Byrne v. Mercy Health System

58 Pa. D. & C.4th 449, 2002 Pa. Dist. & Cnty. Dec. LEXIS 192
CourtPennsylvania Court of Common Pleas, Delaware County
DecidedJuly 19, 2002
Docketno. 98-15864
StatusPublished

This text of 58 Pa. D. & C.4th 449 (Byrne v. Mercy Health System) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Delaware County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Byrne v. Mercy Health System, 58 Pa. D. & C.4th 449, 2002 Pa. Dist. & Cnty. Dec. LEXIS 192 (Pa. Super. Ct. 2002).

Opinion

BURR II, J.,

The defendants Mark Lisberger M.D. and Marple Medical Associates Inc. only, appeal from the judgment entered in the above-captioned medical malpractice wrongful death and survival action alleging that the defendants’ negligent failure to diagnose and treat the coronary artery disease of plaintiff’s decedent, Mary F. Byme, caused her death. Judgment was entered following entry of the order denying the defendants’ motion for post-trial relief seeking judgment n.o.v. or a new trial.

On April 15,1998, at 10:42 p.m., Mary Byrne, age 55, presented to the emergency room of Mercy Community Hospital in Haverford, Delaware County, Pennsylvania, complaining of the sudden onset of intermittent substernal chest pain that she said she had been experiencing for the previous 36 hours. Mrs. Byme described the pain as a squeezing sensation and characterized it as severe at times, or a “nine” on a scale of one to 10. Following an electrocardiogram with results reported as “normal,” and some blood work, Mrs. Byme was administered nitroglycerine, which relieved her pain. The defendant, Dr. Lisberger, a cardiac consultant to the hospital, was called, and after reviewing her test results and examining Mrs. Byme around 1 a.m. on April 16, decided to admit her to the hospital for further cardiac studies, including electrocardiograms, enzyme studies, and an exercise stress test with a nuclear scan component. The defendant’s ini[452]*452tial impression was that the patient had atypical chest pain that “was possibly cardiac in origin and possibly gastrointestinal” in origin. (Defendants’ brief in support of post-trial motion, p. 2.)

It is undisputed that plaintiff’s decedent had several major risk factors for coronary artery disease. She was obese, weighing 188 pounds, at five feet, five inches in height and smoked three packs of cigarettes per day. (7/5/00 N.T. 29, 34.) She had elevated cholesterol and triglycerides and was a borderline diabetic. Her father had died at age 55 from a myocardial infarction, and her mother had undergone bypass surgery. There is also no dispute that, after approximately five minutes on the treadmill while undergoing the stress test, Mrs. Byme complained of significant fatigue and the test was terminated one minute later. Defendants claim that the results of all tests performed on Mrs. Byme on April 16, 1998, including the stress test, were negative and/or normal, whereupon Dr. Lisberger determined that Mrs. Byme could be discharged from the hospital that day, with the further thought that her symptoms derived from musculoskeletal difficulties. (Defendants’ brief in support of post-trial motion, p. 2.) Mrs. Byme reported some incidents of chest pain before leaving the hospital, but there is no evidence that these were reported to Dr. Lisberger. (Defendants’ brief in support of post-trial motion, p. 2.) Indeed the defendants admitted through the testimony of their expert, Dr. Brace Berger, that, at no time when she was actually experiencing chest pain in the hospital, was Mrs. Byme in the process of being examined by a physician. (7/10/00 N.T. 42.)

