About Us
News / Success
July 21, 2010
Medical Malpractice Defense Verdict
After a three-day trial, Michael E. Olszewski and Tracie M. Dorfman, obtained a defense verdict for the defendant hospital in a case of alleged medical malpractice.
On March 1, 2007, plaintiff underwent a radical neck dissection and laryngectomy for treatment of stage 4 laryngeal cancer. The surgery took approximately ten hours. On March 2, 2007 at approximately 8:30 a.m., the defendant hospital’s ICU nurse noted that the plaintiff had purple mottled feet bilaterally which she recognized to be a sign and symptom of vascular compromise. She contacted plaintiff’s surgeon who instructed her to continue to monitor the plaintiff and that he would be in to see the plaintiff at 12:00 p.m. At approximately 12:00 p.m., the surgeon examined the plaintiff and informed the defendant hospital’s nurse that he would obtain a vascular surgery consultation. The defendant’s nurse continued to monitor the plaintiff and when the vascular surgery consultation did not arrive, the defendant’s nurse contacted the attending surgeon to inquire. She was assured that the vascular surgeon was on his way. At approximately 2:00 p.m., plaintiff’s family physician examined him and did not perceive his condition to be emergent. He ordered an arterial Doppler study to examine the plaintiff’s blood flow in the legs. The defendant hospital’s nurse did not receive the Doppler results until 6:00 p.m. at which time she updated the family physician. Once again she was told that the vascular surgeon was on his way. The vascular surgeon did not arrive until 8:00 p.m. By then, the mottling had advanced up plaintiff’s leg and his legs were no longer salvageable. He underwent bilateral above-knee leg amputations.
Plaintiff alleged he lost his legs because the defendant hospital breached the standard of care by failing to timely respond to the plaintiff’s signs and symptoms of vascular compromise. The defendant hospital denied the allegations and the case proceeded to trial on July 14, 2010.
Plaintiff’s expert, a nurse from Richmond, Virginia, testified that the defendant hospital’s nurse breached the standard of care by not informing the plaintiff’s healthcare providers about the plaintiff’s changes in condition. Plaintiff’s causation expert, a vascular surgeon from Johns Hopkins testified that if interventions had begun sooner in the day, the plaintiff’s legs could have been saved. Defendant’s expert, a critical care physician from Martinsburg, West Virginia, testified that the defendant hospital’s nurse promptly recognized the plaintiff’s signs and symptoms of vascular compromise, appropriately communicated the plaintiff’s changes in condition to his healthcare providers and carried out all physician orders in a timely manner.
After deliberation by the jury for eight hours, the jury returned a verdict for the defendant.
March 24, 2010
Medical Malpractice Defense Verdict
After a three-day trial, Richard L. Nagle and Tracie M. Dorfman, obtained a defense verdict for the defendants on behalf of a vascular surgeon in a case of alleged medical malpractice.
On December 4, 2006, plaintiff underwent a prostatectomy in the supine position. Following the prostatectomy, plaintiff developed right leg pain and plaintiff’s urologist asked the defendant vascular surgeon to consult. Defendant vascular surgeon examined plaintiff on December 6, 2006 and noted that plaintiff had redness, swelling, tenderness and pain in the right leg. After conducting a thorough examination, defendant vascular surgeon diagnosed superficial thrombophlebitis. Plaintiff was discharged from the hospital on December 8, 2006 by his urologist. Plaintiff returned to the hospital on December 9, 2006 with a right foot drop. On December 10, 2006, defendant vascular surgeon performed a right anterior fasciotomy which revealed six centimeters of dead muscle. By February 2007, plaintiff no longer had a foot drop, according to his physical medicine and rehabilitation physician.
Plaintiff filed his lawsuit in the Fairfax Circuit Court alleging defendant vascular surgeon breached the standard of care because he should have diagnosed compartment syndrome, not superficial thrombophlebitis, as early as December 6, 2006. As a result, plaintiff claimed he suffered permanent injuries including foot drop. The defendant vascular surgeon denied the allegations and the case proceeded to trial on March 22, 2010.
