Aragon v. Issa

103 So. 3d 887, 2012 Fla. App. LEXIS 18064, 2012 WL 4896949
CourtDistrict Court of Appeal of Florida
DecidedOctober 17, 2012
DocketNo. 4D10-3993
StatusPublished
Cited by7 cases

This text of 103 So. 3d 887 (Aragon v. Issa) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aragon v. Issa, 103 So. 3d 887, 2012 Fla. App. LEXIS 18064, 2012 WL 4896949 (Fla. Ct. App. 2012).

Opinion

PER CURIAM.

In this medical-malpractice case, the key issue is whether the plaintiff presented competent substantial evidence that the defendant proximately caused the death of Leo Aragon. We conclude that the plaintiff presented evidence that could support a jury finding that the defendant more likely than not caused the death of Aragon. It is the jury’s province, not the judge’s, to weigh conflicting evidence and assess the credibility of the witnesses, and the testimony given by plaintiffs expert witnesses was not speculation based upon the standard set forth by this Court in Hancock v. Schorr, 941 So.2d 409 (Fla. 4th DCA 2006), and the Florida Supreme Court in Cox v. St. Josephs Hosp., 71 So.3d 795 (Fla.2011). Because the trial judge erred in granting a motion for judgment in accordance with the motion for directed verdict against the plaintiff notwithstanding a jury verdict, we reverse.

STANDARD OF REVIEW

In a de novo review of a trial court’s granting of a motion for judgment in accordance with the motion for directed verdict, an appellate court must view the evidence, resolve all conflicts in the evidence, and construe every reasonable conclusion that may be drawn from the evidence in the light most favorable to the non-moving party. Hancock, 941 So.2d at 412.

FACTS

Viewed in the light most favorable to the plaintiff, the evidence at trial was as follows.

Leo Aragon, forty-one, and married with children, woke up on Sunday, November 7, [889]*8892004 with chest pain. He entered the emergency room of Memorial Regional Hospital at around 11:50 a.m. Aragon complained of symptoms commonly associated with acute coronary syndrome: left arm and left chest pain, which radiated to his neck and back, nausea, mild shortness of breath, and elevated blood pressure. Aragon was significantly overweight and allergic to shellfish. His shellfish allergy was noted in his hospital chart and he wore a wrist band indicating his shellfish allergy.

A patient with a shellfish allergy is more likely to have an adverse anaphylactic reaction to the iodine-based contrast dye used in cardiac catheterization procedures.

Both the EKG and cardiac-enzyme tests ordered by the emergency-room doctor returned a normal result. The cardiac-enzyme test is used to detect troponin, the presence of which is an indication of a heart-muscle injury. However, it usually takes a few hours for the cardiac-enzyme test to return a positive result. Therefore, the test should always be repeated.

The emergency-room doctor contacted the service of Aragon’s primary-care doctor to recommend admission to the hospital. Dr. Moisés Issa, an internal medicine physician (the “Internist”), was on call to cover for Aragon’s primary-care physician that Sunday. He returned the emergency-room doctor’s phone call at about 3:50 p.m.

By that time, Aragon’s chest pain had subsided. His blood pressure had come down and was approaching normal. After consulting with the emergency-room doctor, the Internist issued a telephone order admitting Aragon to the hospital. The purpose of the admission was to monitor Aragon in the hospital’s telemetry unit for twenty-four hours to determine whether Aragon had suffered a myocardial infarction.

By phone, the Internist also ordered two additional cardiac-enzyme tests to be administered every eight hours from the initial noon test to monitor any changes in the troponin level. The Internist did not see the patient in person nor did he contact the telemetry unit to inquire about the cardiac-enzyme test results later that day.

The second cardiac-enzyme test was administered at 9:30 p.m. and the third test was administered at 4:55 a.m. the next morning. Although the 9:30 p.m. test showed a positive result for the presence of troponin, the Internist was not informed by a nurse via telephone of the positive test results until approximately 7:20 a.m. the next morning. The Internist realized the significance of the troponin-positive cardiac-enzyme test result and decided to involve a cardiologist with Aragon’s treatment.

The Internist called Dr. Randy Gould (the “Initial Cardiologist”), and reached him at home. During their approximately two-minute telephone conversation, the Internist informed the Initial Cardiologist that he had a patient at the hospital with chest pain, positive cardiac enzymes, and in need of a cardiac catheterization. The Initial Cardiologist responded with “Okay, I will take care of it.”

The Internist went to the hospital to see Aragon. The Internist took Aragon’s history and gave him a physical examination at 8 a.m. He learned that Aragon was overweight. Aragon had been stable, pain-free, and his medical record indicated that Aragon had a shellfish allergy. The Internist noted that Aragon’s second cardiac-enzyme test was positive. But he did not find out the results of the third test. As it turned out, the level of cardiac enzymes was still positive, but the level was lower than that of the second test. The Internist made a note in Aragon’s chart that Aragon “will go to cath[eterization] [890]*890lab later,” and the Internist will “continue to take care of the patient while here in the hospital.”

Even though the Internist gained additional information by seeing Aragon in person and reviewing Aragon’s record, the Internist did not call the Initial Cardiologist to relate to'him this new and more complete information. The Internist also made no plans regarding Aragon’s shellfish allergy and the planned cardiac cath-eterization.

The physical examination at 8 a.m. was the last involvement the Internist had with Aragon’s treatment. Later that evening, the Internist received information from Aragon’s primary-care doctor that Aragon had passed away during the catheterization procedure. It was then that the Internist found out for the first time that Dr. Mian Hasan (the “Interventional Cardiologist”) was the cardiologist who performed the procedure.

When the Initial Cardiologist received the Internist’s phone call in the morning, he related the information he received from the Internist — a gentleman with chest pain, elevated cardiac enzymes, and in need of catheterization — to the Inter-ventional Cardiologist.

The Interventional Cardiologist was under the impression that the Initial Cardiologist had already completed an evaluation and that he was asked to do a procedure, instead of a cardiology consultation on the patient. The Interventional Cardiologist was not available until 4 p.m. that day, and he scheduled Aragon’s cardiac catheterization at that time. Because the Internist did not pass along the information regarding Aragon’s latest condition to the Initial Cardiologist, the Interventional Cardiologist, as the last person in the communication chain, did not know that Aragon was overweight, had been pain-free, had a shellfish allergy, and that the level of tro-ponin had dropped. The Interventional Cardiologist only learned of this information for the first time between 3 and 4 p.m. in the holding area of the catheterization lab.

Based on his understanding that the cardiac catheterization had to be performed that day and that some ongoing risks associated with Aragon’s cardiac condition would evolve, the Interventional Cardiologist decided to operate on an emergency basis and proceeded with a single dose of solucortef (a form of steroid) given to Ara-gon less than one hour before the cardiac catheterization to prevent an anaphylactic reaction to the contrast dye.

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Bluebook (online)
103 So. 3d 887, 2012 Fla. App. LEXIS 18064, 2012 WL 4896949, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aragon-v-issa-fladistctapp-2012.