Facts

Plaintiff Leeann Standlee had a complex medical history requiring use of Coumadin, an anticoagulant since 1998. Use of Coumadin requires monitoring of INR for assessing the thickness/thinness of blood. Too low of an INR can result in clotting risk, while too high of an INR can result in bleeding risk. Standlee's anticoagulation therapy was managed briefly by the Coumadin Clinic at Scripps Clinic in 2000, and was then managed by various outside providers until March of 2009, when she returned to the Scripps Clinic Coumadin Clinic for anticoagulation management.

On Nov. 16, 2010, Standlee presented to a physician at Scripps Clinic with symptoms of sinus infection, who prescribed Augmentin, an antibiotic. Standlee tested her INR value on Nov. 26, and obtained an elevated value of 8.0. A Coumadin Clinic pharmacist called her the next day and left a message to inquire as to the cause of the elevated INR, and advised to go to the emergency room with any severe bleeding or bruising. On Nov. 28, Standlee presented to the emergency room with a severe headache and it was discovered she had a subdural hematoma. She subsequently underwent craniotomy.

PLAINTIFF'S CONTENTIONS:
Plaintiffs claimed the care and treatment by Scripps Clinic's Coumadin Clinic fell below the standard of care. Standlee testified she did not recall various physicians discussing the risk of bleeding with use of Coumadin, or the risk of drug interactions between Coumadin and antibiotics. She testified she had absolutely no understanding she was obligated to inform the Coumadin Clinic of newly prescribed medications due to potential drug interactions. Plaintiffs' expert, Dr. Michlin, testified the Coumadin Clinic had a duty to reach the patient on Nov. 26 when an elevated INR value of 8.0 was obtained. Further, the pharmacist was obligated by the standard of care to review Standlee's medical record at the time, which would have revealed a complaint of headache from two days prior. Plaintiffs alleged violation of policies and procedures, and a deficient on-call system for INR values drawn over the weekend, which purportedly resulted in subdural hematoma and related damages. Dr. Michlin characterized Standlee's actions of ingesting excess Coumadin and disobeying physician recommendations as "crazy" and asserted intervention was required.

DEFENDANT'S CONTENTIONS:
Standlee initially went to a lab to obtain INR values. However, she had substantial difficulty going to the lab due to childcare responsibilities, missed multiple lab appointments, and the Coumadin Clinic assisted her in arranging for a home INR monitor for ease of testing. During her management by the Coumadin Clinic, Standlee had several instances in which she unilaterally took unprescribed medications without advising the Coumadin Clinic. On one occasion, she ingested excess doses of Coumadin, had a headache, and was told by the Coumadin Clinic of the possibility of intracranial hemorrhage and urged to seek medical attention at Urgent Care.

Defendant contended that the physician instructed Standlee to follow-up with the Coumadin Clinic, as antibiotics may have adverse interactions with Coumadin. Standlee did not do so. On Nov. 24, 2010, Standlee returned to Scripps Clinic, she was seen by another physician, again with sinus pressure, as well as eye pain. She was prescribed another course of Augmentin and advised to follow-up with the Coumadin Clinic due to potential drug interactions.

Defense expert Dr. Howard Williams testified the standard of care was met in all respects. He testified the on-call system was appropriate and offered more accessibility than most Coumadin Clinics. He testified Standlee was capable of understanding and following instructions, and was informed of potential drug interactions. He testified that while there is a recognized interaction between Augmentin and Coumadin, Augmentin would not typically elevate the INR to 8.0, and based on Standlee's past history of self-medicating on various occasions, he believed the cause of the elevated INR on Nov. 26 was due to excess ingestion of Coumadin, not due to drug interaction with Augmentin. Dr. Williams testified Standlee had a history of somatization and severe pre-existing headaches, and craniotomy did not cause the headaches or complaints currently reported by the patient.

Damages

Plaintiff Standlee claimed past and future non-economic damages consisting of pain and suffering. She claimed medical negligence resulted in subdural hematoma and need for craniotomy. She alleged persisting, severe, left-sided headaches from the craniotomy. Frank Meram claimed loss of consortium. Plaintiffs identified out-of-pocket medical bills totaling approximately $35,000.

Result

Defense verdict  

Other Information

FILING DATE: Nov. 22, 2011.

Deliberation

three hours

Length

five days