Facts

On June 13, 2011, plaintiff Jane Doe, 40, presented to defendant Roe hospital with abdominal pain, nausea and vomiting. She had a history of both gastric bypass surgery and lap banding. The ED physician suspected that her pain was associated with her lap band procedure. She was treated for pain and discharged home with instructions to see her surgeon and return if her condition worsened.

On June 15, plaintiff returned to the ER at defendant hospital with severe abdominal pain assessed at 10/10. Dr. Christopher Angemi, D.O., who consulted gastroenterologist Dr. Roe, saw her. Dr. Roe believed that plaintiff could have a bleed due to her anemia and complaints. He testified that he recommended to the ER doctor that a surgical consult be obtained and agreed with the recommendation for plaintiff to be admitted. The hospital did not have a bariatric program, nor did it have access to any bariatric surgeons for consultations. No one attempted to contact plaintiff's private physician despite being provided the contact information at the time of presentation.

The next morning, Dr. Zoe, a hospitalist, performed the initial history and physical and followed plaintiff during her hospitalization. He believed that plaintiff most likely had regional enteritis and severe anemia. He ordered a CT scan. However, a CT scan could not be obtained because plaintiff was in severe pain and unable to lie flat. The hospital staff did not contact the attending physicians when they were unable to obtain the CT scan secondary to plaintiff's complaints of pain.

On June 17, plaintiff's stool was black and positive for blood. Nursing staff failed to record vitals for up to 12 hours at a time. When vitals were recorded, plaintiff's vitals were continuing to deteriorate as she developed tachycardia and low blood pressure.

Dr. Roe continued to follow plaintiff and performed an endoscopy on June 18. By this time, plaintiff was developing difficulty breathing and was severely anemic. During the procedure, plaintiff's condition deteriorated, as she became hypoxic, requiring emergency intubation. She was transferred to ICU where she was found to be septic. A surgical consult was ordered that day. Later in the evening, plaintiff was seen by Dr. Poe, a general surgeon, who had no surgical experience with bariatric patients. The June 18 CT revealed bibasilar atelectasis, bilateral pleural effusions, moderate to large ascites and a small bowel obstruction. Ultrasound revealed diffuse free fluid in the abdomen, a cystic area in the right upper quadrant and dilated bowel. She also contracted Methicillin-resistant Staphylococcus aureus nares.

On June 19, Dr. Poe saw plaintiff again and reviewed the CT findings. He discussed with the family finding a bariatric surgeon for emergent surgery.

On June 20, plaintiff was finally transferred to a hospital with a bariatric program for emergency surgery. During that surgery, it was revealed that essentially her entire bowel was found to be dead as a result of a bowel torsion at the site of the sutures from her prior gastric bypass surgery. She had gangrene of the entire jejunum and ilium except for a total of 10 centimeter. She has undergone multiple repair surgeries.

PLAINTIFF'S CONTENTIONS:
Plaintiff alleged that her presentation on June 15 required immediate consultation with a bariatric surgeon. A general surgeon would not have the expertise and training to recognize plaintiff's abdominal complaints as a potentially known complication of gastric bypass surgery. As a result of the failure of the physicians to recognize the complication, and their failure to consult an appropriately trained bariatric surgeon, the delay in treatment caused irreversible ischemic damage to most of plaintiff's bowels.

Plaintiff also alleged that the hospital failed to have a system in place to identify patients who require services, which the hospital could not provide, specifically bariatric services. The hospital failed to recognize a patient in their facility as one, which required services not available whose condition was rapidly deteriorating.

Plaintiff claimed that the hospital staff failed to monitor plaintiff properly, and failed to go up the chain of command when plaintiff's condition deteriorated and the physicians were not appropriately intervening.

DEFENDANT'S CONTENTIONS:
All settling defendants contended that they met all applicable standards of practice and care, and that a bariatric surgeon was not required by the standard of care to treat plaintiff's condition or that she been transferred to another facility.

Defendant also contended there was nothing in her condition that signaled the need for a surgical consult until June 18, and that by then it was too late to make a difference.

Dr. Angemi claimed that other settling defendants violated the applicable standards of practice and care but he did not. Several of Dr. Angemi's experts testified that plaintiff required a surgical consult on June 15, and that had she received the surgical consult, she would have been taken to surgery and would not have suffered any of the injuries and damages she now has. However, they testified that the responsibility for getting this surgical consult fell to other doctors, not Dr. Angemi.

Settlement Discussions

Shortly after Dr. Roe, Dr. Zoe and Dr. Poe were deposed, plaintiff served each with a demand pursuant to CCP 998 for their respective $1 million insurance policies. All three consented to settle, and they tendered their policies. Dr. Angemi responded by offering $25,000 and then $50,000, both of which were rejected. On Dec. 18, 2014, plaintiff, Roe hospital and Dr. Angemi went to mediation before attorney Robert N. Dobbins of Judicate West Inc. As a result of the mediation, plaintiff's claims against the hospital were settled for a total payment of $6 million. Dr. Angemi's highest offer was $250,000, and was rejected by plaintiff. Total settlement as to all parties except Dr. Angemi was $8,999,998. Plaintiff served a CCP 998 offer of $1 million policy limits on Dr. Angemi. As of the time of the mediation, Dr. Angemi had given his written consent to settle the case. Plaintiff offered another opportunity to Dr. Angemi and his carrier to tender his applicable policy. They refused. On June 15, 2015, plaintiff proceeded to trial solely against Dr. Angemi. Defendant first demanded and received a trial on the statute of limitations issue, which was heard by an advisory jury and decided in favor of the plaintiff by the judge. Upon the judge's ruling, Dr. Angemi tendered his $1 million policy limits. Plaintiff rejected the offer, and countered with a $3 million offer to settle.

Damages

At the time of the incident, plaintiff was a union member for the Pacific Maritime Association as a longshoreman. Plaintiff's projected loss of past and future income was $3,571,093. Plaintiff's past medical expenses was covered by a self-funded ERISA plan. To date, the ERISA plan has paid out more than $3.3 million in medical and disability benefits on plaintiff's behalf. Future medical and related expenses were calculated between $12.7 million and $21 million, present value. Dr. Angemi disputed the nature and extent of plaintiff's damages. They projected lost income/benefits of $1,787,205. Defendant believed plaintiff could return to work, at least part time, and that her medical and related expenses were significantly less, calculated by their economist at $2,628,190.

Injuries

Plaintiff claimed short bowel syndrome requiring parenteral nutrition and gastrostomy tube feedings for the rest of her life.

Result

Defense verdict in favor of Dr. Christopher Angemi, D.O.

Other Information

VERDICT DATE: ________________ MEDIATOR: Robert Dobbins, Judicate West Inc.