Facts

His primary care physician, Mojtaba Sabahi, M.D., had followed Virgil Ealy, 72, with a history of hypertension and chronic renal insufficiency, since 2003. Ealy presented to the emergency department of Long Beach Memorial Medical Center (LBMMC) on July 17, 2008 with complaints of bilateral lower extremity swelling and pain as well as upper right quadrant pain. He was discharged in stable condition the following day after undergoing a number of tests with instructions to follow up his primary care physician.

On the morning of July 25, 2008, Ealy presented to Dr. Sabahi's office and was evaluated by Dr. Sabahi's physician's assistant at which time he was immediately referred to the emergency room for further evaluation and work-up due to low blood pressure.

While in the emergency room, Ealy was diagnosed with acute renal failure, uremia and a history of gout. He was given IV fluids, rehydrated, stabilized and eventually admitted to the hospital for further observation.

Once admitted, a nephrologist as well as Dr. Sabahi and his physician assistant initially followed Ealy. Ealy continued to remain stable and had no complaints of pain until the early morning of July 27, at which time he began to exhibit abdominal pain.

Dr. Sabahi examined Ealy and noted a change in his status, abdominal pain and distended abdomen with lympanetic sounds. A stat CT scan and a surgical consult were requested. Based on the CT scan results and surgical evaluation, it was recommended that Ealy undergo an exploratory laparotomy.

During the course of the procedure, the general surgeon found several perforations to Ealy's small bowel, which was repaired without difficulty. Ealy had a rocky postoperative hospital course that required intubation, but started to recover and was able to participate in physical therapy once extubated. During his rather lengthy hospital course, Ealy followed and monitor by a number of health care specialists including Dr. Sabahi, an infectious disease specialist, the surgeon, nephrologist, cardiologist, as well as the hospital's occupational and physical therapists in conjunction with a speech therapist.

In the early morning of hours of Sept. 3, 2008, Ealy vomited and aspirated leading to the development of aspiration pneumonia. He passed away on Sept. 4.

PLAINTIFFS' CONTENTIONS:
Plaintiffs' expert, James Lineback, M.D., testified that Dr. Sabahi failed to diagnose a "leak," or impending perforation during the first two days of the July 25, 2008 admission. This allowed for additional bowel contents to enter the peritoneal cavity causing damage to Decedent, which could have been avoided with earlier diagnosis and treatment. Plaintiffs also contended that Dr. Sabahi was negligent in that he treated the decedent with improper pain medications following the surgery, which led to the compromise of his gag-reflex, which in turn allowed him to aspirate.

DEFENDANT'S CONTENTIONS:
It was the defendant's contention that had the decedent presented with a leak or perforation upon admission, there would have been tell-tale signs, such as abdominal pain, present upon physical examination. None of the many healthcare providers examining the patient documented that the decedent was in any pain prior to the early morning hours of July 27, 2008. In addition, the decedent had undergone a renal ultrasound on July 25, 2008. Had there been a perforation at that time, evidence of the perforation would have been seen and reported. As for the post-operative administration of narcotic pain medication, it was the defendant's contention that the Fentanyl (transdermal patch) was not contraindicated. The decedent had already received Fentanyl via IV drip for approximately 10 days post operatively and had shown that he could tolerate this medication. The patch was administered at lower doses while the patient was under observation in the hospital's telemetry unity. In addition, the patch was discontinued approximately three weeks prior to the patient aspirating. As such, there was no significant Fentanyl remaining in the decedent's system as of Sept. 2, 2008. The medical records also showed that the decedent had a strong gag-reflex as of Sept. 2. As such, there was no causal link between the administration of the Fentanyl patch and aspiration.

Result

Defense verdict.

Other Information

Plaintiffs' motion to tax cost was denied. FILING DATE: Dec. 3, 2009

Deliberation

one hour.

Length

nine days