Plaintiff’s expert, a vascular surgeon from Sewickley, Pennsylvania, testified that defendant vascular surgeon breached the standard of care because he did not appropriately rule out compartment syndrome on his differential diagnosis. Plaintiff’s expert testified that the standard of care required the defendant vascular surgeon to diagnose compartment syndrome on December 6, 2006 despite the fact that plaintiff did not have any of the common signs or symptoms of compartment syndrome.
Defense experts, both vascular surgeons practicing in Richmond, Virginia and Durham, North Carolina, respectively, testified that defendant vascular surgeon met the standard of care when he ruled out compartment syndrome and diagnosed superficial thrombophlebitis because plaintiff may not have even had compartment syndrome, and even if he did, it was such an unusual presentation that the standard of care did not require the defendant vascular surgeon to diagnose it until December 10, 2006. The defense experts testified that the hallmark indicator of compartment syndrome is pain on passive movement and that the classical signs used to aid the diagnosis of compartment syndrome are pain, pallor, paraesthesia, paralysis, pulselessness, pressure and poikilothermia. The defense experts testified that even on December 10, 2006, when the right anterior fasciotomy was performed, plaintiff was still missing the common signs of compartment syndrome. Additionally, the defense experts testified that nothing within plaintiff’s clinical setting or history put him at an increased risk for developing compartment syndrome. Finally, both defense experts testified that by December 10, 2006, plaintiff’s CPK values were decreasing which signified that all of the muscle death had already occurred which is inconsistent with compartment syndrome. Based upon plaintiff’s clinical signs and symptoms, his history and setting and his presentation over the course of his hospitalization, the defense experts testified that the defendant vascular surgeon met the standard of care when he ruled out compartment syndrome and diagnosed superficial thrombophlebitis.
After deliberation by the jury for one hour and fifty minutes, the jury returned a verdict for the defendants.
February 10, 2010
Medical Malpractice Defense Verdict
After a four-day trial, Sean P. Byrne and John E. Peterson Jr. obtained a defense verdict on behalf of an obstetrician in a case of alleged medical malpractice. The plaintiff sued her obstetrician over the loss of her child following a placental abruption and stillbirth delivery at approximately 38 weeks gestation.
The patient first came to the defendant obstetrician with her gestational age measured by ultrasound at 24 weeks. She had not previously received any prenatal care. The patient had an uneventful prenatal course until her thirty-fifth week of pregnancy when she experienced pre-term uterine contractions. In response, the doctor admitted her to the hospital for monitoring. During the hospitalization, the patient had some elevated blood pressures; however, they stabilized in the normal range. Laboratory testing and fetal monitoring were reassuring. She was discharged from the hospital with instructions to restrict activity. Thereafter, the patient had transiently elevated blood pressures at the beginning of some office visits, which stabilized in the normal range.
During her thirty-seventh week of pregnancy, the patient reported a severe frontal headache and measured her own blood pressure at a local pharmacy. It was high. She called her obstetrician, who advised her to go to the hospital. She was monitored in the hospital and her blood pressure was generally normal. Her laboratory testing and fetal monitoring results were normal and reassuring. Her headache went away after treatment with Tylenol and IV fluids. She was discharged on restricted activity with instructions to be seen in the office in several days.
At her next office visit, the patient’s urine protein test, which had previously been normal (negative), was abnormal at 2+. Her blood pressure was normal. She was instructed to return to the office in three days for close monitoring. The patient was next seen in her obstetrician’s office a few days later, on the morning of the day when she eventually delivered the stillborn baby. A certified nursing assistant again obtained initially-elevated blood pressure measurements. When the blood pressures were checked by the doctor after a period of rest, they trended downward and were normal by the time the patient left the office. Unfortunately, at approximately 11 p.m. that night, at her home, the patient suffered a placental abruption with massive blood loss. She was taken to the hospital by rescue squad and received an emergency c-section, but the baby did not survive. The patient spent several days in the ICU before she was discharged from the hospital.
At trial, the plaintiff called experts in maternal-fetal medicine from Virginia Beach, Virginia and Memphis, Tennessee to testify that the elevated blood pressure and positive urine protein screen required additional monitoring, inpatient hospitalization, or earlier delivery. They argued that although this patient did not meet the strict definitional criteria for preeclampsia, she had enough warning signs that the standard of care required additional intervention by the doctor.
