Facts

Decedent, Mayra Ibarra Reynoso, age 30, gave birth to her fourth child on May 27, 2015. On June 12, 2015, she presented at the emergency room of Mercy Southwest Hospital in Bakersfield, complaining of chest tightness, shortness of breath, and dizziness. EKG was abnormal for possible myocardial infarction. An echocardiogram showed pericardial effusion with threatened cardiac tamponade. This hospital had no cardiac surgery program, and therefore the patient was transferred to Bakersfield Memorial Hospital ("BMH") which did. ER physician made arrangements with the ER physician at BMH and the cardiac surgeon on call to admit to ICU for possible surgical intervention to prevent tamponade.

On June 13, 2015, the cardiac surgeon asked for a cardiology consultation from defendant Thomas Wen, M.D. Dr. Wen, along with the surgeon and intensivist followed the decedent in ICU from June 13-15, during which she never had chest pain, shortness of breath, or abnormal vital signs. Her cardiac marking testing results were abnormal but improving. Pericardial effusion was monitored with serial echocardiograms and did not progress. The intensivist decided on the evening of June 15 to transfer the patient to Telemetry Unit, due to her improved condition. The morning of the 16th, the decedent was eating, talking, and eager to go home. She got up to use the restroom and did not come out. Mr. Martinez, the father of all four children, called a nurse, who forced open the bathroom door, and found the patient on the floor in cardiac arrest. Despite Code Blue and 50 minutes of resuscitative efforts, the decedent expired.

PLAINTIFFS' CONTENTIONS: Plaintiffs claimed that as the cardiology consultant, Dr. Wen was making all of the important decisions. The surgeon was just waiting for direction from Dr. Wen to surgically intervene. Defendant should have ordered an angiogram. Had he done so, it would have revealed that the left anterior descending coronary artery had dissected, causing a distruiption of blood flow to the anterior left ventricle. That part of the heart infarcted and was at risk of rupture. The angiogram would have showed this defect as well. Immediate surgery would have by passed the blocked artery and a patch could have been sewn over the ventricular defect, preventing the wall from rupturing.

Had this been done, the patient would have survived surgery and had a normal life expectancy as she had no history or evidence of heart or artery disease and was only 30 years old.

DEFENDANT'S CONTENTIONS: Defendant denied any negligence. Defendant claimed that the life-threatening crisis at the time was the pericardial effusion which was likely due to the resolution of an old myocardial infarction or a viral infection. If the fluid increased, the patient could experience cardiac tamponade which would require immediate surgery to relieve the pressure on the heart or death will result. The EKGs, resolving cardiac marker testing and the patient's clinical condition suggested an infarct that was complete and needed no immediate treatment, as restoring blood flow to "dead" heart tissue would have accomplished nothing. Therefore, an angiogram was not indicated and could be risky. The rupture of the ventricle was entirely unforeseeable and not preventable.

Settlement Discussions

On June 14, 2017, plaintiffs served a a CCP 998 Offer to Compromise on defendant in the amount of $500,000. On Oct. 11, 2017, Plaintiffs served a CCP 998 Offer to Compromise on defendant in the amount of $375,000. Both Offers to Compromise were rejected. On Dec. 14, 2021, plaintiffs made a demand of $1 million (policy limits) which would expire once closing arguments began (scheduled for Dec. 16, 2021). On Dec. 17, 2021, defendant offered $500,000.

Damages

Plaintiffs, ages 6 through 19 at the time of trial, claimed loss of past and future financial support and loss of past and future household services provided to them by decedent. Decedent was employed as a medical assistant in an local HMO. Based upon their expert economist's testimony, plaintiffs asked the jury to award $1,206,197 in past and future economic damages. The also asked the jury for $500,000 in past and future non-economic losses.

Result

The jury returned a verdict finding that Dr. Wen was not medically negligent, by a vote of 10 - 2.

Other Information

An autopsy limited to the chest cavity was performed. Based upon the findings and upon examination of the tissue slides taken at autopsy, defendant's pathology expert opined that decedent experienced an exceedingly rare case of arteritis, which caused the dissection of the left anterior descending artery (less than 30 such cases reported in the world-wide medical literature). Examination of the tissue slides revealed the occlusion and resultant damage to the left ventricle probably occurred up to 14 days prior to death. The effusion was due to the healing process (scarring over of the infarcted heart tissue). If dead heart tissue ruptures, it usually does so within 3-5 days of the event, and therefore rupture 14 days after the heart attack was not foreseeable. The autopsy revealed no other evidence of heart or vessel disease.

Deliberation

2.5 days

Poll

10-2