Facts

Elsa Crabtree was 62 years old when she presented in the emergency room at Garden Grove Hospital Medical Center on Feb. 3, 2015 following a fall at home. Her medical history was significant for diabetes, and she indicated that her diabetic neuropathy was felt to cause bilateral lower extremity weakness and numbness, possibly contributing to her fall. A CT scan of the lumbar spine revealed diffuse degenerative disc disease with spinal canal stenosis at L2-5. In light of these findings, it was decided that the patient would be admitted to the hospital under the care of Dr. Asaad Hakim, who would obtain a neurosurgery consult from Tien Nguyen, M.D.

The patient was placed on sequential compression devices on Feb. 4, 2015 by defendant Dr. Hakim to reduce the risk of deep vein thrombosis formation, but the patient was not given low dose heparin for that purpose given the probability of spine surgery within the next few days. Tien Nguyen, M.D., did proceed the patient to surgery for a posterior lumbar laminectomy on Feb. 7, 2015, and again ordered sequential compression devices as post-operative DVT prophylaxis rather than low dose heparin.

Crabtree remained in the hospital through Feb. 10, 2015, without obvious symptoms of a deep vein thrombosis. However, she was unable to participate in physical therapy in any meaningful fashion, due to pain in her lower back and legs, and developed a dramatically elevated white blood cell count and uncontrolled blood sugars. Despite those developments, Crabtree was transferred to a skilled nursing facility for further rehabilitation and therapy on Feb. 10, 2015. On Feb. 12, the patient became suddenly unresponsive and expired. An autopsy revealed the cause of death to be a pulmonary embolism from a DVT in the left leg.

Plaintiff was decedent's adult daughter.

PLAINTIFF'S CONTENTIONS:
Plaintiff contended that Dr. Hakim and Mary Alessi breached the standard of by failing to place the patient on low dose heparin as DVT prophylaxis before and after surgery, and failing to ensure that the sequential compression devices were utilized throughout the majority of each day. Plaintiffs claimed that defendants failed to investigate the post-operative complaints of severe leg pain, including the order of a venous Doppler ultrasound, and discharged the patient to a skilled nursing facility without first determining the cause of the patient's post-operative severe leg pain, elevated white blood cell count and elevated blood sugars.

DEFENDANT'S CONTENTIONS:
Defendants contended that low dose heparin was contraindicated for DVT prophylaxis in a patient before and after spine surgery, and that sequential compression devices were an appropriate alternative for DVT prophylaxis. There was no evidence that defendants themselves were made aware of any failure to utilize the sequential compression devices as ordered. The patient did not present with the typical signs and symptoms of a DVT, and for that reason a venous Doppler ultrasound of the lower extremities was not indicated. Defendant also contended that the patient was ready for transfer to a skilled nursing facility on Feb. 10, 2015, and that the patient's complaints of severe post-operative pain were normal following spine surgery. The elevated white blood cell count was felt to be secondary to atelectasis, and could be followed at the skilled nursing facility, as could continued efforts to control the patient's elevated blood sugars.

Damages

A claim for the statutory maximum of $250,000 in non-economic damages was asserted, along with a claim for $60,000 in economic damages.

Injuries

Death of a beloved mother and grandmother, who also provided significant household services to the family and to the family business.

Result

Defense verdict in favor of Dr. Hakim and Alessi and against the plaintiff, Kathy Cervantes.

Other Information

INSURER: The Doctors Company insured defendants. FILING DATE: July 28, 2015.

Deliberation

105 minutes

Poll

12-0 (on negligence in favor of Dr. Hakim and Alessi)