Hemorrhagic stroke blamed on delayed CT scan in hospital. Defense verdict. Orange County.

Facts and Background

• Facts and Background:

  Kerri Ann Deveney was 44 years old when she collapsed at home in the early morning hours of October 16, 2014 and was transported by paramedics to the emergency room at Providence St. Jude Medical Center in Fullerton, in respiratory distress with markedly elevated blood pressure. Upon arrival in the emergency room, the patient was evaluated by the emergency room physician, Dr. Joseph Dinglasan, to be suffering an acute exacerbation of her existing asthma, with possible pneumonia, and was promptly intubated to protect her airway. He did issue a stat order for a CT scan of the brain to rule out a stroke, although he testified that this possibility was very low on his list of potential explanations for the patient’s condition.

  With regard to the patient’s elevated blood pressure, Dr. Dinglasan ordered that hydralazine be administered, with the first dose being provided to the patient within minutes of arrival.

  The patient remained under the care of Dr. Dinglasan and the emergency room nurses from 0441 to 0545 on October 16, 2014, during which time the blood pressure remained markedly elevated but without further treatment. During that same time period, the stat CT scan of the brain was not performed. At 0541, as Dr. Dinglasan approached the end of his shift in the emergency room, he contacted  intensivist Dr. Panagiotis Bougas in the ICU (also nearing the end of his shift) to inform him that an intubated patient with a history of asthma and possible pneumonia would be coming to the ICU that morning after presenting in the hospital in respiratory distress. Dr. Bougas indicated that the patient would be accepted in the ICU that morning and even entered five orders in the patient’s medical record before the end of his shift, at which time care was transferred to the next intensivist, Dr. James Hardeman.

  At the end of Dr. Dinglasan’s shift in the emergency room, Dr. Iksoo Kang became the next emergency room physician responsible for Ms. Deveney, but he did not evaluate her because she was felt to be a stabilized patient awaiting transfer to the ICU. Both Dr. Dinglasan and Dr. Kang testified that there was a shared responsibility with the physicians in the ICU for this patient after the phone call to Dr. Bougas, while the intensivists contended that their responsibility for the patient did not commence until she physically arrived in the ICU.

  At approximately 0715, Dr. Hardeman noticed that the patient had not arrived in the ICU and went to the emergency room to evaluate Ms. Deveney. He noted that her blood pressure was still quite high and successfully initiated further treatment at that time. However, neither Dr. Bougas or Dr. Hardeman became aware that a stat CT scan of the brain had been previously ordered and still not performed. It was not until the CT scan of the brain was performed around 0838 that it was discovered that this patient had a large bleed in her brain. A neurosurgeon, Dr. Hector Ho, was summoned and he took the patient urgently to surgery to evacuate the collection of blood, which was pushing the brain 7.5 mm to one side and causing a brain herniation.

  Despite the surgical intervention by Dr. Ho, the patient was left profoundly disabled and requires 24/7 assistive care for the remainder of her life expectancy.

• Plaintiff's Contentions:

  Plaintiff contended that the intensivists, Dr. Bougas and Dr. Hardeman, both were required to have reviewed the patient chart once the emergency room physician requested transfer to the ICU, and that they should have noticed (a) that a stat CT scan of the brain had been ordered but not performed, and (b) that the blood pressure remained markedly elevated and was not being addressed. In the context of an intracranial hemorrhage, the diagnosis needs to be made as soon as possible and blood pressure needs to be controlled in order to avoid expansion of the blood collection.

  As a result of the failure to timely diagnose this hemorrhagic stroke, the patient suffered a devastating brain herniation that left her profoundly impaired and requiring 24/7 assistive care for the remainder of her life expectancy.

• Defendant's Contentions:

  The two defendant physicians asserted that their care and treatment of this patient complied with the standard of care in all respects. Dr. Bougas pointed out that he was informed by ER physician Dr. Dinglasan that a patient was being transferred to the ICU with respiratory distress secondary to asthma or pneumonia, who had already been intubated and stabilized, with no mention of any concerns regarding blood pressure or a CT scan to check for a possible stroke. Dr. Bougas relied upon that information in deciding that he did not need to see the patient before she arrived in the ICU, and shared that information with Dr. Hardeman at the end of his shift. Dr. Hardeman relied upon that information in waiting to evaluate this patient in the emergency room until after he had checked on all of his patients in the ICU.

  The defendants also argued that the patient had already suffered significant brain damage by the time she arrived in the emergency room and that they had no opportunity to have materially altered her outcome.