Teffeteller v. University of Minnesota, C8-00-1935.

• Decision Date: 13 June 2002
• Docket Number: No. C8-00-1935.,C8-00-1935.
• Citation: 645 N.W.2d 420
• Parties: Jean TEFFETELLER, as trustee for the heirs of Thad Roddy, Respondent, v. UNIVERSITY OF MINNESOTA, dba University of Minnesota Hospital and Clinics, petitioner, Appellant, Pediatric Research and Education Foundation, Petitioner, Appellant.
• Court: Minnesota Supreme Court

645 N.W.2d 420

Jean TEFFETELLER, as trustee for the heirs of Thad Roddy, Respondent, v. UNIVERSITY OF MINNESOTA, dba University of Minnesota Hospital and Clinics, petitioner, Appellant, Pediatric Research and Education Foundation, Petitioner, Appellant.

No. C8-00-1935.

Supreme Court of Minnesota.

June 13, 2002.

Geraghty, O'Loughlin & Kenney, P.A., David C. Hutchinson, Jean B. Hoppe, St. Paul, MN, for Appellant U of M Hosp. & Clinics.

Gislason & Hunter, LLP, David D. Alsop, Elliot L. Olsen, Minnetonka, MN, for Appellant Pediatric Research & Educ. Foundation.

Rischmiller, Knippel & Aronson, Roger J. Aronson, Minneapolis, MN, for Respondent.

Heard, considered, and decided by the court en banc.

OPINION

STRINGER, Justice.

Respondent Jean Teffeteller, as trustee for the heirs of Thad Roddy, commenced this medical malpractice action against appellant University of Minnesota, doing business as University of Minnesota Hospital and Clinics, and appellant Pediatric Research and Education Foundation (PREF) alleging that both appellants negligently failed to recognize signs of morphine toxicity, and failed to appropriately treat morphine toxicity resulting in Roddy's death. The district court granted appellants' motions for dismissal ruling that respondent's expert was not qualified to testify as to the applicable standard of care and that, even if the expert had the appropriate qualifications, the expert affidavit submitted by respondent failed to meet the requirements of Minn.Stat. § 145.682 (2000).¹ The court of appeals reversed and remanded. We reverse the court of appeals and reinstate the ruling of the district court.

In November 1995, 14-year-old Thad Roddy was diagnosed with leukemia. He was admitted to the University of Minnesota Hospital on December 4, 1996 and underwent a bone marrow transplant on December 12, 1996. In the week following the transplant, Roddy received morphine to help manage his pain. The morphine dosage was increased on December 18, 1996 in an attempt to reduce his worsening throat pain.

At approximately 7:05 a.m. on December 19, 1996, members of the University of Minnesota nursing staff and Dr. Cynthia Wetmore, a medical resident employed by the University of Minnesota, checked on Roddy and found him to be alert, oriented, and responsive. Around 8:30 a.m., Sima Perry, a nurse employed by the University of Minnesota, checked on Roddy and found him to be unresponsive. Specifically, Nurse Perry wrote in her progress notes that she was unable to arouse Roddy with "verbal, vigorous tactile stimulation as well as sternal pressure." She also noted that Roddy's pupils were sluggish and that he had "dusky nailbeds." Nurse Perry notified Dr. Wetmore who immediately went to Roddy's bedside. Dr. Wetmore found that while Roddy was not completely unresponsive and did arouse some, he was not in his normal state of arousal. Dr. Wetmore also found that Roddy was respirating, that his blood pressure and heart rate were fine, and that his nailbeds were not in fact dusky.

At approximately 8:45 a.m., Dr. Wetmore called the intensive care unit and spoke with Dr. Kenneth Tegtmeyer, a fellow in pediatric intensive care employed by the University of Minnesota. Dr. Wetmore presented Roddy's condition to Dr. Tegtmeyer and the two discussed the possible reasons for Roddy's change in condition, including sepsis, a head bleed, and morphine toxicity. Dr. Wetmore believed that morphine toxicity was an unlikely cause of Roddy's change in condition because he had been doing fine for the preceding nine hours when he had been on a continuous morphine drip. Dr. Wetmore discussed the possibility of morphine toxicity with Dr. Tegtmeyer, recognizing that toxicity must always be considered when a patient is on morphine. In their discussion, Dr. Wetmore and Dr. Tegtmeyer agreed that they had four different options: (1) give a dose of Narcan (also known as naloxone), (2) give a dose of Nubain, (3) turn off the morphine drip completely, or (4) wait, watch, and do nothing. Dr. Wetmore and Dr. Tegtmeyer ultimately agreed that Dr. Wetmore would order a small test dose of 0.5 milligrams of Nubain be given to Roddy in an effort to assess whether a component of morphine toxicity was present. Dr. Wetmore preferred to order Nubain rather than Narcan, because she believed that administering Nubain was a more conservative diagnostic test for determining whether morphine was playing a role in Roddy's condition, while Narcan would have immediately and abruptly reversed any morphine toxicity. Dr. Wetmore feared that any such immediate reversal of morphine toxicity caused by administering Narcan could lead to a number of undesirable side effects, including a sudden increase in intracranial pressure, a sudden rise in blood pressure, a sudden onset of extreme pain, or vomiting.