[453]*453Mrs. Byrne collapsed on her bathroom floor in the early morning hours of April 18,1998, and was transported to the defendant hospital where she was pronounced dead at 5:20 a.m. An autopsy performed by the Delaware County medical examiner, Dr. Dmitri L. Contostavlos M.D., the following morning, April 19,1998, determined the cause of death to have been coronary artery disease with significant narrowing of the left anterior descending coronary artery and left circumflex artery which, having been blocked by a clot, caused an infarction.1 (7/5/00 N.T. 21-25.) This was followed by a rupture in the heart wall in the supply area of the circumflex branch which had weakened due to the infarction. (7/5/00 N.T. 20-21.) The rupture had caused a tamponade, or bleeding into the pericardium (the sac around the heart), creating pressure on the heart and preventing it from pumping, and causing immediate death. (7/5/00 N.T. 21, 40.) In Dr. Contostavlos’ opinion, the estimated time period between rupture and death was between one-half hour and 45 minutes. (7/5/00 N.T. 41.)

The plaintiff initiated this lawsuit, alleging that after decedent presented at the emergency room of the defendant hospital with a sudden onset of intermittent chest pains, she was diagnosed as having suffered a possible heart attack and was admitted and prescribed diagnostic [454]*454testing for the next day after the defendant, Dr. Lisberger, had been brought in for consultation. (Complaint, ¶¶10-11.) Plaintiff charged the defendants with negligence in the failure to appropriately interpret the results of Mrs. Byrne’s diagnostic tests so as to diagnose her coronary artery disease; in the failure to promptly and properly perform diagnostic studies, such as a heart catheterization; and in the failure to conform to acceptable standards of medical care in the diagnosis, treatment and management of Mrs. Byrne, including the failure to assure that she underwent necessary treatment for her coronary artery disease. (Complaint, ¶¶17-18.) The defendants, in their answer to plaintiff’s complaint, simply denied all averments of negligence or deviation from the applicable standard of care in the referenced conduct of Mrs. Byrne’s case. (Answer, ¶¶17-18.) Defendants pleaded the same in new matter, and averred the defenses of contributory/comparative negligence, assumption of the risk, that the cause of death was the result of an unspecified underlying medical condition of Mrs. Byrne, or was caused by other persons over whom the defendants exercised no control or right of control. (Answer, ¶¶31-33.) The defendants’ claim of contributory/comparative negligence was withdrawn at trial. (7/5/00 N.T. 277.)

Plaintiff presented Dr. Contostavlos, who was qualified as an expert in the field of forensic pathology, as his first trial witness. (7/5/00 N.T. 9.) Dr. Contostavlos testified that, prior to the autopsy, he had obtained a report of the circumstances of Mrs. Byrne’s cause of death, “probably” from the family, or conceivably from the hospital, he could not say for certain. (7/5/00 N.T. 13.) [455]*455The witness’ uncertainty of the source of this history was later noted by the defendants for the record. (7/5/00 N.T. 31.) Dr. Contostavlos said that part of that report indicated that unnamed “physicians” believed that Mrs. Byrne’s pain resulted “when she grabbed a rail and when she tripped while descending the stairs on the 8th of April.” (7/5/00 N.T. 14.) The witness said that his own initial belief was that Mrs. Byrne had died of heart disease, “[b]ecause of the symptoms she exhibited and the mere fact of sudden death were very suggestive of a heart disease death.” (7/5/00 N.T. 14.)

Dr. Contostavlos reported that examination of the decedent’s upper lung lobes showed a “moderate or marked” degree of emphysema, a condition which would cause her lung function to decrease somewhat, “and there might be some degree of shortness of breath upon exertion,” and a “diminution in her capacity for exercise.” (7/5/00 N.T. 16-18.) After providing his opinion as to cause of death, Dr. Contostavlos gave direct testimony, without objection from the defendant, that he believed the age of the infarct, or blockage of the artery which led to Mrs. Byrne’s death at 5 in the morning of April 18th, was “between two to five days,” depending on the body’s “defense mechanism or its attempt to healing [sic] and to remove dead tissue.” (7/5/00 N.T. 26-27.) Dr.

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Bluebook (online)
58 Pa. D. & C.4th 449, 2002 Pa. Dist. & Cnty. Dec. LEXIS 192, Counsel Stack Legal Research, https://law.counselstack.com/opinion/byrne-v-mercy-health-system-pactcompldelawa-2002.