Germanoff v. Aultman Hospital, Unpublished Decision (9-23-2002)

CourtOhio Court of Appeals
DecidedSeptember 23, 2002
DocketCase No. 2001CA00306.
StatusUnpublished

This text of Germanoff v. Aultman Hospital, Unpublished Decision (9-23-2002) (Germanoff v. Aultman Hospital, Unpublished Decision (9-23-2002)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Germanoff v. Aultman Hospital, Unpublished Decision (9-23-2002), (Ohio Ct. App. 2002).

Opinion

OPINION
{¶ 1} Plaintiff-Appellant Stephen Germanoff, the administrator of the estate of Connie Sue Germanoff, appeals the decision of the Court of Common Pleas, Stark County, which entered judgment in favor of various defendants in a medical malpractice action. The relevant facts leading to this appeal are as follows.

{¶ 2} On December 26, 1999, Connie Sue Germanoff, age 49, died from heart failure after reporting to the emergency room at Appellee Aultman Hospital ("Aultman") in Canton, Ohio. Between December 16, 1999 and the date of her death, Connie went to Aultman on four occasions and was seen by several different physicians. On December 16, 1999, Connie presented to Aultman with chest pain radiating into her left arm. Serial enzyme blood tests were ordered, including readings for "cardiac markers" myoglobin, troponin, and creatine phosphokinase (CPK). Peter Y. Lee, M.D., a cardiologist, was consulted on the morning of December 17, 1999 to assess the nature of Connie's chest pain. Dr. Lee reviewed Connie's records, including results from a stress test conducted in September 1999, and performed a physical examination. He further ordered an adenosine cardiolyte stress test, which mimics the effect of physical activity without the patient having to undergo a treadmill exercise test. Dr. Lee left the hospital upon completion of his rounds on December 17, 1999, and commenced a vacation. He did not review Connie's aforementioned myoglobin and troponin results prior to departing. At the time, Aultman's "reference ranges" for troponin, an indicator of heart muscle damage, were as follows: .03 or less was normal, .04 to .15 was a "gray" or indeterminate zone, and .15 or higher was diagnostic of a heart attack. Connie's first troponin level was .03. On the morning of December 17th, it was .05. At 5:00 pm that afternoon, it was .08. Connie's myoglobin readings, which are recognized as less specific cardiac markers, also went up during this period from 130 to 145, both of which were in an elevated range. Dr. Lee, however, admittedly did not see said results and did not order a cardiac catheterization for Connie. On December 17, 1999, Connie was seen by Allen Kamen, M.D., a cardiologist and partner of Dr. Lee. Dr. Kamen found Connie's laboratory results to be nondiagnostic. Dr. Kamen also supervised the adenosine cardiolyte stress test previously ordered. The results of that test were normal. Dr. Kamen thereupon determined that Connie could be discharged from a cardiology standpoint. On December 18, 1999, Dr. Humble, one of Connie's family physicians, discharged Connie from Aultman with instructions to follow up with him in two to three weeks and to consult with a gastroenterologist.

{¶ 3} Connie returned to Aultman on the evening of December 20, 1999, again experiencing chest pain radiating into her left arm. She was seen at that time by M.W. Hatcher, M.D., an emergency room physician and an employee of Appellee Canton Aultman Emergency Physicians, Inc. Dr. Hatcher ordered an EKG and one set of cardiac marker enzymes. The EKG was normal. Connie's troponin level registered in Aultman's indeterminate range (.04) and her CPK level was normal, while her myoglobin level was abnormal. Nonetheless, Dr. Hatcher marked the overall cardiac marker panel as normal. Dr. Hatcher also reviewed Connie's medical history and performed a physical exam. Connie's blood pressure was initially elevated, but subsequently returned to normal. Dr. Hatcher also ordered a chest x-ray, which was normal. Because Connie's chest pain had lasted for several hours during that evening, Dr. Hatcher felt that this symptom was more consistent with gastroesophageal reflux. He concluded that Connie should be discharged that night with directions to take Reglan for acid reflux in the esophagus.

{¶ 4} On December 24, 1999, Connie and was taken by ambulance to Aultman. The paramedics ran a single-lead cardiac monitor strip en route to the hospital, which they attached to their report for the hospital.1 Connie's condition was first observed by a registered nurse, who noted that her vital signs were normal. Although the ambulance paramedic told Aultman that Connie reported chest pain, both the nurse and Ginger Hamrick, M.D., the e.r. physician, recalled that Connie was experiencing epigastric pain, i.e., in the area of the upper abdomen just below the sternum. Thereafter, Dr. Hamrick examined Connie and reviewed her history. Dr. Hamrick also attached a cardiac monitor lead which could send an alarm to the nursing station if necessary. The monitor readouts were normal during this event. No EKG was ordered on this occasion.2 In light of such factors and her review of the previous cardiologists' recommendations, Dr. Hamrick reached the conclusion that the likelihood of a cardiac event at that time was "very slim." Tr. at 1806. Dr. Hamrick thus discharged Connie with directions to follow up with her family physician.

{¶ 5} On December 26, 1999, Connie contacted Dr. Humble's office, complaining of chest pains. At Dr. Humble suggestion, Connie went to Aultman's emergency room. She died during this visit. The corner's report listed as the cause of death acute myocardial failure, cardiac tamponade, ruptured myocardium, acute myocardial infarction, coronary artery disease, hypertension, and cigarette smoking. The report concluded that Connie's heart attack was 48 to 72 hours old, and noted, inter alia, a 70 percent narrowing of the right coronary artery.

{¶ 6} On June 16, 2000, appellant filed suit in the Stark County Court of Common Pleas, naming as the defendants Appellee Aultman, Appellee Canton Aultman Emergency Physicians, Inc. ("Emergency Physicians, Inc."), G. Hamrick, M.D., M.W. Hatcher, M.D., Appellee Cardiology Associates of Canton, Inc. ("Cardiology Associates"), Peter Y. Lee, M.D., Commonwealth Comprehensive Care, and Stacey Hollaway, M.D. Prior to trial, the issue of the aforementioned troponin "reference ranges" came into play. On January 3, 2000, shortly after Connie's death, Aultman changed the hospital's reference range to increased levels. Thus, certain troponin levels which were abnormal under the older reference range would be classified as normal under the newer version. Appellant filed a motion in limine to preclude admission of Aultman's subsequent change in the reference range. The trial court overruled the motion in limine. In addition, appellant sought discovery concerning the change in the troponin reference range. However, in judgments rendered August 27, 2001 and September 11, 2001, the trial court ruled that appellant was barred from discovery on the subject based on statutory peer review privilege.

{¶ 7} On August 23, 2001, the trial court granted Aultman's motion for summary judgment, finding, inter alia, no genuine issue of an employee relationship between the hospital and defendant physicians. A jury trial commenced on August 27, 2001 against Emergency Physicians, Inc. and Cardiology Associates. Again, the issue of Aultman's subsequent change in the troponin reference ranges was brought to the court's attention. The court ruled in response to a motion that it would permit evidence on the changed reference range, but the specific reasons for the change were determined to be privileged and inadmissible. The court also addressed the issue of admitting evidence of troponin reference ranges at the California hospital utilized by Dr. Kaiser, appellant's expert. A similar discussion took place concerning reference ranges at the hospital utilized by appellant's emergency room expert.

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Bluebook (online)
Germanoff v. Aultman Hospital, Unpublished Decision (9-23-2002), Counsel Stack Legal Research, https://law.counselstack.com/opinion/germanoff-v-aultman-hospital-unpublished-decision-9-23-2002-ohioctapp-2002.