Defense standard of care experts -- an obstetrician from Falls Church, Virginia and a maternal-fetal medicine specialist from Cincinnati, Ohio -- countered plaintiff’s theory. They argued that she had some transient initially-elevated blood pressures at several office visits, but that this was consistent with her history as a smoker, and the effects of recent activity and stress. On each occasion when her blood pressure was elevated in the office as measured by a nurse, it returned to normal when measured by the physician. Defendants’ experts also argued that the one positive urine protein screen was likely an erroneous result based on the negative tests before and after. Defendants argued that the abruption was unpreventable and unpredictable.
On causation, the defense presented a placental pathologist from Larchmont, New York who testified that this abruption was probably not caused by chronic hypertension because the tell-tale signs of high blood pressure impacting the placenta were not present in the gross or microscopic analysis of the tissue.
The jury deliberated for approximately an hour and a half and returned a defense verdict.
August 21, 2009
Medical Malpractice Defense Verdict
After a five-day trial, Sean P. Byrne and Lauran G. Stimac obtained a defense verdict on behalf of an anesthesiologist in a case of alleged wrongful death.
Plaintiff’s decedent, a 69-year-old man, was visiting his family from his native country of India when he fell on June 2, 2006, fracturing his left femur. He was treated in the emergency department with IV fluids, pain medication, and anti-emetics. Initial diagnostic testing performed in the emergency department was essentially normal.
The patient was admitted at 7:00 p.m. to the orthopedic floor; surgery was planned for the following morning. A pre-operative medical evaluation was performed at 2:00 a.m. by the night-shift hospitalist, who was not a defendant to this action, who noted that the patient was OK for surgery. The night-shift hospitalist also changed the patient’s pain medication from Demerol to Dilaudid in an effort to address his nausea and vomiting, known side effects of Demerol.
Overnight, the patient experienced further vomiting. His son-in-law, who accompanied him to the hospital and remained with him until he went to surgery the next morning, testified that he vomited several additional times when the nurses were not present. The nursing staff documented only one additional episode of vomiting during the night at 2:55 a.m., which vomit was noted by the nurse to be brownish red. The nurse did not contact the night-shift hospitalist or any other physician to report this episode of brownish-red vomiting.
At 8:00 a.m., the day-shift nurse contacted the defendant hospitalist, who assumed call at 7:00 a.m., to inform him that the patient was nauseous, had refused the anti-emetic that had been ordered, and that he requested Mylanta. The hospitalist stated the patient could have Mylanta if it was alright with the surgeon, because the patient was NPO for surgery. A factual dispute arose with regard to whether the nurse informed the hospitalist during this telephone call that the patient had vomited and that his emesis was coffee ground in appearance.
The defendant orthopedic surgeon evaluated the patient for surgery at approximately 9:00 a.m. He reviewed the chart, assessed the patient, and spoke with the nurse, who informed him that the patient had been projectile vomiting coffee ground emesis during the night, and she asked the surgeon whether a GI consult should be obtained. The surgeon testified that he went to the nurses’ station, asked the nurses to call medicine and was under the belief that he relayed information to the defendant hospitalist through an unknown individual of the patient’s continued nausea and vomiting of coffee ground emesis and confirmed that the patient was clear for surgery. The defendant hospitalist testified that he was not contacted regarding this patient prior to surgery other than the 8:00 a.m. phone call from the day-shift nurse to request Mylanta. The surgeon proceeded with plans for surgery.
When the patient arrived in the preoperative holding area, he was interviewed and assessed by the anesthesiologist, who planned to use spinal anesthesia, with general anesthesia as a backup plan. After the anesthesiologist reviewed the patient’s chart, discussed the anesthesia plan with the patient and his family, and performed a physical examination of the patient, he cleared the patient for anesthesia, and the patient was taken to the OR. Spinal anesthesia was attempted, but was unsuccessful, so the anesthesiologist converted to general anesthesia using rapid sequence induction with cricoid pressure applied by a nurse. During induction, the patient vomited and apparently aspirated. A nurse fact witness could not recall cricoid pressure being applied before the patient vomited. The anesthesiologist recalled cricoid pressure being applied prior to the patient vomiting, and the contemporaneous medical record was consistent with the anesthesiologist’s recollection. A factual issue arose from these differing memories, and that factual dispute formed the only basis of the liability argument against the anesthesiologist. It was undisputed that the anesthesiologist was not informed preoperatively of any signs of a potential GI bleed.
