Читать книгу Bad Blood - James Baehler - Страница 10

Sanjay Madhava, M.D. visited his malpractice attorney. They shook hands and this almost gave Dr. Madhava a neck strain as he had to look up at attorney, Paul Stuart, handsome, dark hair, penetrating eyes, six foot four and with the build of a professional wrestler. Before Stuart could say a word, Dr. Madhava blurted out, “I don’t belong on this suit. What are chances of getting me dismissed.”

Stuart calmly replied, “I don’t blame you, doctor, and I assure you we always strive for that goal if possible, but to reach it we need to provide the judge with a very good reason. The big issue will be the heparin injection.”

“Dr. Harris insisted it be used.”

“I can appreciate that, doctor, and it will be my job to convince the jury likewise. We will study the medical chart carefully and be fully prepared to defend your actions if this suit comes to trial. We need an expert witness anesthesiologist to testify on your behalf. We’ve used Dr. Torgerson from the University of Illinois and I plan to send him the record. Do you know him?”

“He’s well known I’ve seen him at meetings. I never met him though.”

“Does he meet with your approval.”

“Oh yes.”

“I’ll need your curriculum vitae and I want you to write up what happened from your standpoint as you understand it. We’ll meet every so often. The plaintiff’s attorney will depose you when they’re ready. Have you ever been involved in a deposition?”

“No.”

“We’ll be with you during the depositions and we’ll advise you a few days before you go.”

“Okay. Thank you.”

Betty Wu contacted Glen Drossman M.D. who agreed to consult as an expert witness. His hematology expertise was well recognized throughout the United States, and he was considered a world authority on coagulation, thrombotic and platelet disorders. All of these were relevant to DIC. It would be difficult for anyone to dispute the opinion of Dr. Drossman, so Dr. Harris was hopeful that Dr. Drossman would see the case as he saw it. Betty Wu sent him a copy of the record and scheduled him to see her in two weeks. He arrived at her office with the record and nine pages of single spaced type written notes. He was a soft-spoken man with an air of confidence that comes with long concentration and a lifetime of work on a specific medical topic. He was fifty-eight years of age, and headed up the hematology section at Loyola for twenty-two years. His glasses and neatly trimmed salt and pepper beard gave him a professorial air. “It’s a pleasure to meet you, Mrs. Wu. First let me say that I will gladly testify for Dr. Harris. I haven’t asked around about him, nor have I checked his curriculum vitae, but judging from his thought processes, which are well described in the medical record, I believe he is an excellent and knowledgeable physician.”

“That’s great to hear, doctor. I had a similar impression.”

“Here is a copy of the resons for my conclusions. I would like to go over them with you, so you will be better prepared to defend your client. In addition, I believe I could play the devil’s advocate and suggest to you what tactics the plaintiff’s attorneys may take.”

“That would be most helpful, doctor.”

Drossman said, “Let’s get the bad news out of the way first. “First you’ll have to be prepared for the plaintiff’s attorneys to make the suggestion that Dr. Harris did indeed make a surgical mistake and covered it up. Even though he had a surgical assistant, sometimes they just hold retractors and don’t get involved in the actual fine surgical techniques and could easily miss a small error by the surgeon. Did he fail to ensure hemostatsis or bleeding control? Expect them to throw out all sorts of these suggestions. I’ve seen it happen before. I don’t have to tell you that all they need is a little doubt in the juror’s minds.”

“Yes, I agree.”

“Also, when they attempt to hire a hematologist to testify against Dr. Harris, they will not be able to find one. No well-trained hematologist will be able to say that Dr. Harris’s treatment did not meet the standard of care. I might add that many surgeons would not have thought of, much less knew so much about DIC. So from that standpoint Dr. Harris is to be congratulated.”

Smiling, Betty Wu said enthusiastically, “I thought the same thing. There is no fault to be found in Dr. Harris’s actions and it is hard to believe a competent hematologist would testify to the contrary. But, that doesn’t mean they won’t be able to get a so called expert.”

Drossman said, “That’s exactly the point I was going to make. Be prepared for a general

internist, family practitioner, you name it. To most people a doctor is a doctor, and I’ve seen jurors accept some of the most outrageous medical suggestions made by a doctor trained in a discipline unrelated to the case at hand.”

“How well I know that. But, doctor, I would like to get back to the point you made about the plaintiff suggesting that Dr. Harris covered up a surgical mistake. Why would he ask the patient’s wife for permission to have the pathologist perform an autopsy if he made a mistake that clearly would be uncovered by the autopsy.”

“Let me play the plaintiff’s attorney and respond to that. You be the witness.”

“Okay.”

Drossman assumed a questioning pose, “How many autopsies are performed in this hospital each year?”

“I don’t know.”

“I don’t know either, but I can tell you that the number may be zero or it may be just a few. I know that, because those are national statistics. There are very few autopsies done in community hospitals in this day and age. Today we have CAT scans, ultrasound, MRI’s, MRA’s, PET scanners, sophisticated blood tests, and so on that allow ante-mortem diagnosis. In the old days people died of unknown causes. Today we only rarely have a patient die undiagnosed. When doctors ask the family for autopsy permission the answer is almost always no, so I say to you that Dr. Harris asked permission for the autopsy knowing full well that the odds were greatly in favor of the wife refusing. Smart move. Now Dr. Harris could say, “If I was hiding something why would I want an autopsy.” Admittedly that was taking a chance, but the odds were all in his favor, and now he’s got a good cover-up.”

