Cahanin v. Louisiana Medical Mutual Insurance Co.

235 So. 3d 1250
CourtLouisiana Court of Appeal
DecidedDecember 20, 2017
DocketNO. 17-CA-284
StatusPublished
Cited by1 cases

This text of 235 So. 3d 1250 (Cahanin v. Louisiana Medical Mutual Insurance Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cahanin v. Louisiana Medical Mutual Insurance Co., 235 So. 3d 1250 (La. Ct. App. 2017).

Opinion

GRAVOIS, J.

|tIn this survival action and wrongful death case, plaintiff Janet Cahanin, wife of the decedent Ronald Cahanin, brought suit against Dr. Ludwig Heintz, a general surgeon, for medical malpractice following the death of her husband hours after he underwent elective laparoscopic surgery to repair an inguinal hernia.1 The jury found that Mrs. Cahanin proved the standard of care, that Dr. Heintz breached the standard of care, but that said breach was not a proximate cause of Mr. Cahanin’s death.2 The trial court entered a judgment reflecting the jury’s verdict, dismissing Mrs. Ca-hanin’s suit against defendants with prejudice. Mrs. Cahanin moved for a judgment notwithstanding the verdict, which the trial court denied. Mrs. Cahanin now appeals, arguing that the jury’s conclusion that Dr. Heintz’s breach of the standard of care was not a proximate cause of her husband’s death was manifestly erroneous, and also that the trial court erred in denying her motion for judgment notwithstanding the verdict.

Following a thorough review of the record in its entirety, as well as the applicable law, we find that the jury’s conclusion that Dr. Heintz’s breach of the standard of care was not a proximate cause of Mr. Caha-nin’s death is not reasonably factually supported by the record and is manifestly erroneous. Rather, for the reasons set forth herein, we find that Dr. Heintz’s breach of the standard of care was a proximate cause of Mr. Cahanin’s death. We accordingly reverse the judgment of the trial court and render judgment in favor of Mrs. Cahanin and against Dr. Heintz and his insurer, Louisiana Medical Mutual Insurance Company, in the amount of $500,000.00 in damages, plus interest and costs, as further explained below.

I «FACTS AND PROCEDURAL HISTORY

When he elected to undergo surgery to repair a hernia in 2012, Ronald Cahanin was 64 years old' and had a preexisting, blood disease called polycythemia vera (“PV”),3 a myeloproliferative disease of the blood.4 Its hallmarks are: (1) an over' production of red blood cells, making the blood thick and “sludgy” and increasing the risk of thrombolytic events, ie-., blood clots; and (2) an impairment in the function of platelets, which are responsible for blood clotting, putting sufferers at greater than the normal risk for bleeding. Mr. Cahanin had discovered that he had PY approximately two years before the hernia surgery. He was under the regular care of a hematologist, Dr. James Carinder, who managed Mr. Cahanin’s disease in two ways. To lower the risk of clotting, Dr. Carinder performed regular therapeutic phlebotomy, the taking of blood from Mr. Cahanin in an office procedure, which lowered the amount of red blood cells in his blood and which also made him mildly anemic, which in turn helped suppress the production of new red blood cells. Mr. Cahanin also took low dose (81 mg) aspirin on a daily basis, as well as Vitamin E, as part of Dr. Carinder’s treatment plan, which was described as another method of preventing blood clots. Dr. Carinder testified that in general, in a PV patient, the risk of blood clots is greater than the risk of bleeding, which is why they are treated with aspirin, a known anti-coagulant that also interferes with clotting. These two treatments, phlebotomy and aspirin,, managed the blood clot risk, but did not treat the bleeding risk.

When it was discovered in late 2012 that Mr. Cahanin had an inguinal hernia, he elected to have it surgically repaired. He went to Dr.'Ludwig Heintz, a general surgeon who had previously operated on Mrs. Cahanin. The surgery was | ¡¡medically indicated because the hernia was symptomatic (painful).5 A surgical consult appointment took place on November 29, 2012, at which time Mr. Cahanin informed Dr. Heintz about his PV and that he was under Dr. Carinder’s care. The surgery was scheduled for December 10,2012.

Mr. Cahanin had a pre-operative appointment on December 4, 2012 at St. Tammany Parish Hospital. He had blood work done, and also informed Joy Porter, the nurse, that he regularly took, aspirin, vitamin E, fish oil, and Novase (blood pressure medicine). Believing that the aspirin was contraindicated for a surgical procedure, Ms. Porter contacted Dr. Heintz’s office to let the surgeon know that Mr. Cahanin was taking aspirin.6 She spoke' with Rhonda Robertson, an employee of Dr. Heintz who assisted him with setting up surgical procedures and who was Ms. Porter’s regular contact at that office. Ms. Robertson testified that it was the office’s standard procedure to have patients discontinue aspirin use prior to surgery, a claim that Dr. Heintz denied at trial. She advised Ms. Porter-that the aspirin needed to be stopped, but this.was not an order: from a doctor and was not communicated to Mr. Cahanin. Dr. Heintz testified that-Ms. Robertson did not tell him that Mr. Cahanin was taking aspirin, nor did he know he was taking aspirin, despite it being in Mr. Cahanin’s pre-operative record in at least two places.7 It is undisputed that Mr. Cahanin was not advised to discontinue taking the aspirin before the surgery and did not do so.

Mr. Cahanin had an appointment with Dr. Carinder several days before the surgery, but did not tell him that he would be undergoing surgery in a couple of I ¿days. The record is undisputed that Dr. Heintz did not contact Dr. Carinder to ask for a surgical clearance for Mr. Cahanin and the two doctors did not communicate before the surgery.8 The surgery was performed at St. Tammany Parish Hospital on December 10, 2012, from approximately 9:00-10:00 a.m.

On the morning of the surgery, Mr. Cahanin' advised the nurse at the surgery intake that he had continued to take all of his medications, including the aspirin. Dr. Heintz reviewed the lab results taken at the pre-operative appointment, which; showed that Mr: Cahanin’s "white blood cell count was abnormally high, as well as several other lab values that were out of the range of normal. Mr. Cahanin' told Dr. Heintz'that his high white cell count was' typical, as was borne out by a later' review of Mr. Cahanin’s medical records. Dr. Heintz testified that he considered postponing the surgery based on Mr. Caha-nin’s lab work, but Mr. Cahanin elected to proceed with the surgery.9 They did not discuss the issue of Mr. Cahanin’s aspirin use, because Dr. Heintz was not aware of it. •

Mr. Cahanin’s surgery was performed without any difficulties. He was kept for standard post-operative observation, first in a post-anesthesia care unit, and thereafter in an ambulatory care unit. Upon the request of Mrs, Cahanin, Mr. Cahanin was kept a while longer than usual at the hospital because he looked a little gray, pale, and sweaty. However, he was discharged from the hospital around 3:00- in the afternoon, after being cleared by an anesthesiologist, who hád -reviewed his vital signs prior to discharging him.

' Upon discharge, Mrs. Cahanin brought her husband home and put him to bed, made him a sandwich for dinner, and left to fill his' prescriptions. When she returned, she noted that he had not eaten his sandwich. She gave him his |r,medicines and left him resting in their bedroom while she went into the den. She checked on him a few timéé, and later joined him and went to bed. Mr.

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235 So. 3d 1250, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cahanin-v-louisiana-medical-mutual-insurance-co-lactapp-2017.