Confidential

Facts

Plaintiff John Doe initially presented to Dr. Roe on June 15, 2010. In his pre-procedure gastroenterology consultation with Dr. Roe, the doctor noted that plaintiff presented with abdominal pain while taking medications. Plaintiff also had a history of male breast cancer diagnosed and treated 6 and a half years prior. Plaintiff reported burning in the mid-abdomen and throat, and recently, the onset of adult asthma, with one year of asthma symptoms plus occasional cough. He reported four cardiac stents and the use of Plavix under the care of his cardiologist. His cardiologist had performed a cardiac catheterization on July 28, 2009. Plaintiff had undergone another cardiac catheterization, performed by his cardiologist, on Sept. 8, 2009.

Dr. Roe advised plaintiff that there was an increased incidence of second primary cancer in most patients with male breast cancer. Because of his history and his reports of abdominal pain, Dr. Roe advised plaintiff that it would be reasonable to perform a gastric mapping, which was described as an intensive biopsy throughout the entire stomach to evaluate for intestinal metaplasia. Dr. Roe authored a handwritten progress note that indicated that he discussed the risks of stopping aspirin and Plavix before the procedure.

Dr. Roe noted that the medications being taken included aspirin and Plavix, and that they were discussed. Dr. Roe noted that he advised that current data demonstrated increased risk of myocardial infarction if Plavix was stopped. He advised that the risk of bleeding was increased, but that stopping Plavix increased the risk of myocardial infarction, and was potentially more deadly than continuing with the procedure while on Plavix. Plaintiff understood the risks involved and questions were answered. Then plaintiff was scheduled for gastric mapping.

Plaintiff signed the consent to undergo an esophagogastroduodenoscopy with possible biopsy, polypectomy and hemostatic. Plaintiff underwent an upper panendoscopy with biopsy performed by Dr. Roe on June 17, 2010.

On June 18, 2010, plaintiff presented to the emergency room with complaints of three episodes of syncope that evening. He was admitted for an acute upper gastrointestinal bleed and acute anemia. He was discharged on June 21, 2010.

PLAINTIFF'S CONTENTIONS:
Plaintiff claimed that Dr. Roe should not have performed the gastric mapping because plaintiff's cardiologist told him he could not do biopsies on plaintiff and because Dr. Roe knew plaintiff was taking aspirin and Plavix. Plaintiff asserted that Dr. Roe did not consult with plaintiff's cardiologist prior to the gastric mapping, which was below the standard of care and resulted in the performance of a procedure that plaintiff's cardiologist would have disallowed under the circumstances. Plaintiff further claimed that defendant's negligence has increased his anxiety and emotional distress over his personal health.

DEFENDANT'S CONTENTIONS:
Dr. Roe denied liability and claimed that plaintiff needed to remain on aspirin and Plavix at the time of the procedure. Plaintiff was changing insurance and was losing his deductible, and therefore wanted the procedure soon. Dr. Roe claimed it was appropriate to evaluate plaintiff with a gastric mapping procedure given plaintiff's history. In order to acquire an accurate diagnosis, biopsies were required. It was within the standard of care to perform the procedure with biopsies while plaintiff remained on anticoagulation therapy. Dr. Roe further claimed that it was not necessary for him to consult with plaintiff's cardiologist when there was no plan to discontinue plaintiff's dual antiplatelet therapy.

Dr. Roe authored a post procedure note on the day of surgery. He documented that he spoke to the patient's cardiologist who advised that he did not want the patient's aspirin and Plavix discontinued and did not want the proton pump inhibitor started secondary to reduction in the Plavix efficacy. The cardiologist felt that the risk of major morbidity/mortality was higher with the patient off of these medications that it continuing. Dr. Roe discussed these recommendations with plaintiff and plaintiff's wife in the recovery room. Plaintiff elected to follow the cardiologist's recommendations. The discharge instructions, written in a nurse's handwriting, indicated that the patient should start taking his Plavix the day of the procedure as per his cardiologist and Dr. Roe.

Plaintiff was hospitalized for four days following the surgery, where he was transfused, and then fully recovered. No damages were claimed following the hospitalization.

Settlement Discussions

Plaintiff made a CCP 998 demand for $30,000. Defendant made no offer.

Specials in Evidence

$23,000 past medical and $2,300 out of pocket expenses

Result

Defense verdict.

Other Information

INSURER: The Doctor's Company insured Dr. Roe. FILING DATE: June 15, 2011.

Deliberation

half day

Poll

11-1 (defense)

Length

11 days