Tringali v. Lal

• Decision Date: 22 December 1987
• Docket Number: Docket No. 87505
• Parties: Patricia TRINGALI and Carmelo Tringali, Plaintiffs-Appellants, v. Sarla LAL, M.D., Defendant-Appellee. 164 Mich.App. 299, 416 N.W.2d 117
• Court: Court of Appeal of Michigan — District of US

Page 117

416 N.W.2d 117

Patricia TRINGALI and Carmelo Tringali Plaintiffs-Appellants, v. Sarla LAL, M.D., Defendant-Appellee.

Docket No. 87505.

164 Mich.App. 299, 416 N.W.2d 117

Court of Appeals of Michigan.

Submitted March 3, 1987.

Decided Nov. 3, 1987.

Released for Publication Dec. 22, 1987.

[164 MICHAPP 300] Lopatin, Miller, Freedman, Bluestone, Erlich, Rosen & Bartnick by Monica Farris Linkner, Detroit, for plaintiffs-appellants.

Barbier, Petersmarck, Tolleson, Mead & Paige, P.C. by James A. Callahan, Detroit, for defendant-appellee.

Before KELLY, P.J., and SULLIVAN and JOSLYN, ^* JJ.

JOSLYN, Judge.

Plaintiffs, Patricia Tringali and her husband, Carmelo Tringali, filed a medical malpractice complaint against defendant, Sarla Lal, M.D., in the Macomb Circuit Court alleging that defendant failed to properly diagnose Patricia's condition and to timely refer Patricia to a gastroenterologist for treatment. On June 24, 1985, the jury returned a verdict finding defendant negligent but finding no proximate cause. Judgment was entered on June 27, 1985. Plaintiffs moved for a new trial, which was denied by order dated August 26, 1985. Plaintiffs appeal as of right.

Trial on this matter commenced on June 12, 1985. Defendant, a general practitioner, was called under the adverse witness statute, M.C.L. Sec. 600.2161; M.S.A. Sec. 27A.2161. Defendant testified that she first saw Patricia Tringali on June 30, 1975. At that time, plaintiff was experiencing severe migraine headaches, probably caused by tension. Between June 30, 1975, and July 29, 1975, defendant saw [164 MICHAPP 301] plaintiff four times. On July 29, 1975, defendant hospitalized plaintiff at Harrison Hospital until August 6, 1975.

On February 7, 1976, defendant prescribed Valium and Tylenol 3 for plaintiff's headaches. By October, 1976, plaintiff's blood pressure was up. Defendant gave her a physical examination, which was normal.

On February 28, 1977, plaintiff visited defendant complaining of numbness of the right hand and gastrointestinal spasms. X-rays were ordered for plaintiff's hand and Bentyl was prescribed for her spasms. Plaintiff returned on March 17, 1977, complaining of diarrhea. At that time, defendant prescribed hemorrhoid suppositories and Lomotil. Defendant also told plaintiff about having a sigmoidoscopy, thinking plaintiff had colitis, and defendant wanted to rule it out." However, plaintiff did not want the sigmoidoscopy performed.

Defendant hospitalized plaintiff on March 21, 1977, until March 25, 1977, for irregular heavy uterine bleeding that plaintiff had been experiencing intermittently for the preceding two and one-half years, numbness of the right hand and mucous stools. After defendant made a physical examination of plaintiff, her impressions were that plaintiff had dysfunctional uterine bleeding, right carpal tunnel syndrome, mucous colitis and arthritis. Defendant called in specialists for everything except plaintiff's arthritis.

During hospitalization, plaintiff was examined by internist Dr. Douglas Wood. Dr. Wood was to treat plaintiff for difficulty on open urination. Dr. Wood was also to examine plaintiff relative to her mucous stools. Dr. Wood noted that plaintiff was hesitant to have a sigmoidoscopy at the time. Plaintiff also refused to have a urological work-up done, as Dr. Wood recommended. Defendant stated [164 MICHAPP 302] that every time she spoke with plaintiff while she was hospitalized, she told plaintiff that she should have a sigmoidoscopy performed. Defendant also explained the reasons for the test to plaintiff and told her how the procedure was performed. However, plaintiff told defendant that she did not want to have the test performed.

