Shia v. Chvasta
| Decision Date | 23 November 1988 |
| Docket Number | No. 18379,18379 |
| Citation | 377 S.E.2d 644,180 W.Va. 510 |
| Parties | Jeanette SHIA and John Shia v. T.E. CHVASTA, M.D. and Ohio Valley Medical Center, Inc. |
| Court | West Virginia Supreme Court |
Syllabus by the Court
1. "No party may assign as error the giving or the refusal to give an instruction unless he objects thereto before the arguments to the jury are begun, stating distinctly, as to any given instruction, the matter to which he objects and the grounds of his objection; but the court or any appellate court, may, in the interest of justice, notice plain error in the giving or refusal to give an instruction, whether or not it has been made subject of an objection." Rule 51, in part, W.Va.RCP.
2. Even if a requested instruction is a correct statement of the law, refusal to grant such instruction is not error when the jury was fully instructed on all principles that applied to the case and the refusal of the instruction in no way impeded the offering side's closing argument or foreclosed the jury's passing on the offering side's basic theory of the case as developed through the evidence.
William S. Druckman, Hunt & Wilson, Charleston, for Shia.
Patrick S. Cassidy, Bradley H. Thompson, O'Brien, Cassidy & Gallagher, Wheeling, for Chvasta.
Elba Gillenwater, Jr., Galbraith, Seibert & Kasserman, Wheeling, for OVM.
Jeanette Shia had been suffering from severe diarrhea for over three weeks and consulted Dr. Thomas Chvasta, a gastroenterologist. When Dr. Chvasta examined her he discovered that she was dehydrated and had lost weight; consequently, Dr. Chvasta recommended that Mrs. Shia be admitted to Ohio Valley Medical Center the following week for tests to determine the cause of her problem. Over the weekend, however, Mrs. Shia's condition deteriorated and she was admitted to Ohio Valley Medical Center through the emergency room. Dr. Chvasta was listed as her attending physician.
The admitting diagnosis was a possible non-tropical sprue. Non-tropical sprue is a gastrointestinal disease marked by a failure of the body to absorb certain nutrients, including Vitamin K, a vitamin essential in the blood clotting process. The medical records indicate that Mrs. Shia was severely dehydrated when she was admitted to the hospital and that her acid-base balance was out of alignment. On 16 June 1977, a platelet test showed a markedly elevated platelet count due to the gastrointestinal illness. Platelets consist of cell-like matter within the blood that is integral to the clotting process. The higher the platelet count, the more likely it is that blood will clot.
On 16 June 1977 a blood test known as a "prothrombin time" was run. This test measures the blood's clotting time; the higher the clotting time, the greater the risk that a person will hemorrhage. Two prothrombin times were run on 16 June, and both of them were markedly elevated.
On the same day, Dr. Moncado, a resident physician who had just rotated to the medicine service, was telephoned and told of Mrs. Shia's prothrombin time results. These results were also discussed with Dr. Chvasta, and it was determined that 15 milligrams of Aquamephyton (Vitamin K) should be given intramuscularly. Vitamin K, as indicated above, is essential to blood clotting. Dr. Moncado communicated this order by telephone. However, an error was made and 50 milligrams of Aquamephyton were given by a nurse rather than the prescribed 15 milligrams. The following day Dr. Chvasta came to see Mrs. Shia. Unfortunately Dr. Chvasta did not check the chart to determine whether a correct dose of Vitamin K had been given the previous day, and he ordered an additional 20 milligrams of Aquamephyton to be given intravenously that day and the next day. Intravenous administration is the most potent and, perhaps, most dangerous way to administer Vitamin K.
Within 24 hours of receiving the last dose of Aquamephyton, i.e., after receiving 90 milligrams in all, 40 milligrams of which were by intravenous injection, Mrs. Shia suffered a stroke from a blood clot in the brain. The stroke left her permanently paralyzed over half her body and totally disabled. She lost her long- and short-term memory. For many years she was unable to speak, and her present condition of being unable to speak normally is a permanent condition.
