was hospitalized in Jasper Memorial Hospital, July 18--28, 1971.

4. That such failure was a proximate cause of her death.

5. That defendants failed to obtain such x-rays of Mrs. Rhoda Holmes abdomen from July 22 through July 28, 1971, as would have been obtained by a physician of ordinary prudence acting under the same or similar circumstances, engaged in the practice of medicine in this or similar communities.

6. That such failure was a proximate cause of her death.

7. That Dr. A. J. Richardson, Jr., failed to obtain the express consent and authorization of Mrs. Holmes to perform the hysterectomy of July 19, 1971.

8. That the hysterectomy resulted in abdominal complications including a gangrenous bowel.

9. That the abdominal complications were a producing cause of her death.

We first take up the factual sufficiency of the evidence so support the jury's findings that defendants were negligent in delaying Mrs. Holmes' transfer to Beaumont (S.I. No. 1) and were negligent in failing to obtain earlier consultation with specialists (S.I. No. 2). In passing upon the 'no evidence' points we consider the evidence favorable to the plaintiff-appellee; in passing upon the 'insufficiency of the evidence' points we consider the record as a whole.

A discussion of this evidence follows. Its length is oppressive but unavoidable.

The first medical witness called was Dr. A. J. Richardson, Jr., a general practitioner in Jasper, Texas. Mrs. Holmes was admitted in the Jasper Memorial Hospital on the night of July 18 for elective surgery. On July 19 defendant Dr. W. D. Bailey did an AP repair on the patient; then he and Dr. Richardson performed the hysterectomy. They were recommended by Dr. Thomas R. Jones. On the afternoon of the next day--Tuesday--she began to vomit. The vomit was brown in color, and the patient's temperature was 102.4. Vomiting occurred that afternoon and night, but by 10 P.M. her fever--under medication--was reduced to 99.4. The vomiting at 10 P.M. that evening was 'projectile'--or projected out. At 11:25 P.M. vomit was green, but her fever remained just over 99 .

At 1:25 on the 21st of July, the nurses' records show more vomiting of dark liquid which continued at various times into midmorning. At 10:30 A.M. her stomach was slightly distended, or bloated, which became very distened by afternoon. She vomited dark green which Dr. Richardson said was bile from the gall bladder. At 6:30 P.M. he (the doctor) put a tube in her stomach to help the bloating and vomiting.

On the 22nd, she remained intubated. She had a 'fair eight hours' but continued to vomit. At 10:30 A.M. she was x-rayed, which was diagnosed by the x-ray doctor as showing paralytic ileus. On the 24th she still had some pain and vomiting.

On the morning of the 25th, Sunday, Dr. Richardson's diagnosis was 'still paralytic ileus, persistent.' Blood work and the temperature indicated infection such as peritonitis. Early that morning her temperature was 101.4. At 4:30 A.M. a colon tube was inserted, and the patient expelled large amounts of flatus (gas). At 5 A.M. she appeared jaundiced; she took no nutrition. In fact, the records show she took almost none the entire time of her stay at Jasper. At 10:20 A.M. she sat on the side of the bed. At noon vomiting continued, which at 2 P.M. was at fifteen minute intervals. She remained intubated. By Monday--26th--'My diagnosis was she still had her peritonitis and were (was) still concerned about the persistent ileus and were (was) beginning to consider other things.' No further x-rays were ordered. On the 26th '(p)atient had large amount of serous drainage on dressing.'

'We (the doctors) did not think she needed an x-ray that day.' (26th).

On the 27th she was still intubated. Her complaints were essentially the same as the 26th. At 8:40 patient was given a slush enema producing large amounts 'of flatus there with particles of solid stool.'

On the next day, x-rays were ordered at 11 A.M. Drainage from the incision was 'a large amount of brown serous liquid and foul smelling odor.' At 3:20 P.M. she was transferred to Beaumont. Records from the hospital in Beaumont reveal Dr. Miller opened her incision and 'immediately voluminous amounts of fecal fluid escaped from the wound, and it became obvious there was a dehiscence beneath the skin of the entire abdominal wall. On removing several of the sutures a loop of gangrenous bowel was presented between the separated fascia edges of the wound with considerable exudate around the bowel indicating that it had been present in this position for sometime. The bowel was gangrenous and black.'

Dr. Kenneth T. Miller, a surgeon in Beaumont, admitted Mrs. Holmes to St. Elizabeth's Hospital on July 28th for 'diagnosis and treatment for abscess and probable bowel obstruction.' After seeing her, he ordered an enema, got partial results, which meant she didn't have a complete obstruction. He operated on her within three or four hours after the initial examination. At the examination 'she was alert, cooperative, really belied the severity of her disease. She didn't look like she was all that critical until I opened the wound in the abdomen.' She had had no fecal vomiting. This she knew because of her background as a nurse. 'The calibre and type of material that was in her nasal gastric tube was certainly not suggestive of obstruction of the gut.' He regarded her as a surgical emergency because 'in the mid position of the wound there was a brownish, foul, thin fluid escaping from between some of the sutures. . . . On opening the wound it was apparent that there was some bowel interposed between the layers of the abdominal wall by virtue of the fact that sutures had given way and the bowel was black gangrenous. This immediately put this into an emergency category. * * *

'On removing several of the sutures a loop of gangrenous bowel was presented between the separated fascial edges of the wound with considerable exudate about the bowel. * * *

'(E)xudate is a reaction of nature . . . tissues are trying to wall off, really trying to heal an area. . . . (T)his doesn't occur immediately, it probably takes, oh, I'm sure within twelve hours there is some of it forming, but it is hard to tell how long it has been there. I would think that this gut had been interposed for at least twelve hours. . . . (W)hat gave a false clinical impression perhaps, in that this patient's abdomen when I saw her was not real tight and distended like in an obstruction or even an ileus . . . and yet she was apparently decompressing. I think she told me this leakage had started the day before. . . . It (the bowel) was between the skin and the fascia which is the fat layer.' It was not inadvertently sewed into the fascia. There is no way to tell what caused it. It could be the result of an infection. His diagnosis of mesenteric thrombosis or gangrenous bowel was suspected before he opened the wound by the foul drainage. There was no way of knowing of the black bowel except opening the wound. It was the foul drainage that put him on notice of the problem. He feels that by virtue of his special training he may be able to determine things in cases of intestinal obstruction that a general practitioner would not be familiar with. The general practitioner is not qualified to reopen her incision and do what was necessary confronted with a gangrenous bowel. 'I'm sure the woman had paralytic ileus in some form post-op. How long, where this became mesenteric thrombosis with devitalized bowel is something I don't know how one could determine because a dynamic ileus can last sometimes for a week.' He removed approximately eighty percent of her bowel. Her gangrenous bowel '(p)robably could have occurred in three days.' A mysenteric thrombosis is a clotting of blood in the veins and arteries. It is very difficult in these cases to know when one should go back in. At the time he originally saw her, he did not suspect mesenteric thrombosis. 'The convincing factor as far as I was concerned was when I did this surgery and opened her wound.' Her problems were caused by the clotting. She did pretty well after the surgery and would probably have made it if she hadn't developed renal failure.

The next medical witness was Dr. Edward A. Fitch of Pasadena, Texas, a general and thoracic surgeon. He had reviewed the hospital and autopsy records of Mrs. Holmes. From the records he concluded Mrs. Holmes had paralytic ileus at Jasper following the surgery. The records 'gave me the definite notion that a specialist . . . should have . . . given an opinion on the patient.' He was asked when this would have been appropriate in the exercise of proper standards of medicine. His answer: 'The records don't give me the information as to when it would have been appropriate. It was sometime prior...