Dr. Wetmore testified at her deposition that she then called Dr. Michael Shannon, an attending physician in the pediatric intensive care unit employed by PREF, at approximately 9:00 a.m. She presented Roddy's condition to Dr. Shannon and explained the decision she and Dr. Tegtmeyer had reached about administering Nubain instead of Narcan. According to Dr. Wetmore, Dr. Shannon agreed with her assessment that, given the fact Roddy's vital signs were still stable, as well as the potential side effects of Narcan, ordering a small test dose of Nubain was reasonable and also a more compassionate and conservative approach than administering Narcan. Dr. Shannon testified in deposition that he did not recall any of this discussion with Dr. Wetmore and that he was not consulted about Roddy's care until shortly before he arrived at Roddy's room later that morning. He also testified that he was unfamiliar with the use of Nubain under the circumstances of this case. In any event, Roddy's morphine drip was stopped and 0.5 milligrams of Nubain were administered around 9:15 or 9:20 a.m.

Dr. Bruce Blazar, a pediatric pulmonary transplant staff physician employed by PREF, and Dr. Brenda Weigel, a pediatric bone marrow transplant fellow employed by the University of Minnesota, were getting ready to begin their rounds when they were called into Roddy's room between 9:25 and 9:30 a.m. Dr. Blazar testified in deposition that either he or Dr. Weigel ordered the first dose of Narcan to be administered shortly after assessing Roddy's condition. A total of two or three doses of Narcan were administered between 9:30 and 10:23 a.m.

Dr. Shannon testified that he arrived with Dr. Tegtmeyer at Roddy's room sometime between 10:00 and 10:15 a.m. to assist in Roddy's care. According to the nurses' progress notes, Roddy began deteriorating shortly after Dr. Shannon arrived, during the administration of a dose of Narcan. At approximately 10:23 a.m., Roddy experienced a respiratory arrest and a code was called. Roddy was immediately intubated and two or three more doses of Narcan were administered between 10:25 and 11:30 a.m. Roddy never regained consciousness. He was placed on mechanical ventilation but died on January 3, 1997 after being removed from life support. Roddy's autopsy report indicated that he died as a result of multi-organ system failure, but that his decreased respiratory state before his arrest on December 19, 1996 was caused by the administration of morphine.

Respondent commenced this lawsuit on or about December 1, 1998. With the summons and complaint, respondent served an affidavit of respondent's attorney as required by Minn.Stat. § 145.682, subds. 2, 3 (2000), stating that the facts in the case had been reviewed by respondent's attorney with a medical expert whose qualifications provided a reasonable expectation that the expert's opinion could be admissible at trial and, in the opinion of the expert, the appellants' deviations from the applicable standard of care caused injury to respondent. There is no contention that this affidavit failed to meet the statutory requirements of Minn.Stat. § 145.682, subd. 3.

In February 1999, respondent and both appellants entered into a stipulation that the 180-day deadline for meeting the expert affidavit requirements of Minn.Stat. § 145.682, subd. 4 (2000) was extended to 90 days following the completion of certain discovery depositions. The last of these depositions occurred on June 17, 1999. On or about August 25, 1999, respondent served appellants with an affidavit of the expected testimony of respondent's expert, Dr. William Perloff. Dr. Perloff's curriculum vitae indicated that (1) he has been board certified in pediatrics and pediatric critical care, (2) he has held numerous teaching positions related to pediatric care, (3) he served as the medical director of the pediatric intensive care unit at the University of Wisconsin Children's Hospital in Madison, Wisconsin from 1982 to 1998, (4) he has served on multiple pediatric and critical care committees, and (5) he has published articles and given presentations on various aspects of pediatric care. The affidavit stated, in part:

Dr. Perloff is expected to testify that the medical and nursing care provided by the defendants fell below acceptable levels of care practiced by reasonably prudent physicians and nurses, under the circumstances of this case. It is Dr. Perloff's opinion that it was below accepted standards of care for the defendants to fail to timely recognize that Thad Roddy was experiencing Morphine toxicity on the morning of December 19, 1996. At 8:30 a.m., when the nurses noted that they were unable to rouse him with verbal, vigorous or tactile stimulation, or with sternal pressure, and Thad had pinpoint and sluggish pupils, the applicable standard of care would require recognition that Thad was in a state of Morphine toxicity. * * *

An acceptable level of care between 8:30 and 9:25 would have required frequent boluses or a continuous infusion of naloxone, under continuous medical supervision, until there was evidence of ongoing reversal of narcotic toxicity * * *.

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