Mrs. Shia and her husband, John, sued Dr. Chvasta and the Ohio Valley Medical Center in the Circuit Court of Ohio County. The case was tried before an Ohio County jury, which returned a verdict in favor of the defendants. The plaintiffs now appeal assigning as their principal error the failure of the trial court to give Plaintiffs' Instruction No. 38. Plaintiffs' Instruction No. 38 is sometimes called the "thin-skull" instruction; it would have told the jury that the defendants "took the plaintiff as they found her." 1
At trial defendants did not contest the fact that Dr. Chvasta and employees of Ohio Valley Medical Center were negligent in administering 50 milligrams of Aquamephyton to the plaintiff. That was essentially stipulated. The entire issue at trial was whether the negligence of the defendants was the proximate cause of plaintiff Jeanette Shia's injuries. The plaintiffs presented expert medical testimony tending to show that excessive doses of Vitamin K caused or contributed to Mrs. Shia's stroke. Plaintiffs' expert explained that because Mrs. Shia was dehydrated from her underlying condition, her blood was thicker, and thicker blood is more likely to clot than normal blood.
Plaintiffs' expert opined that Mrs. Shia's increase in blood platelets--a condition related to her underlying gastrointestinal condition--also made her blood thicker and more susceptible to clotting, and that her acidosis (imbalance in the acid-base alignment) had the tendency to constrict blood vessels, which also made the blood more prone to clot. Plaintiffs' expert testified that when a patient has malabsorption syndrome, the blood does not form clots, even though it is more prone to do so, because the prothrombin time elevates. This elevation occurs because Vitamin K is not being absorbed by the body.
The bottom line in plaintiffs' expert's testimony was that Mrs. Shia's bodily functions were generally out of alignment and that the medical problem presented to the defendants was to restore equilibrium. In this regard, the plaintiffs' expert testified as follows:
Well, what you want to do is you want to bring the factors back into equilibrium, but you want to do it very gradually, very slowly so that you don't create a state in which you start inducing thromboembolization. So properly what is recommended is that you give lower doses and treat this phenomenon that is to decrease your blood factors very slowly bringing back into normality your coagulation factors. At the same time it gives you time to treat the other things that are wrong, the acidosis, the dehydration, the electrolyte imbalance. And, if you will, you gradually bring everything back into physiological equilibrium.
What occurred here is you gave at least a three times dose necessary to treat the patient. You gave it right now and so you very rapidly corrected everything not giving yourself time to correct dehydration, acidosis and all of its inherent problems and the high platelet count, just with the 50 milligrams I.M.
Plaintiffs' expert concluded that the administration of too much Vitamin K, too rapidly, corrected the prothrombin time without concurrent correction of the dehydration, acidosis and elevated platelet count, and this rapid correction of the prothrombin time by the negligent administration of the Vitamin K, without the correction of Mrs. Shia's other problems, created an environment that left her more prone to form a blood clot than if she had been treated non-negligently. Plaintiffs' expert admitted, however, that appropriate measures were undertaken to address the dehydration and acidosis and that these conditions were improving by the time the Vitamin K was administered.
The defendants relied primarily on evidence that the 35 additional milligrams of Vitamin K did not proximately cause the stroke. Defendants' expert testified that the view of the plaintiffs' expert "... doesn't make physiological sense...." Defendants' expert testified that in his opinion, Mrs. Shia's stroke was an embolic stroke, which resulted from a condition of marantic endocarditis, a condition that occurs in patients with a chronic disease like Mrs. Shia's, and is manifested by small thrombi (clots) on the inside of the heart. These small thrombi, in turn, eventually break off and cause a stroke.
Defendants' expert testified that marantic endocarditis is in no way related to an excessive administration of Vitamin K. Furthermore, defendants' expert testified that although Vitamin K is necessary for normal blood coagulation, any excess of Vitamin K in the system is excreted from the body and could not...
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