Blatchley v. St. Anthony Summit Med. Center

Court of Appeals for the Tenth Circuit·Decided July 17, 2020·No. 18-1231·Unpublished

Opinion

FILED

United States Court of Appeals UNITED STATES COURT OF APPEALS Tenth Circuit

FOR THE TENTH CIRCUIT July 17, 2020

Christopher M. Wolpert

Clerk of Court

JODY BLATCHLEY; DELFINA BLATCHLEY,

Plaintiffs - Appellees,

v. No. 18-1231 (D.C. No. 1:15-CV-00460-WYD-NYW)

ST. ANTHONY SUMMIT MEDICAL (D. Colo.) CENTER,

Defendant - Appellant.

ORDER AND JUDGMENT*

Before BRISCOE, LUCERO, and EID, Circuit Judges.

This medical malpractice case is about double recovery. Plaintiff Jody Blatchley alleges that he suffered permanent disability because of the negligence of medical staff while he was receiving care at St. Anthony Summit Medical Center (“SASMC”). After he and his wife Delfina Blatchley (collectively, “the Blatchleys”) filed suit, they settled with the orthopedic surgeons and physician assistants (“PAs”) responsible for Blatchley’s care but not with SASMC, which employed his nurses. SASMC filed a nonparty designation stating that the surgeons and PAs were wholly

*

This order and judgment is not binding precedent, except under the doctrines of law of the case, res judicata, and collateral estoppel. It may be cited, however, for its persuasive value consistent with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.

or partially at fault, thereby alerting the district court that comparative fault would be an issue. The district court struck the designation and did not allow SASMC to amend. At trial, the court refused to instruct the jury on comparative fault, thus allowing the Blatchleys to recover twice for the same harm—from SASMC and from the settling codefendants. Exercising jurisdiction under 28 U.S.C. § 1291, we reverse and remand to the district court.

I

On March 5, 2013, Blatchley, a coach for the New Zealand national women’s snowboarding team, severely fractured his leg while demonstrating a jump. He was transported to SASMC. Over the next few days, he developed acute compartment syndrome (“CS”), a secondary injury caused by the swelling of soft tissue. The swelling causes pressure to build up in closed compartments of the body surrounded by fascia, a non-pliable connective tissue. If pressure increases to the point where blood cannot enter the compartment, the muscles, nerves, and soft tissue in that area do not receive enough oxygen and nutrients, leading to soft tissue death. This is referred to as fulminant CS. Once acute CS becomes fulminant, the condition is full- blown and irreversible. The only intervention—which must be made within approximately six to eight hours of onset—is to perform a fasciotomy, which involves opening the skin and cutting the fascia around the affected compartment to decrease the pressure therein. The medical team responsible for Blatchley failed to diagnose his CS in time to prevent it from becoming fulminant. This case concerns who is liable for that failure.

On March 5, Dr. Richard Cunningham performed a tibial plateau surgery on Blatchley’s fractured leg. There was testimony at trial that Dr. Cunningham told other medical staff that he performed four compartment fasciotomies at the time of the tibial plateau surgery. But plaintiffs’ expert Dr. Robert Pedowitz testified to the contrary that Dr. Cunningham did not perform fasciotomies on Blatchley on March 5. Although the surgery performed by Dr. Cunningham required making an incision of the fascia, the operation was not a fasciotomy because the incision was not a long one, and it was closed at the end of the operation. Dr. Pedowitz also testified that Dr. Cunningham’s misleading of the other medical staff led to confusion, but this confusion did not entirely excuse the medical team’s failure to diagnose CS in time. In its brief, SASMC emphasizes the consequences of the alleged misinformation and suggests Dr. Cunningham was partially responsible for Blatchley’s injuries. The Blatchleys downplay the importance of any misinformation.

After the surgery, SASMC nurses monitored Blatchley for CS symptoms.

SASMC stresses evidence from trial of the numerous examinations performed by its nurses. In contrast, the Blatchleys emphasize evidence that the nurses did not provide quality care, including one nurse’s testimony that he copied verbatim notes from the prior shift into records he prepared.

On the afternoon of March 7, Dr. John Elton performed calcaneal surgery on Blatchley’s right heel. Before, during, and after surgery, Dr. Elton examined Blatchley’s left leg and concluded he did not have CS. In a post-operative report, Dr. Elton’s PA, Molly Bryan, ordered close observation of Blatchley for symptoms of

CS. Bryan had also noted earlier that day that Blatchley was able to wiggle all the toes of his left foot.

Steven Plante was the nurse in charge of Blatchley that night. He did not read all of Bryan’s order, and he did not check on Blatchley every hour, as required. Instead, Plante observed Blatchley only three times over the course of his twelve- hour shift, and his notes from those observations are copied verbatim from notes taken during prior shifts that day.

According to Dr. Pedowitz, the period spanning from the conclusion of the calcaneal surgery to the following morning was the critical period before Blatchley’s CS became irreversible. Plante testified that there was no change in Blatchley’s condition during his shift. But when Annadane Dayton, another SASMC nurse, arrived at 7 a.m. the next morning, she immediately determined that Blatchley could not move his ankle. She contacted Dr. Peter Janes, who assessed Blatchley and decided against diagnosing him with CS because he had soft compartments and no pain when the area was passively stretched.

From March 8 to 11, the physicians and PAs continued to examine Blatchley.

They documented that he had extreme pain—a pain level of at least eight out of ten— in his left leg and right foot at several points during that time but concluded that he did not have CS. Blatchley’s CS was finally diagnosed on March 11, and he underwent fasciotomies that day. But by that point, his CS had become fulminant and irreversible. He is now permanently disabled and suffers from ongoing pain.

In 2015, Blatchley and his wife sued the following defendants involved in Blatchley’s care: the physicians, including Drs. Cunningham and Janes; several PAs; the PAs’ medical group; and SASMC, which employed the nurses. The Blatchleys claimed that Blatchley’s injuries resulted from defendants’ negligence. Eventually, after settling with some defendants, they stipulated to the dismissal of all defendants except SASMC. SASMC filed a designation of nonparties pursuant to Colo. Rev. Stat. § 13-21-111.5(3), designating Drs. Cunningham and Janes, the PAs, and the PAs’ group as nonparties wholly or partially at fault. It then amended the designation to remove the PAs’ group.

The Blatchleys moved to strike the designation as defective, arguing SASMC failed to meet the requirements of a filing under § 13-21-111.5(3). The court granted the motion at an oral hearing. It explained its conclusion that the designation did not meet the notice requirements for designation of a nonparty set forth in Redden v. SCI Colorado Funeral Services, 38 P.3d 75 (Colo. 2001). When SASMC stated that it intended to file an amended designation complying with the requirements as explained by the court, the court responded that it was not “fundamentally fair or right” to allow amendment because “the law is self-evident as to what is required.” SASMC filed a second amended designation providing more information about the basis for its assertion that the designated defendants were liable. The court struck the second amended designation, concluding SASMC was not entitled to a “second bite at the apple.”

At trial, the jury found SASMC liable and awarded $6.333 million in damages.

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