Brain damage results from bleeding during heart surgery, leaves patient in vegetative state. $68M. Fresno County.

Facts and Background

• Facts and Background:

  Plaintiff Perez is a 71-year-old male with no prior history of heart issues, generally healthy. However, on March 31, 2012, he complained of shortness of breath and chest pains. As a result, he was taken to the emergency room at Community Regional Medical Center, in Fresno, where he was admitted for further testing and evaluation. In the days that followed, it was determined that Perez needed to undergo urgent open heart surgery, which was scheduled for April 2, 2012. 

  On April 2, 2012, plaintiff Silvino Perez underwent open heart surgery to have an aortic valve replacement and to repair an ascending aortic aneurysm. The surgery was performed by Dr. Pervaiz Chaudhry, a cardiothoracic surgeon. General surgeon Dr. Kalwant Dhillon, and a physician's assistant, Bella Albakova, assisted in the surgery. By all accounts, the surgery went well.

  Toward the end of the surgery, Chaudhry allegedly left Albakova and Dhillon to close the chest. Not only did Chaudhry leave the operating room, he also left the hospital to go meet a new cardiologist across town in a restaurant called Campagnia. However, after Chaudhry left the operating room, at 12:17 p.m., Perez began to have bleeding complications. As a result, Perez went into hypovolemic shock and coded. As a result, calls were made to Chaudhry and chest compressions were performed on Perez's freshly closed chest. Albakova then re-opened Perez's chest and attempted to cannulate Perez's heart to get him back on the bypass machine. However, when she was unable to do so, Albakova began to manually massage Perez's heart.

  Once Chaudhry arrived back at the hospital at 1:29 p.m., he was able to quickly cannulate Perez and get him back on the bypass machine so that his body and brain were again able to receive circulated oxygenated blood. Chaudhry then performed further surgery to repair the perforation of the heart. After several more hours of surgery, Perez was finally sent to the intensive care unit at about 8:50 p.m. As a result, Perez had been on the operating room table for over 13 hours.
  
  Although Perez's life was saved, he suffered a brain injury.
  
  Perez's stepson, Cristobal Arteaga, acting individually and as Perez's guardian ad litem, and Perez's wife, Maria Arteaga Alvarez, acting individually, sued the operator of Community Regional Medical Center and Community Medical Centers, Fresno Community Hospital and Medical Center (which was initially erroneously sued as "Fresno Community Regional Medical Center"); the corporate entity that operates Fresno Community Hospital and Medical Center, Community Hospitals of Central California; Chaudhry; Chaudhry's medical groups, Valley Cardiac Surgery Medical Group and Chaudhry Medical Inc.; the anesthesiologist present during the surgery, Dr. Ashwin Bhatt; Bhatt's medical group, Community Regional Anesthesia Medical Group Inc.; and a cardiologist, Dr. Sanjay Srivasta.
  
  Before trial began, Arteaga and Arteaga Alvarez reached a confidential settlement with the hospital defendants. Bhatt, Community Regional Anesthesia Medical Group, and Srivasta were also dismissed from the case. Thus, the matter only continued against Chaudhry, Valley Cardiac Surgery Medical Group, Chaudhry Medical Inc.

• Plaintiff's Contentions:

  Plaintiffs' counsel contended that phone records revealed that at 12:25 p.m., after Chaudhry left the operating room and hospital, a phone call was placed from Albakova's cell phone to Chaudhry. Albakova did not recall the phone call. Chaudhry allegedly said that it was customary for her to call once the case was completed. However, plaintiff's counsel noted that the medical records showed that at 12:28 p.m., Chaudhry telephonically ordered a DIC panel, which is a blood test that one would allegedly only order if one had a concern about abnormal bleeding.