Postoperatively, the patient was taken to the ICU, where he remained until his death from complications of aspiration pneumonia and ARDS on September 16, 2006.
Plaintiff’s surgery expert testified that the defendant surgeon should have either spoken directly with the hospitalist or ordered a gastroenterology consult when he was informed that the patient had coffee ground emesis. Plaintiff’s surgery expert further opined that the surgeon should have postponed the surgery until either of those consults could be obtained. Defense surgery expert countered that coffee ground is a subjective description of emesis and the surgeon complied with the standard of care by advising the hospitalist of the change in the patient’s condition.
Plaintiff’s expert against the hospitalist, an internal medicine physician whose practice is largely office-based, testified that the defendant hospitalist should have re-evaluated the patient when he learned that the patient had vomiting and coffee ground emesis. The defense hospitalist expert agreed that if the hospitalist knew about the coffee ground emesis, evaluation was required, but the hospitalist did not know about any continuing vomiting and thus no additional response was required in response to the nurse’s request for Mylanta.
Plaintiff’s anesthesiology expert testified that, if cricoid pressure was not applied at the point in rapid sequence induction when the patient vomited, the defendant anesthesiologist breached the standard of care. Defense expert agreed, and the anesthesia experts acknowledged the factual dispute between the anesthesiologist and the nurse on that point. Both also acknowledged that the contemporaneous medical record and defendant anesthesiologist’s habit testimony were consistent with his account.
After deliberation by a jury for three hours, the jury returned a verdict in favor of all defendants.
August 13, 2009
Medical Malpractice Defense Verdict
After a three-day trial, Richard L. Nagle and Heather E. Zaug obtained a defense verdict on behalf of an obstetrician in a case of alleged medical malpractice.
During plaintiff's pregnancy in 2005, which was complicated by obesity and gestational diabetes, the mother plaintiff received prenatal care from defendant obstetrician. On June 2, 2005, the mother plaintiff presented to the hospital for labor and delivery. During the delivery, the defendant obstetrician encountered a shoulder dystocia. In response, the defendant obstetrician employed various maneuvers in an effort to safely deliver the infant plaintiff. Despite her efforts, the infant plaintiff suffered a stretching of his brachial plexus. Following his birth, the infant plaintiff underwent two surgeries in connection with his injuries. Although the infant plaintiff experienced some improvement from the surgeries, his brachial plexus injuries are permanent.
Plaintiffs filed their lawsuit in the Richmond City Circuit Court alleging defendant obstetrician failed to adhere to the standard of care in failing to inform the mother plaintiff of the risk of shoulder dystocia and in failing to offer the mother plaintiff a cesarean section. Further, plaintiffs alleged the defendant obstetrician mismanaged the delivery by applying excessive traction to the infant plaintiff’s head. Plaintiffs also alleged the defendant corporation was liable for the conduct of the defendant obstetrician. The defendants denied the allegations and the case proceeded to trial.
Plaintiffs’ expert, an obstetrician from Reston, Virginia testified the standard of care required the defendant obstetrician to recognize the mother plaintiff was at increased risk for a shoulder dystocia and to offer her a cesarean section. Plaintiffs’ expert testified that the defendant obstetrician’s failure to offer the mother plaintiff a cesarean section was a breach of the standard of care. In addition, plaintiffs’ expert testified that the defendant obstetrician negligently handled mother plaintiff’s delivery by pulling on the infant plaintiff’s head causing his brachial plexus injuries.
Defendants’ standard of care expert, a board certified obstetrician, testified that the mother plaintiff was not at an increased risk for shoulder dystocia due to the estimated fetal weight and the mother plaintiff’s delivery history. Therefore, the applicable standard of care did not require the defendant obstetrician to offer the mother plaintiff a cesarean section. Further, the defendants’ expert testified that the defendant obstetrician appropriately handled the delivery. During the trial, the defendant obstetrician denied applying excessive traction to the infant plaintiff’s head. Defendants’ experts, a board certified obstetrician and a board certified pediatric neurologist, testified that maternal forces of labor (the combination of pushing and contractions) caused the infant plaintiff’s bilateral brachial plexus injuries.
