"PA Jury Awards Nearly $2.2 Mil. in Missed Diagnosis Case"

May 18, 2009 - A jury in Philadelphia Common Pleas Court has returned a verdict of nearly $2.2 million to the wife and estate of a 51-year-old man who died after doctors failed to diagnose and treat him for a heart condition.

After about eight hours of deliberation following an almost two-week trial, the jury returned a verdict of $2,185,000 in Judge Patricia McInerney's courtroom May 11.

According to the plaintiff's pretrial memorandum, plaintiff Zachary James died when his undiagnosed aortic aneurysm ruptured.

In James v. Skobeloff, James was admitted to St. Joseph's Hospital's emergency department around 8:30 a.m. April 20, 2006, with chest and back pain and elevated blood pressure, according to the plaintiff's memorandum.

Defendant Dr. Thomas Powell ordered a chest X-ray that was performed later that morning and an echocardiogram that was performed around noon, the plaintiff's memorandum said.

Defendant Dr. Emil Skobeloff then took over for Powell after Powell left the hospital to attend a meeting, the plaintiff's memorandum said.

It was Skobeloff's first day of work at the hospital, and he was scheduled to be orientated by Powell, the plaintiff's memorandum alleged, but the orientation never happened because Powell left the hospital.

Skobeloff testified he could not find the chest X-ray performed earlier on James and that he searched for it, though there is no notation of this on the hospital chart and hospital personnel testified that Skobeloff never asked them to help him find the film, according to the plaintiff's memorandum.

Ten hours after his admission, James died, the plaintiff's memorandum said.

Despite the hospital's policy at the time that emergency department doctors were to initially interpret X-rays and then have a radiology technician submit them to the on-duty radiologist for review, the film wasn't submitted to and reviewed by a radiologist until the next morning, according to the plaintiff's memorandum.

Because there was no cardiologist on duty the day James died, cardiologist Dr. David Knox reviewed James' echocardiogram the next day as well and found, among other warning signs, "severe aortic insufficiency," which Knox testified requires immediate attention, according to the plaintiff's memorandum.

Skobeloff testified that he was aware that the echocardiogram showed aortic insufficiency but that the technician who performed the study did not indicate the severity of it, the plaintiff's memorandum said.

At about 2:30 p.m. on the day of James' death, a second set of labs had found increased CK and Troponin I levels, which are considered "critical values," but James never received any treatment, according to the plaintiff's memorandum.

Skobeloff testified that he asked Dr. Gene Newton to evaluate James, thinking Newton was Knox, the cardiologist, but Newton denied ever speaking to Skobeloff and said he was never notified that James was admitted to his care, the plaintiff's memorandum alleged.

Around 5:20 p.m. on the night of his death, James was moved from the emergency department to the telemetry unit under Newton's care but, despite hospital policy, was never evaluated by Newton or by a house physician, the plaintiff's memorandum said.

At about 7:35 p.m., James died, the plaintiff's memorandum said.

Plaintiff's expert Dr. Jeremy Brown said in his report that "the emergency department care, including the physicians and nursing staff caring for the patient, fell below accepted standards of care."

The plaintiff's vascular surgical expert, Dr. Robert C. Villare, internal medicine expert Dr. Paul Genecin, hospital consultant expert Dr. Samuel H. Steinberg and nursing expert Barbara Money Dewees all agreed.

Skobeloff said in his own settlement memorandum that as an emergency medicine specialist it was not his responsibility to provide long-term or continuing care, but rather to request a timely consult, which he said he did.

The hospital, in its own pretrial memorandum, said Skobeloff had all the resources he needed to make a proper diagnosis but failed to do so.

Powell, in his pretrial memorandum, said Skobeloff had already been orientated during an eight-hour shift he worked five days prior to the incident and that even if he hadn't, he was a board certified emergency medicine specialist familiar with general emergency department protocol.

Powell also said in his pretrial memorandum that he fulfilled his duty by discussing the "concerns and expectations" for each of the emergency department patients with Skobeloff before leaving the hospital for his meeting.

Both Skobeloff and the hospital also argued that even if doctors had been able to perform the aortic surgery James required, the mortality rate for the procedure was still very high.

The plaintiff's economic expert, David L. Hopkins, evaluated James' wrongful death damages at between $624,000 and $1.9 million.

James' wife's attorney, Stephen J. Pokiniewski Jr. of Anapol Schwartz Weiss Cohan Feldman & Smalley in Philadelphia, said there had been a mediation session but that no real settlement demands or offers were made.

According to the jury verdict questionnaire as marked by Pokiniewski, the jury apportioned the verdict so that the hospital must pay 16 percent of the total $2,185,000, Skobeloff must pay 36 percent and Powell must pay 48 percent.

According to The Legal 's calculations, that means the hospital is responsible for $349,600, Skobeloff is responsible for $786,600 and Powell must pay the balance of $1,048,800.

Pokiniewski said he felt the jury's verdict was a "substantial sum," especially considering the fact that James' prognosis would not have been good even if he had been timely diagnosed and treated.

Powell's attorney, Lawrence M. Silverman of Spector Gadon & Rosen in Philadelphia, could not be reached for comment, nor could St. Joseph's Hospital's attorney, Benjamin A. Post of Post & Post in Berwyn, Pa.

Skobeloff's attorney, Steven D. Costello of Post & Schell in Allentown, Pa., said "this was a very complicated case with a lot of legal and factual issues and we will be covering those in our post-trial motions."

"We were able to present a strong factual defense on behalf of Dr. Skobeloff but this admittedly was a very tragic and sympathetic case," he said.

 

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