  Counsel contended that another call was placed from the cell phone of the circulating nurse, Geri Breaux, to Chaudhry at 12:39 p.m. to let him know that there were 200ccs of blood in the Pleur-evac Chest Drainage System. It was undisputed that the nurses had a standing order to call Chaudhry whenever the bleeding reached 200ccs. Chaudhry subsequently ordered blood products over the phone and they were placed, according to the records, four minutes later, at 12:43 p.m. Plaintiffs' counsel also noted that Bhatt testified that he ordered Factor VII, which is another blood product that would only be ordered in response to excessive bleeding, and ordered the nurses to call Chaudhry because he was concerned about excessive bleeding.
  
  It was undisputed by those who remained in the operating room following the 12:39 p.m. call to Chaudhry that Perez was bleeding profusely. The witnesses included the anesthesiologist, Bhatt; the perfusionist, Aaron Schreur; the scrub nurse, Marni Allen; and the two circulating nurses, Geri Breaux and Nichole Kroes. Almost all of the witnesses testified that Perez bled out 1500ccs in the 20 minutes after the 12:39 p.m. call to Chaudhry, at which point Perez went into hypovolemic shock and coded. Thus, plaintiffs' counsel argued that when Chaudhry left, he did not ensure that there was a backup cardiothoracic surgeon in the hospital.
  
  Plaintiffs' counsel contended that Chaudhry was called again at 12:59 p.m. to let him know that Perez had coded. He was a half hour away from the hospital, at Campagnia, and there was no backup cardiothoracic surgeon at the hospital. Counsel contended that as a result, Chaudhry immediately called Albakova and his partner, Dr. Robert Stewart, who was also a cardiothoracic surgeon, and allegedly told them both to get to the operating room as soon as possible. However, Stewart was also a half hour away and, according to the medical records, he arrived in the operating room at the same time as Chaudhry, at 1:29 p.m.
  
  Albakova was still in the hospital when she got the call from Chaudhry and she rushed to the operating room within minutes. Plaintiffs' counsel contended that when Albakova arrived, others were performing chest compressions on Perez's freshly closed chest, which never should have been done. As a result, Albakova immediately intervened, re-opened Perez's chest, and tried to cannulate Perez's heart to get him back on the bypass machine so that his brain would continue to receive oxygenated blood.

  However, plaintiffs' counsel contended that Albakova had never cannulated a patient since she was not a cardiothoracic surgeon. Albakova then began to manually massage Perez's heart, at which time she allegedly felt her thumb go through the right ventricle. Plaintiffs' counsel argued that the perforation of the heart happened either when the chest compressions were being done or when Albakova began doing the manual heart massage. Regardless, counsel contended that there was so much blood in the chest cavity by that point that Albakova testified that she could not even see the heart and, more importantly, no one could get Perez back on the bypass machine so that his oxygenated blood could be circulated.
  
  Thus, plaintiffs' counsel argued that Chaudhry breached the standard of care and hospital rules by leaving the operating room early and having his physician assistant complete the surgery by closing the chest. Counsel also argued that Chaudhry breached the standard of care and hospital rules by leaving the hospital with no backup cardiothoracic surgeon available when the patient was not yet stable in the intensive care unit. Counsel argued that as a result, when Perez coded, there was no qualified physician able to timely get him back on the cardiopulmonary bypass machine and that the delay resulted in a massive brain injury due to the lack of circulated oxygenated blood.

• Defendant's Contentions:

  Defense counsel contended that Chaudhry did not leave the surgery early and that he remained in the operating room, supervising his physician assistant through the closure of the chest. Chaudhry also asserted that he did not violate the standard of care by leaving the hospital because, when he left, Perez was stable in the operating room, which acts as a recovery room for open heart surgery patients following surgery.

  Chaudhry claimed that even though his name was on the order for the DIC panel, someone else ordered it and just used his name as the lead surgeon for the order. Chaudhry was also adamant that all he was told was about was when Perez's bleeding reached 200ccs, which he claimed was not concerning enough for him to return to the operating room, so he kept driving to his business meeting.