After deliberation by the jury for two hours and 45 minutes, the jury returned a verdict for the defendants.
Special Recognition
August 18, 2010 - Hancock, Daniel, Johnson & Nagle, P.C. is pleased to announce that W. Scott Johnson was recently named as a member of Governor Bob McDonnel's Virginia Health Reform Initiative Advisory Council.
This Council will provide recommendations to the Governor towards a comprehensive strategy for implementing health reform in Virginia.
Mr. Johnson was also recognized for his position on the governor's advisory council in the Richmond Academy of Medicine e-newsletter, The Leg.Up.
August 2010 - We are proud of the six attorneys who have been selected by their peers for inclusion in the 2011 edition of The Best Lawyers in America.
Thomas F. Hancock, III, in the practice area of Administrative Law; W. Scott Johnson, in the practice area of Government Relations Law; Richard L. Nagle, in the practice area of Medical Malpractice Law; Kimberly W. Daniel, in the practice area of Employment Law; and Sean P. Byrne and Anisa P. Kelley, in the practice area of Medical Malpractice Law. Congratulations everyone!
June 24, 2010 - Thirteen (13) HDJN Attorneys selected as Virginia Super Lawyers and Rising Stars. HDJN is honored to have so many of our attorneys selected as Virginia Super Lawyers and Rising Stars based on their professional achievements and through peer recognition.
Congratulations to our Super Lawyers: Kimberly W. Daniel, Employment & Labor; Thomas F. Hancock, III, Health Care; Mary C. Malone, Health Care; and Sean P. Byrneand Richard L. Nagle, in the practice area of Medical Malpractice Defense.
Congratulations Rising Stars:Rodney S. Dillman, Heather E. Zaug, Daniel M. Kincheloe, and Paul T. Walkinshaw in the practice area of Medical Malpractice Defense and Michael R. Newby, Harold H.B. Han, Mark C. Watson and Alexander L. Brown in the practice area of Health Care.
December 2009 - Congratulations! James M. Daniel, Jr. (Health Law); W. Scott Johnson (Legislative/Regulatory); Richard L. Nagle (Civil Litigation); William H. Hall, Jr. (Business Law); and Kimberly W. Daniel (Labor/Employment), for being selected by your peers as a member of Virginia's Legal Elite for 2009.
November 2009 - Congratulations Mary C. Malone for being recognized in your field by The Presidential Who's Who Among Business and Professional Achievers.
HDJN Announces New Directors for 2010
Hancock, Daniel, Johnson & Nagle, P.C. is pleased to announce that Michael R. Newby and Heather E. Zaug have been elected Directors in the firm.
New Additions to the Firm
August 2010 - W. Clay Landa
Clay Landa's practice focuses on commercial disputes involving healthcare providers, as well as insurance coverage litigation and counseling.
August 2010 - Colin P. McCarthy
Colin McCarthy's practice focuses on risk management, regulatory compliance, and other matters relating to day-to-day healthcare operations.
May 2010 - Corey A.-T. Stegeman
Corey Stegeman primarily concentrates his practice in the representation of healthcare providers in the defense of professional liability litigation.
April 2010 - Garland B. Nagy
Garland Nagy will be devoted to defending healthcare providers in professional liability matters.
March 2010 - Timothy A. Litzenburg
Timothy Litzenburg's practice focuses on representing healthcare providers in civil litigation.
You will need Adobe Acrobat Reader to view any Articles. If you do not have this software already installed on your computer, click here to download the free Acrobat Reader.
Note: This page includes news about our firm and information about important developments in health law. This information is provided solely to alert readers to general issues and developments that may affect their business and professional practices. This information is provided strictly as a convenience and is not intended, and should not be taken, as legal advice.
Individuals seeking legal advice in any area discussed on this site should contact a qualified attorney. Under no circumstances will Hancock, Daniel, Johnson & Nagle, P.C. be liable for any direct, indirect, or consequential damages resulting from the use of this material.