Riser v. American Medical Intern., Inc.
| Decision Date | 25 May 1993 |
| Docket Number | No. 93-CA-153,93-CA-153 |
| Citation | 620 So.2d 372 |
| Parties | William RISER, Claudette Riser O'Neil, and Patricia Riser Jones, Individually and on Behalf of Their Deceased Mother, Anne Valerie Miranne Riser v. AMERICAN MEDICAL INTERNATIONAL, INC., a/k/a AMI, Individually d/b/a and St. Jude Medical Center. |
| Court | Court of Appeal of Louisiana — District of US |
R. Ray Orrill, Jr. and Viki A. Williams, New Orleans, for plaintiff/appellee, William Riser, Claudette Riser O'Neil and Patricia Riser Jones, Individually and on Behalf of their Deceased Mother, Anne Valerie Miranne Riser.
William S. Penick, Lemle, Kelleher, Kohlmeyer, Dennery, Hunley, Moss & Frilot, New Orleans, for defendant/appellant, Erich K. Lang, M.D.
Before BOWES, DUFRESNE and WICKER, JJ.
Defendant, Dr. Erich K. Lang, appeals from a judgment of the trial court which found him liable to plaintiffs for the wrongful death of their mother, Ann Valerie Miranne Riser. We affirm.
In May of 1986, the decedent, Mrs. Riser, a 69 year old woman, was admitted to De La Ronde Hospital and placed under the care of Dr. Vikrom Sottiurai, a vascular surgeon. Mrs. Riser suffered from several serious medical conditions, including diabetes mellitus, end-stage renal failure necessitating dialysis, and arteriosclerosis. Mrs. Riser had dialysis shunts in both arms and was experiencing impaired circulation in both lower arms/hands, including manifestations of gangrene in her right index finger. In order to determine the cause of gangrene, the extent of the circulation problems and the possibility of by-pass surgery, Dr. Sottiurai requested bilateral brachial (elbow) arteriograms of both arms. Because DelaRonde Hospital could not accommodate his request, Dr. Sottiurai contacted defendant, Dr. Lang, and on May 29, 1986, Mrs. Riser was transported to St. Jude Medical Center for the procedure. Dr. Lang, however, performed a femoral (thigh) arteriogram which apparently transpired without complications. During the arteriography Dr. Lang obtained images of the blood vessels utilizing both the conventional approach and a new approach called digital subtraction analysis (DSA), which approach utilizes less amounts of contrast material and produces smaller images on a videotape. Mrs. Riser remained under observation for approximately one and one-half hours after the completion of the arteriogram and was then placed in an ambulance for transport back to De La Ronde Hospital. Shortly after the ambulance departed, Mrs. Riser suffered a grand mal seizure and was returned to St. Jude Hospital. Her condition deteriorated continuously and she died eleven days later.
The cause of death was determined to be a thrombus which lodged at the base of the brain and caused a brain stem infarct (stroke).
The plaintiffs, William Riser, Claudette Riser O'Neil and Patricia Riser Jones, are the major children of the decedent. They filed suit individually and on behalf of their mother, Mrs. Riser, for medical malpractice alleging that the decedent was a "poor risk" for an arteriogram using the femoral approach and was exposed to substantially increased risk of brain injury or infarct as a result and that Mrs. Riser's death was caused by the arteriogram. They also alleged that the arteriogram was performed without the informed consent of either decedent or plaintiffs.
After trial on the merits, the court rendered judgment against Dr. Lang and for plaintiffs as follows:
The defendant is ordered to pay the plaintiffs the following amounts: to William Riser, $100,000.00; to Claudette Riser O'Neil, $100,000.00; and to Patricia Riser Jones, $100,000.00. The defendant is also ordered to pay to the three plaintiffs the sum of $79,656.83 representing hospital expenses, funeral expenses, and compensation for their mother's pain and suffering prior to her death. The total judgment against the defendant in favor of the plaintiffs is $379,656.83, plus interest from date of demand and all costs of these proceedings.
The judgment was subsequently amended to provide that Dr. Lang be not personally liable in excess of $100,000.00.
