The Dallas Court of Appeals recently entered an opinion that highlights the risks to patient safety when physicians stop short in working up a condition or illness. The case is styled Harsha Aramada, MD, Tomi Ola-Peters MD, Uzoeshi Anukam, MD, Sado Al Bita, MD, Saurabh Patel, MD, and Chandand Koduro, MD v. Yates; No. 05-20-00960-CV. You can read the opinion here.
This medical malpractice wrongful death case arose from care provided to the patient at Methodist Mansfield Hospital. The patient was admitted for treatment of acute pancreatitis.
The pancreas is a key endocrine organ that produces enzymes and hormones that play important roles in the regulation of glucose/sugar and digestion. Pancreatitis is an inflammation of this organ. Patients typically complain of severe upper abdominal pain, nausea, and vomiting. The typical medical treatment involves determining the source of the pancreatitis and treating it.
Acute, or short-term, pancreatitis can usually be managed and usually resolves after a few days of medical treatment. Chronic, or long-term, pancreatitis is a more serious condition that can require more significant medical interventions. That’s why it’s important for doctors to workup the condition and fully determine if the patient has acute or chronic pancreatitis. That’s the central issue in this case.
Once the patient got to Methodist Mansfield, physicians ordered x-rays and CT scans without contrast, to settle on the diagnosis of acute pancreatitis without inflammation or necrosis. Necrosis refers to a dangerous type of pancreatitis called necrotizing pancreatitis. That’s a serious condition where part of the pancreas itself is dying or being destroyed by the disease process.
After a three-week admission to the hospital, the patient was discharged to Kindred Hospital, a long-term care facility, where he died the same day of acute heart attack.
According to the radiology medical expert retained by the plaintiffs, the defendant physicians should have ordered CT scans with contrast and an MRI with contrast. In his expert report, the radiologist discussed how the chest x-rays included the lower part of the patient’s lungs, showing abnormalities that were consistent with necrotizing pancreatitis. On that basis, the expert explained, the physicians should have ordered CT or MRI imaging with intravenous (IV) contrast. Diagnostic radiology scans of this nature with contrast would have enabled a diagnosis of the more serious condition of necrotizing pancreatitis.
In the medical malpractice wrongful death lawsuit, the patient’s family alleged that the physicians failed to diagnose him with necrotizing pancreatitis and treat him for it and the related lung complications. Their petition alleges that the patient was prematurely discharged from the hospital without appropriate treatment, which led to his respiratory and cardiac arrest and death.
The defendants objected to the radiology expert’s report on the basis that he was not qualified to provide an opinion in this case because he wasn’t actively practicing as an internal medicine physician. Interestingly, the radiology expert was also board certified in internal medicine, although his area of practice is radiology.
When considering objections to the sufficiency of a preliminary expert report in a Texas medical malpractice case, the analysis is limited to the four-corners of the expert report. Courts look at the direct experience of the medical expert in relation to the specific medical issues in the case. That may include teaching and training medical students and physicians. In this case, the question would revolve around the diagnosis and treatment of pancreatitis.
The Dallas Court of Appeals noted that the radiology expert’s report stated that he “taught residents and medical students how to tell the difference between acute non-necrotizing pancreatitis and necrotizing pancreatitis and why that was so critical.”
The expert report also noted that during the COVID pandemic he stood ready to take his turn as a hospitalist and intensivist as they prepared for an “onslaught of critically ill infected patients.” The report elaborated that during his 29-year career he utilized his internal medicine experience and participated in the care of many patients whose cases were similar to that of the patient in this case.
Doing a little Monday morning quarterbacking here, as a plaintiffs’ lawyer I would’ve proceeded in this case with expert reports from a radiologist and internist or hospitalist. That would’ve avoided the whole qualification challenge mounted by the defendants. With that said, in my view, the radiology expert here did a solid job of “threading the needle” to show his direct experience and qualifications to provide expert testimony to this specific case.
In conclusion, the trial court denied the defendants’ challenge to the plaintiffs’ expert report and motion to dismiss. The Dallas Court of Appeals agreed, finding that the trial court could reasonably conclude that the expert was qualified.
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