Collins v. National Healthcare of Leesville, Inc.

101 So. 3d 1110, 12 La.App. 3 Cir. 502, 2012 La. App. LEXIS 1421, 2012 WL 5423392
CourtLouisiana Court of Appeal
DecidedNovember 7, 2012
DocketNo. CA 12-502
StatusPublished
Cited by2 cases

This text of 101 So. 3d 1110 (Collins v. National Healthcare of Leesville, Inc.) 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
Collins v. National Healthcare of Leesville, Inc., 101 So. 3d 1110, 12 La.App. 3 Cir. 502, 2012 La. App. LEXIS 1421, 2012 WL 5423392 (La. Ct. App. 2012).

Opinion

EZELL, Judge.

_JjThis appeal in a medical malpractice case presents several questions pertaining to the damages that the jury awarded for breaches of the standard of care by Dr. David Steiner in his treatment of Mr. Donald Collins, who suffered an open, bilateral fracture of his left forearm. Dr. Steiner claims that any breaches of the standard of care by him were not substantial factors in the damages sustained by Mr. Collins. Dr. Steiner further asserts that the trial court erred in allotting responsibility for the medical expenses incurred after the date of injury to him rather than the Louisiana Patient’s Compensation Fund (PCF). Mr. Collins asserts that the damages he was awarded were inadequate.

FACTS

On June 28, 2003, Mr. Collins was working at his farm trying to load a bull when the bull flipped him over. He was sixty-three years old at the time. As a result of the incident, Mr. Collins broke both the radius and ulna in his forearm. A friend was with Mr. Collins at the time of the accident and transported him to Byrd Regional Hospital. Mr. Collins arrived at the hospital around 1:10 p.m.

Chris Mitchell, the emergency room (ER) nurse, performed the initial evaluation of Mr. Collins. Dr. Jerry Troy was the ER doctor on call and performed the initial treatment of Mr. Collins. An x-ray of the arm was taken. Dr. Troy diagnosed Mr. Collins with an open, bilateral fracture of the left forearm. He contacted Dr. David Steiner, the orthopedic surgeon on call, at 1:25 p.m. Dr. Steiner was out of town at the time. Although Dr. Troy could not remember talking to Dr. Steiner, he testified that he would have told him that both bones were broken and that it was an open fracture. Mr. Mitchell also testified that he would always indicate that it was an open fracture. Dr. Steiner denied that he was told it was an open fracture.

|2Pursuant to Dr. Steiner’s order, a tetanus shot was administered. Physician’s orders indicate that Mr. Collins was admitted to Dr. Steiner’s care with an open fracture to the left forearm at 2:55 p.m. His vital signs were to be monitored every four hours, and he was put on bed rest with bathroom privileges. Mr. Collins was put on IV fluids, and Neosporin was administered to his abrasions. The orders [1114]*1114further provided that Mr. Collins was not to be given anything by mouth in order to prepare him for surgery.

At the time, Dr. Steiner was in Baton Rouge on some church business. He testified that he continued with his church business for about three-and-a-half hours after receiving the call before starting the three-hour drive back to Leesville. Dr. Steiner testified that if he had known the wound was open he would have sent Mr. Collins to another hospital. He testified that he did not tell anyone what time he would get back. Dr. Steiner did admit that he knew that there was a laceration over the area. Dr. Troy indicated that had he known Dr. Steiner was out of town, he would have transferred Mr. Collins to another hospital because it was an open fracture.

