Still v. Ahnemann

• Court: Missouri Court of Appeals
• Writing for the Court: JAMES M. SMART, Jr.
• Citation: Still v. Ahnemann, 984 S.W.2d 568 (Mo. App. 1999)
• Decision Date: 26 January 1999
• Docket Number: No. WD,WD
• Parties: Deborah A. STILL and William B. Still, Appellants, v. Janet L. AHNEMANN, M.D. and The Wetzel Clinic, Inc., Respondents. 55263.

Page 568

984 S.W.2d 568

Deborah A. STILL and William B. Still, Appellants, v. Janet L. AHNEMANN, M.D. and The Wetzel Clinic, Inc., Respondents.

No. WD 55263.

Missouri Court of Appeals Western District.

Submitted Sept. 16, 1998.

Decided Jan. 26, 1999.

Kent Sellers, Kansas City, for appellants.

Chris F. Pickering, Kansas City, for respondent.

Before SMART, P.J., ELLIS and HOWARD, JJ.

JAMES M. SMART, Jr., Judge.

In this medical malpractice case, Plaintiffs Deborah and William Still appeal the trial court's judgment in favor of Dr. Janet L. Ahnemann and the Wetzel Clinic ("the Clinic"). The Stills raise two points on appeal. First, they claim that the trial court erred in excluding portions of Dr. Ahnemann's videotaped testimony. The Stills also contend that the trial court erred in withdrawing their claim for future non-economic damages. The judgment of the trial court is affirmed.

Factual Background

In the fall of 1993, thirty-five year old Deborah Still was in the early stages of pregnancy with her second child. Mrs. Still's family physician at the Wetzel Clinic in Clinton, Missouri, retired in October, 1993. Dr. Janet Ahnemann began working at the Clinic on November 1, 1993. Mrs. Still's first appointment with Dr. Ahnemann was on November 19, 1993. Mrs. Still was fifteen weeks pregnant at the time.

On February 10, 1994, some thirteen or fourteen weeks after her first appointment, Mrs. Still saw Dr. Ahnemann for a routine obstetric examination. Before Mrs. Still saw Dr. Ahnemann, the doctor's medical assistants checked Mrs. Still's weight, blood sugar and the amount of protein in her urine. It is routine to check these three factors in every pregnant patient because excessive weight gain (from swelling), increased blood pressure and significant amounts of protein in the urine are clinical indicators of preeclampsia. Mrs. Still's weight gain was two pounds more than her weight gain in the corresponding week of her first pregnancy. Mrs. Still's blood pressure was 120/80, compared to 124/80 at the beginning of her pregnancy. Only a trace of protein was found in Mrs. Still's urine.

Mrs. Still's next visit with Dr. Ahnemann was on March 24, 1994. During this visit, Dr. Ahnemann noticed a trace of dependent edema, a swelling of the feet and legs. Mrs. Still had experienced dependent edema during her first pregnancy as well. Additionally, Dr. Ahnemann recorded Mrs. Still's blood pressure at 126/80 and noted that it was borderline high. At trial, both plaintiff and defense experts testified that Mrs. Still's blood pressure was normal for her condition.

Mrs. Still's next scheduled appointment with Dr. Ahnemann was on April 7, 1994. When Mrs. Still arrived that day, she discovered Dr. Ahnemann was not at the clinic. Dr. Ahnemann was absent because she determined there was an immediate need to meet with a lawyer to institute a dissolution of marriage. On the morning of April 7, her husband had told her he was filing for divorce. Believing she would have an advantage in the issue of child custody if she filed first, Dr. Ahnemann decided to file for divorce from her husband that day. She went to the hospital to check on her patients and then spoke with the Clinic's administrator about her situation. The administrator arranged for Dr. Ahnemann to see an attorney that morning and assured her that her patients would be cared for. Dr. Ahnemann then informed her medical assistants of the need for all of her appointments for that day to be rescheduled. Her medical assistants began calling and rescheduling Dr. Ahnemann's appointments, but were unable to reach Mrs. Still before she arrived at the Clinic to see Dr. Ahnemann.

When Mrs. Still arrived at the Clinic, she informed one of Dr. Ahnemann's medical assistants that she had a cold, cough, sore throat and fever. She also told the nurse that Mr. Still and their son were suffering from the same symptoms. The nurse asked Mrs. Still if she wanted to see another physician. Mrs. Still declined the offer, but requested a prescription for herself, her husband and her son. The nurse consulted another obstetrician at the Clinic, and he prescribed medication for the Still family. The nurse then rescheduled Mrs. Still's appointment with Dr. Ahnemann for April 13, 1994.

On April 11, 1994, Dr. Ahnemann saw patients at the Clinic all day and was busy all night at the hospital with a patient who was in labor. On April 12, Dr. Ahnemann went directly from the hospital to the Clinic to see patients. During an obstetrical examination, one of Dr. Ahnemann's patient's water broke. Dr. Ahnemann checked this patient into the hospital, anticipating another all-night ordeal. Because she had been awake for two days straight, Dr. Ahnemann requested that her medical assistants call and reschedule her April 13 appointments, including Mrs. Still's appointment. Mrs. Still's appointment was rescheduled to April 15, 1994.

