Brandner v. Pease

361 P.3d 915, 2015 Alas. LEXIS 143, 2015 WL 7709465
Alaska Supreme Court·Decided November 25, 2015·No. 7066 S-15633·Published·Cited by 14 cases

Opinion

OPINION

BOLGER, Justice.

I. INTRODUCTION

A cardiac patient who underwent open heart surgery sued the anesthesiologist and medical providers involved in the surgery. The superior court dismissed the patient's claims on summary judgment, concluding that the patient had offered no admissible evidence that the defendants breached the standard of care or caused the patient any injury. On appeal the patient relies on his expert witness's testimony that certain surgical procedures were suboptimal and that patients generally tend to have better outcomes when other procedures are followed. But we agree with the court's conclusion that this testimony was insufficient to raise any issue of material fact regarding whether the defendants had violated the standard of care in a way that caused injury to the patient. We also affirm the court's orders involving attorney's fees and costs.

II. FACTS AND PROCEEDINGS

A. Heart Surgery

Dr. Michael Brandner suffered a heart attack in September 2009 and was admitted to Providence Alaska Medical Center (the Medical Center) for emergency bypass surgery. Dr. Kenton Stephens was the cardiac surgeon who performed the operation; Dr. Robert J. Pease administered anesthesia. Dr. Brandner is also a medical doctor, licensed to practice plastic and reconstructive surgery.

The surgery lasted six hours. At the outset Dr. Pease intubated Dr. Brandner on his second attempt and used the drug propofol to induce anesthesia. Shortly thereafter Dr. Brandner's blood pressure precipitously dropped, but according to Dr. Stephens, Dr. Brandner did not suffer complete cardiac arrest. Dr. Stephens performed CPR while additional drugs were administered to counteract the drop in blood pressure. Dr. Brandner's blood pressure ultimately stabilized, and the operation continued.

Dr. Pease then placed a transesophageal echo (TEE) probe in Dr. Brandner's esophagus to take ultrasonographic pictures of his heart and obtain diagnostic information about its condition. The TEE probe soon failed, and Dr. Pease then notified Dr. Stephens of this failure. According to Dr. Stephens's deposition testimony, he responded by saying, "Okay, well, I'm pressing on with the operation, do what you can." The TEE probe was not replaced.

Dr. Stephens performed a six-vessel bypass. Dr. Brandner survived the operation and was discharged 12 days later. In his notes from a follow-up appointment about a week after discharge, Dr. Stephens indicated that "[Dr. Brandner] has been progressing quite well." Dr. Stephens also indicated that *918 Dr. Brandner could return to full activity within six weeks of surgery and authorized him to return to his plastic surgery practice. In March 2011 Dr. Stephens wrote a letter on Dr. Brandner's behalf indicating that "Ihlis recovery has been quite exemplary" and that "he had steadily returned to practice." ~

B. Proceedings

In September 2011 Dr. Brandner filed a complaint against Dr. Pease, Providence Anchorage Anesthesia Group (the Anesthesia Group), and the Medical Center. 1 Dr. Brandner alleged that "[the administration of anesthesia performed by Dr. Robert J. Pease was below the standard of care, . was negligently and recklessly performed[,]" and "cause[d] [Dr. Brandner] to sustain permanent injuries." He also alleged that the Anesthesia Group and the Medical Center were vicariously liable for Dr. Pease's actions. Dr. Brandner alleged that he "suffered severe and permanent injuries, loss of past and future wages, ... [and] loss of enjoyment of life[,]" and that he "incurred past and future medical expenses[.]" In response to interrogatories, Dr. Brandner specifically alleged "injury to and loss of myo-cardium with severely compromised cardiac function and reserve"; "(injury to brain with noticeable loss of short term memory function as demonstrated on testing"; and "[sle-vere de-conditioning, loss of calcium, with associated muscoloskeletal problems, displaced sternal incision/wound with prolonged healing and continued pain, as well as hemorrhoids requiring surgery and with ongoing problems."

In February 2012 the providers jointly moved for summary judgment, arguing that the "lawsuit must be dismissed with prejudice unless [Dr. Brandner] can produce an affidavit from a qualified expert claiming Dr. Pease failed to meet the standard of care, [and] this failure caused or contributed to his injuries." The motion was supported by the affidavit of a board-certified anesthesiologist specializing in cardiovascular anesthesia who attested that "[the medical care provided by Dr. Pease to [Dr. Brandner] was appropriate in all respects and met the [standard of [clare."

In July 2012 Dr. Brandner submitted the affidavit of Dr. Steven Yun, a board-certified anesthesiologist, in connection with his opposition to the providers' motion for summary judgment. Dr. Yun attested that the "treatment, care[,] and services provided by ... Dr. Robert Pease[] were suboptimal and contributed to [Dr. Brandner's] prolonged and delayed recovery." Specifically, Dr. Yun stated that "in all medical probability," (1) "[plropofol was not the optimal choice" of induction agent and its use "led directly to ... [Dr.] Brandner's cardiac arrest," 2 (2) the "difficulty in securing [Dr.] Brandner's airway ... directly contributed to [his] cardiac arrest," and (8) the "amount of damage to [Dr. Brandner's] heart, [the] time to hook up the by-pass machine, [and] the extent of surgery performed would have been reduced by the use of a TEE [probe] throughout his surgery." Following the submission of this affidavit, the providers withdrew their summary judgment motions.

In September 2013 Dr. Brandner was indicted in federal court on seven counts of wire fraud. 3 The grand jury charged him with attempting to conceal millions of dollars in assets from his wife during divorce proceedings.

In January 2014 the parties deposed Dr. Yun. During the deposition Dr. Yun admitted that although he was a practicing anesthesiologist, he had not practiced cardiovascular anesthesia or used a TEE probe since about 2001. He also stated that he was not qualified under the current standard of care to practice cardiovascular anesthesia because he lacked certification in the use of TEE probes.

*919 With regard to Dr. Brandner's surgery, Dr. Yun reiterated his opinion that the use of propofol and the failure to intubate Dr. Brandner on the first attempt were "suboptimal," but he refused to say that either fell below the standard of care. Dr. Yun did state that the failure to replace the TEE probe fell below the standard of care and that cardiac patients generally tend to have better outcomes when a TEE probe is used during surgery. But he repeatedly declined to draw any conclusions about whether the lack of a TEE probe caused harm to Dr. Brandner specifically, explaining, "I think that goes a little beyond my area of expertise." Dr. Yun also confirmed that his affidavit, which stated that Dr.

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Brandner v. Pease, 361 P.3d 915, 2015 Alas. LEXIS 143, 2015 WL 7709465 (Ala. 2015).

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