Facts

On Oct. 4, 2018 at 00:53 a.m., decedent, Movses Ter-Oganesyan, a 27-year-old, single man, the son of the plaintiff, presented as a walk-in to the Glendale Memorial Hospital for complaints of abdominal pain, constipation turning to diarrhea and tea-colored urine.

A CT scan of the abdomen without contrast was performed on Oct. 4, 2018 at approximately 3:00 a.m. while still in the emergency department, reported as consistent with bowel obstruction with apparent transition point in the region of the ileocecal valve. A nasogastric tube was placed in the emergency room. He was initially admitted to the medical/surgical floor.

When Dr. Mihranian first consulted at 2:19 p.m. on Oct. 4, 2018, he opined that decedent did not have a surgical abdomen following examination. Meanwhile, the patient was made NPO and placed on pain control, antibiotics, and IV hydration. Thereafter, when the patient became tachycardic, he was transferred to the ICU.

Among the many physicians examining him, at 6:36 p.m., infectious diseases physician Jean-Pierre Antaki, M.D. consulted, with culture and sensitivity pending, ordering amoebic tiers and placing the patient on Rocephin, Zithromax and Flagyl.

The patient reported a history that he had "returned from Armenia where apparently he has been drinking water there from streams and river and over the last day, he started developing increasing abdominal pain together with nausea and vomiting." His assessment was severe sepsis, gastroenteritis, dehydration and acute kidney injury.

Dr. Mihranian was still at the hospital and examined the patient again at 4:00 p.m. and 10:00 p.m. His blood pressure was 110-120 systolic. His abdomen was still distended, soft, tender and not surgical. The nasogastric tube was then working. His diagnosis was "toxic cause." He discussed and explained his findings to the patient and advised he would see him at 7:00 a.m. on Oct. 5, 2018. The patient's condition appeared to stabilize, resuscitated with fluids and albumin, the insertion of a Foley catheter and other efforts.

The patient suffered a Code Blue at 2:00 a.m. on Oct. 5, 2018, and Dr. Mihranian again saw the patient. The patient was intubated. The patient had severe acute respiratory distress syndrome (ARDS) and renal shutdown. His abdomen was distended and tender. The plan was for an exploratory laparotomy and possible bowel resection, with the importance of exploration for possible gangrene of the bowel explained and discussed with the family. The family's questions were answered, and they agreed.

Dr. Mihranian took the patient to emergency surgery early in the morning of Oct. 5, 2018, just before 3:00 a.m.. He found that the distal small bowel had necrosed. At surgery, Dr. Mihranian found that there was no bowel obstruction, that the patient never had a bowel obstruction. The radiologic interpretation of the earlier CT was equivocal. The patient had been suffering from definite diarrhea.

At 7:06 a.m. on Oct. 6, 2018, decedent coded, thought due to ischemic bowel, renal failure, and sepsis. He responded to chest compressions.

At 10:50 a.m., decedent coded again. Dr. Friedlander reviewed the patient's chest x-ray which showed clear evidence of overwhelming ARDS. The patient did not respond and was pronounced dead at 10:53 a.m. The family was present bedside during the second code and requested an autopsy.

The Los Angeles Coroner's Office performed an autopsy, which concluded that the death was natural, and the cause of death was septic shock (clinical) due to sequence of gastroenteritis (clinical).

A private autopsy was performed on Oct. 17, 2019 by Eugene R. Pocock, M.D., whose autopsy report attributed the death to "superior mesenteric venous thromboembolus, probably secondary to long airline travel and vascular stasis, infarction of small bowel with surgical removal and sepsis."

PLAINTIFF'S CONTENTIONS: Plaintiff alleged that Dr. Mihranian breached the standard of care by failing to order a CT with IV contrast or to perform an earlier emergency surgery on first examination.

DEFENDANT'S CONTENTIONS: Dr. Mihranian denied negligence and alleged that his care, treatment and interactions with plaintiff were reasonable, were not negligent and complied with the standard of care. Dr. Mihranian alleged that the patient's presenting condition was due to an enteric infection and was not a surgical condition. Dr. Mihranian also alleged that he did not cause any injury or harm to plaintiff, that the cause of death was septic shock due to sequence of gastroenteritis.

Insurer

Med Pro Group

Settlement Discussions

Defendant offered dismissal for a waiver of costs, each side to bear costs, fees and expenses, per Code of Civil Procedure §998.

Damages

Plaintiff's Alleged Economic Damages: The claimed economic damages were funeral and burial expenses, stipulated to be $50,000, not submitted to the jury. Plaintiff's Non-Economic Damages: Plaintiff claimed general damages of $250,000.00.

Injuries

Plaintiff alleged wrongful death.

Result

Defense verdict.

Deliberation

2 hours, 40 minutes

Poll

11-1

Length

11 days