Facts

Ryan Larkin and Jessica Larkin sued the Regents of the University of California and Drs. Oscar Hines and Barbara Kadell, involving the death of their mother, Deborah Larkin.

Plaintiffs were decedent's adult children. Prior to trial, plaintiffs dismissed the individual defendants and proceeded to trial against the Regents of the University of California only.

PLAINTIFFS' CONTENTIONS:
In 2011, the decedent, 44, underwent her first hernia repair. On Nov. 18, 2013, the decedent underwent a second laparoscopic hiatal hernia repair at the Ronald Regan UCLA Medical Center. The redo repair was performed by Dr. Hines with the assistance of a 4-year resident, Dr. Chow. During the surgery, a gastrotomy (hole in the stomach) occurred that was repaired by Dr. Hines. On post-operation day one, she was complaining of severe pain that was not responding to Dilaudid. This was attributed to the patient's addiction to pain medication, and a pain management consult was obtained. While on post-operation day one, there were occasions when the patient was tachycardic, she worsened considerably on the morning of Nov. 20 (post op day 2). In addition to ongoing abdominal pain she became persistently tachycardic, her sodium level dropped to an abnormal 120 (normal 135-145), her white blood count was abnormally high, and she had become hypotensive, with her blood pressure down to 81/50 at 7:44 am. As the day went on her creatinine level rose from a normal .8 on admission to 1.8 by 11:40 am. Because of the hyponatremia a renal consult was obtained and the nephrologist's assessment was sepsis. At 1:11 p.m., Dr. Chow sent an email to Dr. Hines who then told Dr. Chow to have a gastrografin swallow study done. The study was done and did not show a leak. After the study was done, the patient was returned to the med surgical floor. Laboratory results that afternoon showed a declining CO2 level and an increased lactate level that showed the patient to be in metabolic acidosis. Despite the patient's worsening condition, she remained on the med surgical floor for the next 14 hours without any further attempt at all to identify the source of her infection and sepsis. On Nov. 21, at about 4:30 a.m., the patient's systolic blood pressure dropped into the 80's again for the first time since about 21 hours earlier (it had been mostly in the 90s during those 21 hours). She was then taken to the ICU with an altered mental status, in respiratory distress, and in kidney failure. She required intubation in the ICU, and at about noon of Nov. 21, Dr. Hines performed an exploratory laparotomy that revealed a 4-millimeter gastric leak to be the source of the infection and her profound septic shock. Copious amounts of bile were found in all four quadrants of the abdomen. She was in critical condition going in and out of this surgery. After the surgery, she remained in the ICU, never being able to go off the ventilator or pressors, and with continuing leakage, for the next 27 days until she was disconnected from life support and died on Dec. 27.

DEFENDANTS' CONTENTIONS:
Defendants claimed that the doctors' conducts were within the standard of care.

Settlement Discussions

Long before the trial date plaintiffs made a CCP 998 offer to settle for $250,000. Defendant did not respond to the 998 offer and made no offer to settle the case.

Damages

Plaintiffs did not live with their mother and were not economically dependent on her at all, making this strictly a noneconomic damage case with a MICRA cap of $250,000.

Result

The jury found the Regents negligent and that its negligence was a substantial factor in causing plaintiffs' harm. The jury, which was not informed of the MICRA cap, found for plaintiffs and awarded noneconomic damages in the sum of $1,750,000. Pursuant to MICRA the court reduced the jury verdict to $250,000 and entered judgment in favor of plaintiffs in that amount. The judgment, plus costs of $30,815.15, for a total of $280,815.15, has been paid in full.

Other Information

EXPERT TESTIMONY: Plaintiffs had one expert, Dr. Leo Murphy, a general surgeon from San Diego. Dr. Murphy's principal opinions were that when the patient went into shock the morning of Nov. 20 the standard of care required immediate transfer of her to the ICU for resuscitation and proper monitoring with a central venous line, source identification and source treatment. He also testified that Dr. Hines was below the standard of care for not doing a CT scan after the swallow study did not show a leak, for the source of the infection, sepsis had not been identified, and time was very much of the essence in identifying and treating the source. Dr. Murphy also testified that Dr. Hines was below the standard of care if he did not see the patient during the time between the first and second surgeries. Although Dr. Hines claimed that he saw her every day, there was no documentation of his own, by a nurse, or by orders made directly by him of his seeing her during that time. The defense had two experts, infectious disease specialist Howard Pitchon and general surgeon Moses Fallas. Dr. Pitchon testified that the patient had urosepsis (a diagnosis that was never made by the nephrologist or anyone else at UCLA) from a proven urinary tract infection and did not start to leak the morning of Nov. 20, a position that was contradicted not only by Dr. Murphy, but also by Dr. Fallas and even Dr. Hines. He also claimed, based on the autopsy, that the patient's organs were not damaged except for her lungs that showed ARDS, and that there was no treatment for the ARDS once it occurred. Dr. Pitchon did admit that the ARDS was caused by the sepsis. Dr. Fallas testimony was that it was within the standard of care to rely on the swallow study and not do anything else that day to identify the source of the leak, to observe the patient, and if she was not better the next morning then do the CT scan Dr. Murphy said should have been done right after the negative swallow study. FILING DATE: Dec. 19, 2014.