By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services
(2004-2013)
California Hospital Medical Center
Los Angeles
Morgan Lynch, 2018 JD Candidate
Pepperdine University School of Law
Malibu, CA
News: In 2012, a man was taken to a hospital via ambulance after his legs collapsed, causing him to fall. The treating physician diagnosed the patient with paresthesia and dysesthesia, and discharged him soon thereafter. Less than two weeks later, the patient visited a registered nurse practitioner, who also sent him home. A third medical facility diagnosed the patient with spinal myelopathy and transverse myelitis, which rendered the patient quadriplegic. He was treated with high doses of steroids and requires constant care.
The patient filed a lawsuit in mid-2013 for medical malpractice against the first two medical facilities and the medical professionals who treated him. The case proceeded to a jury trial against one hospital, but the parties came to a settlement while the jury deliberated. The total economic benefit to the plaintiff, including medical bill waivers and multiple settlements, was approximately $8 million.
Background: On May 3, 2012, a man presented to a hospital after falling in his driveway when his legs collapsed. The patient’s treating physician allegedly neglected to order the appropriate diagnostic testing, and diagnosed him with paresthesia and dysesthesia. The man was discharged from the hospital shortly thereafter.
On May 14, 2012, he was evaluated by a registered nurse practitioner at a different medical facility for neck pain and weakness in his arms and legs. The patient failed to disclose the fact that he had been seen previously by another physician. Again, the patient was discharged, but with instructions to return in three months. On May 31, 2012, the patient went to yet another facility (an ED), where he was too weak to stand or walk. The man was then diagnosed with spinal myelopathy and transverse myelitis. The patient was treated with high doses of steroids and was diagnosed with quadriplegia that requires him to be under care 24/7.
The patient notified the defendants in April 2013 that he intended to file suit against them. He then filed a medical malpractice suit on July 23, 2013, against the two medical facilities, the treating physician, the registered nurse, and 10 defendants to be determined (“Doe defendants”).
In his first amended complaint for damages, the patient alleged, among other things, that the defendants failed to order tests and MRIs, failed to consult experts, and failed to diagnose his condition. The complaint further alleged that, if the condition was timely treated, he would not be damaged. Prior to the suit, the patient was hospitalized continuously for 10 months and eventually moved to a different state to receive care from his family. The plaintiff presented a damages calculation range of $20 million to $40 million for the first hospital. It is unknown what the plaintiff asked from the other defendants.
Before the case reached trial, the medical professionals and the second hospital settled with the plaintiff. Thus, the case against only the first hospital proceeded to a jury trial. The plaintiff presented eight experts at trial and the defendant utilized 11. While the jury was deliberating on Jan. 31, 2017, the hospital agreed to pay $5.25 million to settle the action. The plaintiff’s attorneys mentioned that the total economic benefit that included the other settlements and medical bill waivers was close to $8 million.
After the settlement, the hospital’s counsel told media that the care rendered by its staff was appropriate and that the case settled well for them since the bottom line was far less than the plaintiff’s damages calculation. The approximate allocation of liability was 65% for the hospital and 35% spread among the remaining defendants in an unknown internal proportion.
What this means to you: This case demonstrates that a hospital that settles is better positioned to save face in terms of culpability. In this case, the hospital’s attorney told media that the settlement was favorable given the plaintiff’s demand. Additionally, because the case settled, the hospital’s counsel issued a statement that the hospital’s staff conformed with the applicable standard of care. This permitted the hospital to re-establish confidence in the public eye and mitigate any loss of goodwill caused by the suit. Even if a hospital has a strong case against a plaintiff, it may be a wise strategic decision to settle in order to avoid the risks of trial and costs of dealing with the appeals process. While costs may be awarded to the prevailing party on appeal, courts may have the discretion to deny some or all costs in the interests of justice. Even if a hospital is awarded its costs upon a successful appeal, enforcing the court order for fees can be impracticable or impossible given the financial status of the individual.
Another interesting procedural characteristic of this case is the use of Doe defendants. It has been held that failing to include Doe defendants where they are allowed may constitute malpractice. The plaintiff in this case sued 10 Doe defendants, but there is no limit to the number of Does one can sue.
To hedge against the risk of medical malpractice suits, hospitals need to establish proper procedures to ensure medical professionals administer diagnostic testing. Misdiagnosis occurs in approximately 1 in 20 patients in the United States. Clearly, in this case, the medical professionals failed to assess the patient’s symptoms thoroughly. While it is not unusual for a person to fall, especially during activities at home, there is usually an event, such as tripping or slipping, that causes it. However, if the patient states that his legs suddenly collapsed under him, a neurological source must be considered. Allowing the patient to leave without further testing can be considered negligent.
In addition to diagnostic testing, medical professionals need to inquire into patients’ medical histories. Each patient interaction ought to involve a review of his or her history. Most hospitals not only post information about a patient’s rights, but also their responsibilities. An important one is to inform their health providers about their medical histories. Had the patient here informed the second hospital about his fall, the nurse practitioner likely would have discussed his symptoms with her supervising physician.
Finally, after a patient is discharged, patients should be encouraged to follow up with their physicians if symptoms persist or worsen. In this case, the plaintiff argued that the medical professionals failed to consult a neurologist, neurointensivist, and/or neuroradiologist, and missed the opportunity to treat his transverse myelitis. Accordingly, hospitals should encourage medical professionals to consult experts to avoid missing an opportunity to cure diseases that quickly progress into untreatable phases.
REFERENCE
Los Angeles County Superior Court, Case No. BC516100, Jan. 31, 2017.
Two facilities failed to diagnose a patient's condition, leading to quadriplegia and an $8 million settlement.
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