Upon plaintiff's discharge from the hospital, defendant's diagnosis was that she had mucous colitis, but defendant could not rule out ulcerative colitis. In her discharge summary, defendant wrote that, if plaintiff had any gastrointestinal tract problems, plaintiff should have the sigmoidoscopy performed and should be examined by a gastroenterologist.

On June 3, 1977, plaintiff visited defendant's office. The chart notation indicates that defendant suggested a sigmoidoscopy, but again plaintiff refused. Defendant also gave plaintiff two or three names of gastroenterologists that she could contact.

The deposition of Richard V. Utarnachitt, M.D., was read into evidence. Plaintiff was examined on November 9, 1977, by Utarnachitt, who was a gastroenterologist. He scheduled a colonoscopy for plaintiff, which is similar to a sigmoidoscopy except for the fact that the instrument used is longer and the entire colon is inspected. The colonoscopy revealed that plaintiff had ulcerative colitis. Therefore, Utarnachitt prescribed Azulfidine and put plaintiff on a diet. On November 17, 1977, plaintiff was hospitalized because she was not responding to treatment, the diarrhea had not stopped, and she still had rectal bleeding. On November 24, 1977, plaintiff was discharged from the hospital.

On November 26, 1977, plaintiff was rehospitalized due to bleeding and abdominal pain. On December[164 MICHAPP 303] 3, 1977, plaintiff developed toxic megacolon, a dilation of the large intestine as a result of her ulcerative colitis condition. Plaintiff's toxic megacolon did not respond to medication, so on December 5, 1977, Dr. Parnagian performed a subtotal colectomy with ileostomy. Dr. Parnagian removed plaintiff's right colon, transverse colon, and left colon. He brought the ileum out by ileostomy in the right lower abdomen. Consequently, plaintiff has to move her bowel into a bag attached to her skin, because the rectum has no function at all.

Dr. Parnagian then took over plaintiff's principal treatment. Parnagian performed sigmoidoscopy exams on plaintiff several times in April and August, 1978. In December, 1979, Parnagian performed a sigmoidoscopy on plaintiff and that was the last time he saw her.

Plaintiff then testified in her own behalf. She stated that, prior to 1975, she was in good health. Plaintiff began going to defendant in the summer of 1975 for headaches and she was given medication, injections and was hospitalized for ten days. The headaches eventually subsided after the summer of 1975.

Plaintiff testified that she visited defendant through 1976 and 1977, and at no time did she ever refuse a sigmoidoscopy nor was she afraid or embarrassed to have the test done. In fact, plaintiff stated that defendant told her that a sigmoidoscopy was necessary.

In November of 1977, plaintiff's condition had gotten worse and as a result she went to see Dr. Utarnachitt, who immediately hospitalized her. Dr. Parnagian performed surgery on plaintiff. After the surgery, plaintiff saw the huge incision and plastic bag filled with stool, and she felt crazy, dirty, became totally irrational, began throwing [164 MICHAPP 304] things and yelling. Plaintiff refused to listen to lessons given on care of the colostomy bags, nor did she want to deal with it. Plaintiff saw a psychiatrist for a year and a half. She also received medication and could not care for the bag until a month after she went home. Plaintiff testified that she constantly worries about leaks and odors; she no longer is outgoing; she is afraid to be around dogs; she is afraid to stay overnight elsewhere; she has had leaks at business and social events; and her sexual relations have changed because of the bag.

Following deliberations, the jury found defendant negligent but found no proximate cause.

On appeal, plaintiffs claim that the trial judge erred in refusing to instruct the jury on an applicable jury instruction as requested by plaintiffs. Jury instructions must be read as a whole, not dissected piecemeal and assigned error in isolated portions. Willoughby v. Lehrbass, 150 Mich.App. 319, 336, 388 N.W.2d 688 (1986). Under MCR 2.516(D)(2), the trial court is required to...