in Re Iftikhar Ahmed, P.A. and Farhan Khan, M.D.

Court of Appeals of Texas·Decided February 25, 2020·No. 01-19-00584-CV·Published

Opinion

Opinion issued February 25, 2020

In The

Court of Appeals

For The

First District of Texas

Background

On November 8, 2016, Joseph Nicholson was examined at a CVS Minute Clinic where he tested positive for strep throat and was prescribed penicillin for ten days. Five days later, on November 13, 2016, Nicholson went to the emergency room at Houston Northwest Medical Center and reported that he had a sore throat for a week and intermittent fever and chills. In the emergency room, he was treated by Iftikhar Ahmed, a licensed physician’s assistant. Ahmed conducted a physical exam and took a medical history. The medical notes state that Nicholson did not have a fever, but that he had enlarged tonsils with exudate and swelling, indicating his strep infection had not been cleared by the penicillin. Ahmed diagnosed Nicholson with tonsillitis, prescribed a new antibiotic and Ibuprofen, and discharged him with instructions to follow up with an ear, nose, and throat specialist in two-to- three days. The next day, Dr. Farhan Khan reviewed and signed off on the chart as part of the hospital’s standard quality control protocol.

On November 18, 2016, five days after being seen at the emergency room, EMS was called and found Nicholson unresponsive in his bathroom. He was intubated and taken to the hospital where, despite multiple rounds of medications, he could not be resuscitated. The medical examiner concluded that the primary cause of death was acute myeloid leukemia with involvement of the skin, tonsils, lymph

nodes, epiglottis, spleen, lungs, heart, kidneys, liver, testes, and brain. The secondary finding was sepsis from two strains of bacteria. The Underlying Trial Nicholson’s mother and daughter filed a wrongful death suit against various health care providers and facilities, including Ahmed and Dr. Khan, alleging medical negligence and gross negligence. Plaintiffs asserted that when Nicholson presented to the emergency room with a sore throat, he also had evidence of hemorrhage from facial lesions and black tarry stools. At trial, they provided testimony from Nicholson’s mother that he had blood in his stool, as well as an EMS report from November 18, 2016, stating that Nicholson had mentioned this complaint when seen at the emergency room on November 13. Plaintiffs also provided testimony from Nicholson’s mother and sister that he had lesions on his face, and the autopsy report, which described facial scabs.

Plaintiffs’ sole expert, Dr. Arnold D. Rubin, testified that (1) based on this evidence of bleeding, Nicholson should have had a blood test to determine the cause of the blood loss, and (2) based on the leukemic cells that he believed would have been identified by these tests, Nicholson would have been presumed to have acute promyelocytic leukemia, a specific sub-type of acute myeloid leukemia that Plaintiffs contend can be effectively treated within days. Dr. Rubin conceded that the findings in the autopsy report for the alleged lesions on Nicholson’s face were

excoriations (scabs) and not petechiae (spots that appear on the skin as a result of bleeding), and it was possible that there was no rash or splotches on his skin at the time of the emergency room visit. Dr. Rubin further conceded that the autopsy did not mention a massive hemorrhage or bleed.

On January 10, 2019, the jury rendered a verdict in favor of the defendants, finding that Nicholson’s death was not caused by either negligence or gross negligence. Accordingly, the trial court signed a final take-nothing judgment on March 4, 2019. Plaintiffs’ Motion for New Trial On January 25, 2019, after the jury returned a verdict for the defense, Plaintiffs filed a third-party subpoena to obtain autopsy photographs from the medical examiner. On April 3, 2019, the thirtieth day after judgment was signed, Plaintiffs filed a motion for new trial, asserting that the autopsy photographs warranted a new trial. Relators received service of the motion without any attachments or exhibits. The filing was returned from the e-filing system due to improper formatting and Plaintiffs refiled the motion the next day. On April 4, 2019, Relators received service of the motion with 40 autopsy photograph exhibits attached. Thirty-two of the photographs were file-stamped by the trial court on April 4, 2019, but the motion and the remaining seven photographs were not file-stamped until April 5, 2019.

The trial court later granted Plaintiffs’ motion to amend the petition to include an affidavit by their counsel, Todd E. Webb, in support of the motion for new trial. The affidavit was notarized on April 4, 2019 but was not filed until May 1, 2019. The affidavit consists of bare assertions that the requirements for a new trial on the ground of newly discovered evidence were met. Specifically, Webb averred the following in his affidavit:

4. All allegations made in the attached Motion for New Trial requiring the presentation of evidence are true and correct.

5. Evidence has come to light since the time of trial therefor [sic]

it was impossible to present the evidence before the trial closed.

6. It was not because of a lack of due diligence that the information did not come sooner.

7. The new evidence is not cumulative.

8. The evidence is so material that it would probably produce a different result in a new trial.

The affidavit did not provide any specific details or explanation in support of these

assertions.

The trial court granted the motion for new trial on June 12, 2019. The order states in relevant part:

Plaintiffs brought a survivor and wrongful death claim against Defendants for medical malpractice based upon the untimely death of Joseph Nicholson who died on November 11, 2014. A jury returned a verdict for defendants’ [sic] finding the defendants were not negligent. However, after trial, Plaintiffs’

[sic] discovered new evidence in the form of over forty autopsy photographs from the Harris County Institute of Forensic

Science. The Court finds that the new evidence has been discovered since trial; the failure to discover the evidence prior to trial was not because of lack of due diligence; the evidence is not cumulative; and the evidence is so material that it would probably produce a different verdict. For these reasons, the Court grants Plaintiffs’ Motion for New Trial.

This mandamus petition followed.

Standard of Review for Mandamus Relief To be entitled to mandamus relief, a relator must demonstrate (1) the trial court clearly abused its discretion and (2) the relator has no adequate remedy by appeal. In re Reece, 341 S.W.3d 360, 364 (Tex. 2011). A trial court clearly abuses its discretion if it reaches a decision so arbitrary and unreasonable as to amount to a clear and prejudicial error of law or if it clearly fails to analyze the law correctly or apply the law correctly to the facts. In re Cerberus Capital Mgmt., L.P., 164 S.W.3d 379, 382 (Tex. 2005).

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in Re Iftikhar Ahmed, P.A. and Farhan Khan, M.D., (Tex. Ct. App. 2020).

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