On April 15, 1994, Dr. Ahnemann saw Mrs. Still at the Clinic. Dr. Ahnemann's clinical examination on that date revealed that Mrs. Still had gained nine-and-one-half pounds since her last appointment, three weeks earlier. Mrs. Still's blood pressure had increased, and she had a significant amount of protein in her urine. Dr. Ahnemann believed Mrs. Still was developing preeclampsia. According to the medical testimony in the case, preeclampsia can be conclusively diagnosed only by taking blood pressure readings six hours apart after bed rest. The only cure for preeclampsia is delivery of the child. Based upon her diagnosis, Dr. Ahnemann admitted Mrs. Still to Golden Valley Hospital for bed rest, further testing and monitoring of Mrs. Still's blood pressure. Throughout the afternoon, Mrs. Still's blood pressure increased as did the level of protein in her urine. Dr. Ahnemann concluded it was not a severe case of preeclampsia. At this point, Dr. Ahnemann's plan was to continue monitoring Mrs. Still and hopefully achieve a natural delivery before a cesarean section became necessary.

Later that day, Dr. Ahnemann concluded that Mrs. Still had to deliver her child in order to cure the preeclampsia. She was concerned that if Mrs. Still had a protracted natural delivery she could develop severe preeclampsia. Dr. Ahnemann spoke with Mrs. Still about her concerns and they both decided that Mrs. Still should have a cesarean section. A cesarean section was performed that evening, and Mrs. Still delivered a healthy baby girl. After the surgery, Mrs. Still was taken to a recovery room where her blood pressure stabilized and all other signs appeared normal. Dr. Ahnemann left the hospital between 11:00 p.m. and midnight, leaving orders for Mrs. Still's post-operative care with the hospital.

At approximately 2:30 a.m., Dr. Ahnemann received a phone call from the hospital telling her that Mrs. Still's blood pressure had dropped and she was experiencing vaginal bleeding. Dr. Ahnemann ordered several lab tests for Mrs. Still, prescribed medication for her and then left for the hospital. When she arrived at the hospital and received the results of Mrs. Still's lab tests, Dr. Ahnemann concluded that Mrs. Still might be going into HELLP Syndrome, a very severe form of preeclampsia. HELLP stands for Hemolysis, Elevated Liver Enzymes & Low Platelets. She transferred Mrs. Still to the intensive care unit for closer observation. Dr. Ahnemann consulted with a perinatologist (a specialist in high risk obstetrics), Dr. Tracy Cowles, who told her that Mrs. Still's condition would probably worsen, but such patients usually turned around and got better. Dr. Cowles prescribed a blood transfusion for Mrs. Still and advised Dr. Ahnemann to monitor the liver enzymes and clotting factors in Mrs. Still's blood. Dr. Ahnemann followed Dr. Cowles' advice.

Mrs. Still's condition continued to worsen. Her liver enzymes were increasing, her platelet count was dropping, her kidneys were failing and the bleeding continued. Dr. Ahnemann again consulted Dr. Cowles, who advised Dr. Ahnemann to stay the course. After Mrs. Still's condition continued to deteriorate, Dr. Ahnemann ordered her transferred, via helicopter, to K.U. Medical Center. Mrs. Still left the hospital suffering from HELLP Syndrome accompanied by acute renal failure, respiratory distress and postpartum bleeding. Mrs. Still was admitted to K.U. Medical Center in very critical condition, and doctors advised her family that "more than likely she wasn't going to make it."

While at K.U. Medical Center, Mrs. Still experienced numerous complications stemming from her severe preeclampsia, including kidney failure, liver failure, respiratory failure and heart failure. Upon her arrival at K.U. Medical Center, Mrs. Still was placed on a respirator and remained on it for a week. She underwent weeks of kidney dialysis. Mrs. Still eventually developed a fungal infection for which she was treated with amphotericin. This medication resulted in violent side effects in the form of chills and fever. After three and one-half weeks in intensive care, Mrs. Still was transferred to a regular hospital room at K.U. Medical Center. After another week and one-half, she was released altogether. Although Mrs. Still admits that there was nothing she could do before her second pregnancy that she is unable to do now, she continues to complain of fatigue and shortness of breath.

The Action

On April 2, 1996, Mr. and Mrs. Still sued Dr. Ahnemann and the Wetzel Clinic for negligence and loss of consortium. In this petition, the Stills alleged, inter alia, that Dr. Ahnemann was negligent in failing to adequately monitor Mrs. Still's condition, failing to provide medical care at appropriate intervals, and failing to diagnose preeclampsia prior to April 15, 1994. The Stills alleged that Wetzel Clinic failed to ensure that Mrs. Still received adequate care from Dr. Ahnemann, and failed to make sure that appropriate care was provided in Dr. Ahnemann's absence. At trial, plaintiffs' expert, Dr....