Farina v. Kraus

754 A.2d 1215, 333 N.J. Super. 165
CourtNew Jersey Superior Court Appellate Division
DecidedDecember 22, 1999
StatusPublished
Cited by6 cases

This text of 754 A.2d 1215 (Farina v. Kraus) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Farina v. Kraus, 754 A.2d 1215, 333 N.J. Super. 165 (N.J. Ct. App. 1999).

Opinion

754 A.2d 1215 (1999)
333 N.J. Super. 165

Joseph K. FARINA, Executor of the Estate of Marie Farina, Deceased, and Joseph Farina, Individually, Plaintiff-Respondent,
v.
Elliott M. KRAUS, M.D., Defendant-Appellant.

Superior Court of New Jersey, Appellate Division.

Argued December 1, 1999.
Decided December 22, 1999.

*1216 Melvin Greenberg, Newark, argued the cause for appellant (Greenberg Dauber Epstein & Tucker, attorneys; Mr. Greenberg and Michael H. Freeman, on the brief).

Bard L. Shober argued the cause for respondent (Weiss & Shober, attorneys; Mr. Shober, on the brief).

Before Judges KING, KLEINER and PAUL G.LEVY.

The opinion of the court was delivered by KING, P.J.A.D.

I

This is a medical malpractice case premised on negligent diagnosis and treatment of bladder cancer. Plaintiff's wife Marie Farina (Farina) eventually died as a result of a claimed failure to diagnose and treat a "transitional cell carcinoma" of the bladder. Plaintiff recovered a net verdict of $136,000 in this wrongful death and survival action. We conclude that trial error requires a new trial on liability and damages. We reverse and remand.

II

Farina was age seventy-one at the time of her death on July 27, 1995. On February 28, 1990 Farina was admitted to the Shore Memorial Hospital emergency room complaining of an inability to urinate and vaginal bleeding. Staff doctors examined Farina and determined that she was in urinary retention, meaning that she was unable to empty her bladder, and that her bladder was full. The doctors proceeded to catheterize her and found bloody urine: "Gross hematuria is evident [-] blood in the urine." Staff doctors recommended that she see defendant Elliott M. Kraus, M.D., a urologist.

Dr. Kraus first examined Farina on March 1, 1990. He performed a number of tests, including a CBC with a differential (an analysis of red and white blood cell count), a urine culture (detects the presence of infection in the urine), a chest x-ray, an IVP (an x-ray of the patient's kidneys, ureters and bladder after an injection with dye), and a cytoscopy and biopsy of her bladder. Cytoscopy is an endoscopic procedure which uses an instrument like a telescope to look inside the bladder. The cytoscope has three lenses which allow physicians to view the inside of the bladder at various angles. Dr. Kraus testified that the cytoscope enables a doctors to visualize "every square centimeter of the inside of the bladder."

The IVP showed the kidneys and ureters to be normal. The urinanalysis showed she had red blood cells and bacteria in her urine. The cytoscopy, performed on March 2, 1990, showed some signs of infection. Dr. Kraus also performed a biopsy of Farina's bladder. He testified that his diagnosis before he performed the cytoscopy was hemorrhagic cystitis, where the bladder is so inflamed that it begins to bleed, and urinary retention. The cytoscopy revealed hemorrhagic mucosal changes most prominent on the back wall of the bladder.

*1217 At this time, Dr. Kraus "biopsied the most suspicious appearing area of the hemorrhagic mucosal changes on the posterior portion of the bladder on the left side." He described the most suspicious area as the "area that looked worse and could be turning to cancer or be—in fact, cancer." Dr. Kraus found no evidence of malignant tumor at this time. In sum, there, was no sign of cancer as a result of the cytoscopy or the biopsy. Dr. Kraus concluded that Farina had a neurogenic bladder a condition that affects the bladders of older women making them unable to completely empty their bladders in a normal fashion. This condition typically occurs when the sphincter fails to open completely on attempt to urinate, causing the bladder to squeeze harder to expel the urine. Farina was discharged on March 3, 1990 and placed on an antibiotic called Cipro.

Dr. Kraus saw Farina twelve times in that first year after discharge from the hospital. On March 14 and March 28, 1990 Farina was seen by Dr. Kraus at his office. During these two visits, Dr. Kraus performed a urinanalysis. During the March 14, 1990 visit, she was voiding better. The urinanalysis was essentially normal and showed only one or two red blood cells in her urine. This did not surprise Dr. Kraus because her bladder was severely inflamed and raw. During the March 28, 1990 visit, Farina complained of "difficulty urinating, straining, poor flow." The urinanalysis again only showed one or two red cells. Dr. Kraus catheterized Farina because she was carrying 350 cc's of urine. Dr. Kraus diagnosed "probable dyssynergia" (muscle weakness). Dr. Kraus prescribed Hytrin, which relaxes the sphincter muscle. The initial dose was one milligram once a day. Farina did not experience gross hematuria, as before her hospitalization.

Dr. Kraus next saw Farina on April 9, 1990. She reported that she had one episode of retention. Dr. Kraus increased the dose of Hytrin to one milligram twice a day. At her April 11, 1990 visit, the urinanalysis showed some white cells, meaning that she still had an inflammatory

process, but Farina stated that she was voiding better without straining. She continued on the Hytrin. On her next visit, April 23, 1990, Farina stated that she was voiding fairly well but was arising two or three times a night to urinate. She was catheterized at that point and her residual urine was much less about 130 cc's. Dr. Kraus continued Farina on Hytrin. At the April 30, 1990 visit, Farina's post-residual void after catheterization was 260 cc's, an increase of about eight ounces. Dr. Kraus increased the Hytrin to three milligrams per day.

At her May 11, 1990 visit, Farina was unable to void. She eventually voided 40 cc's of urine and then was catheterized for 280 cc's of post-void residual urine. Dr. Kraus increased her Hytrin to four milligrams per day. On her June 20 and August 22, 1990 visits, Farina was voiding well and continued on Hytrin through October 1990. Dr. Kraus testified that in 1990 Farina's voiding ability improved.

In 1991, Dr. Kraus saw plaintiff on three occasions, January 23, April 24 and December 1. The urinanalysis tests performed on these dates showed no signs of blood in her urine. On January 23, 1991 Dr. Kraus ordered a bladder ultrasound test because plaintiff had a neurogenic bladder. This bladder ultrasound study was not performed until May 23, 1991. During the first two visits, Farina was voiding well. At the December 1, 1991 visit, however, she showed signs of acute urine retention. Dr. Kraus prescribed Hytrin for her again.

Farina saw Dr. Kraus about five times in 1992, first on January 2, 1992. A cytometrogram was performed during this visit. The cytometrogram showed that her bladder was irregular and also showed the same type of diverticula that Dr. Kraus had seen when he had examined her in 1990. (Dr. Malloy, defendant's expert, explained that the cause of the diverticula was the fact that the bladder was "working hard and pushing against a fixed resistance.") Dr. Kraus next saw Farina on *1218 January 23,1992. At this time, she had no voiding discomfort, was urinating satisfactorily, and was taking the Hytrin. (Dr. Malloy, defendant's expert, testified that because Farina had a neurogenic bladder and no gross hematuria, there was no reason to consider urine cytology as a test in 1992.) By May of 1992 her urinanalysis was negative. On August 13, 1992 again her urinanalysis was negative. This meant that she had no white blood cells and no red blood cells in her urine at the time.

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Bluebook (online)
754 A.2d 1215, 333 N.J. Super. 165, Counsel Stack Legal Research, https://law.counselstack.com/opinion/farina-v-kraus-njsuperctappdiv-1999.