In his reasons for judgment, the trial judge found as follows:
The evidence establishes that on or about May 29, 1986, the decedent, Anne Valerie Riser, then 69 years of age was being treated by Dr. Vikrom Sottiurai at the Dela Ronde Hospital. The decedent was suffering from serious and varied complications including renal failure and blood circulation problems requiring shunts in both arms and experiencing gangrene on at least one finger. Dr. Sottiurai requested bilateral brachial arteriograms of both upper extremities and had the decedent transferred to St. Jude Medical Center for the procedure. Dr. Erich K. Lang, a radiologist, performed a femoral arteriogram as opposed to a bilateral brachial arteriogram.
The testimony of the plaintiffs in this matter, the children of the decedent, establish that the decedent was strongly opposed to any femoral arteriogram and would not have normally consented to same. The testimony of the witnesses differ as to whether the consent form for the operation was signed by Mrs. Riser's daughter at the insistence of Dr. Lang. The daughter testified that Dr. Lang advised the femoral procedure was necessary in order to save her mother's life and that the mother had not signed the form because she was under sedation. The form submitted to the Court was signed by the daughter and purportedly contained the signature of the mother (decedent) which signature had not been on the document when presented to the daughter. Mrs. Riser, the decedent, when admitted to St. Jude had only agreed to a brachial artery arteriogram as recommended by Dr. Sottiurai.
The testimony further reveals that Mrs. Riser (decedent) had severe cataracts and glaucoma in both eyes and as a result could not see without her glasses. That at the time she was in the St. Jude Hospital, the decedent did not have her glasses with her. The Court is aware that the document could have been read to the decedent but there was no testimony to that effect and therefore the Court refuses to speculate beyond the testimony. Therefore the Court finds, as a matter of fact, that Mrs. Riser, the decedent, did not authorize a femoral arteriogram and that the procedure was without her informed consent.
The Court finds further, as a matter fact (sic), that the result of the procedure would have been of no value to Dr. Sottiurai. That subjecting the patient to a procedure which has a risk of injury and which procedure would be of no benefit to the patient is a breach of the standard of care.
Following the procedure, the decedent remained in the hospital for approximately 2 hours and was then transferred to an ambulance to be returned to the Dela Ronde Hospital. The testimony of the daughter indicated that the decedent was in much distress just prior to being placed in the ambulance which distress was indicated by tremors, glassy-eyes expression, and a scream indicating pain just prior to entering the ambulance. Shortly after the ambulance departed, the decedent experienced a severe seizure and was returned to St. Jude for care. The decedent complained of some pain at the time of exiting from the ambulance, but according to the testimony of the daughter, never spoke again and died some eleven days thereafter.
The cause of death was a thrombus which lodged at the base of the brain and caused a brain stem infarct. Again there was conflicting medical testimony as to the cause of the death i.e., the origin of the thrombus. After weighing all of the testimony, the Court adopts the findings of Dr. Bucklin to the effect that because of the timing of the angiogram and the subsequent catastrophic event, the angiogram was the probable cause of the brain stem infarct.
Therefore, the Court finds that Dr. Lang breached the standard of care required of radiologist in 1986 and is therefore answerable in damages to the plaintiffs. 1
Defendant has appealed both the finding of liability and quantum, presenting the following issues for review.
1. Did the trial court err in finding that the result of the procedure would have been of no value to decedent and therefore defendant breached the standard of care by performing a procedure which would be of no benefit to the patient.
2. Did the trial court err in finding that decedent had not consented to the procedure.
3. Did the trial court err in finding a causal connection between the procedure and Mrs. Riser's death.
4. Did the trial court err in awarding damages which were excessive.
At the onset we reiterate the standard of review by which we are bound in this case as set forth so strongly by the Louisiana Supreme Court in Rosell v. ESCO, 549 So.2d 840, 844-5 (La.1989) as follows:
It is well settled that a court of appeal may not set aside a trial court's or a jury's finding of fact in the absence of 'manifest error' or unless it is 'clearly wrong,' and where there is conflict in the testimony, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed upon review, even though the appellate court may feel that its own evaluations and inferences are as reasonable. The appellate review of fact is not completed by reading only so much of the record as will reveal a reasonable factual basis for the finding in the trial court, but if the trial court or jury findings are reasonable in light of the record reviewed in its entirety, the court of appeal may not reverse even though convinced that had it been sitting as the trier of fact, it would have weighed the evidence differently. Where there are two permissible views of the evidence, the factfinder's choice between them cannot be manifestly erroneous or clearly wrong. In applying the manifestly erroneous--clearly wrong standard to the findings below, appellate courts must constantly have in mind that their initial review function is not to decide factual issues de novo.
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