Lori Allen was the LPN who took care of Mr. Collins when he was admitted to the hospital. When he was admitted, his left arm was already in a sling and Ace bandage. He requested more pain medication, but Ms. Allen noted that it was too early to give him any additional medication. At 5:00 p.m., Ms. Allen noted that Mr. Collins’ left forearm was hurting and swelling. Mr. Collins also complained that his fingers were swelling and stiff, so Ms. Allen loosened the bandage. An icepack was also applied, and Mr. Collins started feeling better. At 6:30 p.m., Mr. Collins was still complaining of pain, so he was given a dose of morphine. At 7:00 p.m., Mr. Collins continued to complain of pain and it was noted that Dr. Steiner still had not arrived. At 7:40 p.m., Mr. Collins indicated that he was very anxious about surgery. He was also told that it was not time for any pain medication.

|sDr. Steiner finally arrived at the hospital around 9:10 p.m. Dr. Steiner indicated that there was a comminuted fracture of the ulna because it was broken in more than two places. There was an oblique fracture, one break at an angle, of the radius. Dr. Steiner noted some dirt around the laceration but no bone was exposed. At 10:00 p.m., Mr. Collins was taken to surgery. Dr. Steiner noted that there were tears in the tissue that went down to the bone. He agreed that it is not ideal to leave a fracture open for a long time.

Dr. Steiner repaired the broken ulna and radius in the left forearm. He utilized a nine-hole plate on the ulna with three screws above and three screws below. Dr. Steiner did not put screws in all the holes. Dr. Steiner testified that when he repaired the radius, he made a decision to use a smaller plate because he did not want to dissect too much tissue. Although he would have liked to use a seven or eight-hole plate, he used a six-hole plate.

When Dr. Steiner pulled the arm out to full length, it became obvious that Mr. Collins had compartment syndrome, a serious condition that involves increased pressure in the muscles which can lead to muscle and nerve damage. Dr. Steiner then performed a fasciotomy, a procedure in which surgical cuts are made in the fascia. The fascia surrounds the muscle tissue, nerves, and blood vessels, and a fasciotomy relieves the pressure caused by swelling. Due to the fact that a fascioto-my had been performed, Dr. Steiner did not close the skin at the end of the procedure because there was too much swelling. He used a sugar-tong splint to accommodate the soft-tissue swelling.

Dr. Steiner next saw Mr. Collins on July 2, 2003. An x-ray was taken. Mr. Collins was concerned with the color and odor of the dressing, but Dr. Steiner thought it appeared satisfactory. On July 3, 2003, Dr. Steiner performed a debridement and ^secondary closure of the open wounds. There was still some swelling, so Dr. [1115]*1115Steiner left a small portion in the center of the outer wound open.

Mr. Collins returned to see Dr. Steiner on July 14, 2003. Dr. Steiner noted that the left hand was beginning to appear normal with good color and wrinkles indicating that the swelling had decreased. On July 15, 2003, the open wound was debrided and closed. Dr. Steiner noted that the other incisions had healed nicely.

When Mr. Collins returned to see Dr. Steiner on July 21, 2003, he was complaining of numbness in the forearm and back of the hand. Dr. Steiner opined that some of the numbness was from tightness of the ace wrap.

At the July 30, 2003 appointment, it was noted that Mr. Collins had limited motion in his left thumb and discomfort with supi-nation and pronation. A long, synthetic cast was applied. X-rays revealed that the position of the bones was good. Dr. Steiner noted that he did not see as much healing as he would like to see. He contemplated that a bone-growth stimulator may be necessary.

Mr. Collins returned to see Dr. Steiner on August 15, 2003, complaining of a knot under the cast at the elbow and worrying about the possibility of infection. The cast was loosened, and he was assured that there was nothing to worry about.

On August 27, 2003, the cast was removed and the lateral incision appeared to have a slow healing spot about mid-incision. X-rays revealed that the position was good but that there appeared to be a bone infection of the radius. Dr. Steiner obtained cultures of the open wound which did not indicate an infection at that point. At that time, Mr. Collins was given a prescription for Augmentin, an antibiotic.

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Bluebook (online)
101 So. 3d 1110, 12 La.App. 3 Cir. 502, 2012 La. App. LEXIS 1421, 2012 WL 5423392, Counsel Stack Legal Research, https://law.counselstack.com/opinion/collins-v-national-healthcare-of-leesville-inc-lactapp-2012.