Betty Wu said, “I understand what you say, but if he were really hiding something, a request for an autopsy now would really be risky. I don’t think I’d be that brave.”

“I’m not sure I would be either. Now let’s get on with the good news.”

“I’m ready.”

“I reviewed this chart minute by minute and made a judgment about Dr. Harris’s treatment as the patient’s clinical story unfolded. My suggestion for you is to take a week and study the report. Take notes and write down questions you may have. I would like you to prepare yourself by a careful study of my interpretation. When you’re ready, call my office and give my secretary some dates when you have the time for me to return. Then we’ll discuss my full report and I’ll answer any questions you may have. About three or four hours should do it. Does this sound like a good idea?

“Definitely. Thank you so much, doctor. I look forward to it.”

**********

Dr. John Velusi was the final interview by attorney Wu. A rapid-speaking man of short sentences, his comment was, “Dr. Harris did nothing wrong. The death was tragic, but not the fault of Dr. Harris. I’d be honored to defend him.”

The next potential witness for the defense of Dr. Madhava was Dr. Edward Torgerson, chairman of the anesthesia department at the University of Illinois. Paul Stuart met him in his downtown law office. Dr. Torgerson was dressed casually. A transplant from California, he didn’t believe in white shirt and tie. He stood five feet six inches tall, was partially bald, and his belly preceded him by six or seven inches.

“Good to see you again, Dr. Torgerson.”

As usual Dr. Torgerson got right to the point. “This case is bull-shit. I’ll take it. I’ll gladly defend Dr. Madhava. I hate to see a guy sucked into a case when he didn’t do a damn thing wrong.”

Without a moment’s hesitation Stuart said, “But he was reluctant to inject the heparin. They’ll pounce on him for that.”

“Let ‘em pounce. In the operating room, you legal guys have made the surgeon the captain of the ship. As long as he’s captain and passes out an order any failure to comply with that order by a subordinate is mutiny. Remember Captain Bligh? Dr. Madhava was a good member of the crew and did what he was told.”

“I understand.”

“I’m sure you do, but don’t allow yourself to fall into a trap that the plaintiff’s attorney will try and set.”

“What’s that, doctor?”

“They’ll try to set up an adversarial relationship between the surgeon and the anesthesiologist. There is not and can never be such a relationship. Don’t let them get away with that crap. If you do you’ll poison the mind of the jury and hurt your case. You can never stress enough that the anesthesiologist and surgeon are in the operating room for one purpose, and that is to work as a team, together with the nursing staff, for the benefit of the patient.”

“I see your point, doctor and it’s a good one that I’ll keep in mind.”

“Stress that teamwork whenever you can.”

“Have you always followed the order of a surgeon, doctor?”

“It’s not just simply following orders. It’s up to us anesthesiologists to decide what to use for a patient under each circumstance that arises. We don’t ask the surgeon. We’re the experts in all areas of sedation, and we use what we have to use based upon the constant monitoring of the patient’s physiological parameters and our review of his or her medical and therapeutic history. We take orders from the surgeon and carry them out under two circumstances.”

“What are they, doctor?”

Dr. Torgerson stood up and raised himself to his full five feet six inches, and walked toward attorney Stuart’s desk. He said, “This is important so take notes or make sure you don’t forget what I’m about to tell you. The plaintiff’s attorney will try and chew up the anesthesiologist on these points. First of all, if the surgeon’s order makes sense to us and we understand it and it doesn’t interfere or may cross-react adversely with what we’ve already given, we’ll do what the surgeon says without hesitation. Secondly if the surgeon gives us an order, as in this very unusual case, where we are dealing with a condition that most anesthesiologists have not experienced, then the order should be carried out. And Dr. Madhava did what any good anesthesiologist would do.”

“Are you saying, doctor that an anesthesiologist would have no experience with DIC?”

“I’m saying that the average anesthesiologist who limits his practice to the operating room may spend an entire career without ever seeing an acute case of DIC. I would agree with the surgeon’s quick diagnostic judgment in this case. He tried to reverse a fatal process. He should be given a medal for trying, not a lawsuit. Having said all that, there are anesthesiologists who may know a great deal about DIC.”

“Who are they, doctor?”

“It wouldn’t be relevant in this case, but there are anesthesiologists who specialize in intensive care. Some of them become intensive care directors and spend their working hours in the intensive care unit. There they see many patients who have the pre-conditions for developing DIC. Conditions such as sepsis, septic shock, malignant disease, gangrene, major surgical and obstetrical emergencies etcetera. Dr. Madhava, like most anesthesiologists, is not in this category, and don’t let the plaintiff’s attorneys suggest that all anesthesiologists are experts in DIC. The bottom line is that your client did exactly as he should have done and like a good crewman he followed orders.”

“Just out of curiosity, doctor, did you ever not follow a surgeon’s order?”

“Many times, but when I gave them my rationale, the great majority of surgeons saw the light and didn’t push me.”

“Great majority? You mean there were some that insisted on their order even after your explanation?”

“Yes.”

“What did you do?”

“I gave the surgeon a few words which translated as hell no. I used different terminology you understand; language I wouldn’t want a court reporter to have to take down. Then I invited him to take me before the quality committee where we could thrash it out.”

“Did they ever?”

“Never. And the patient didn’t get what the surgeon wanted either.”

“Very interesting. I think you’ll be a tough advocate for my client.”

“You can bet your ass I will. He deserves it.”