Manning v. BELLAFIORE

991 A.2d 399, 2010 R.I. LEXIS 41, 2010 WL 1438922
CourtSupreme Court of Rhode Island
DecidedApril 12, 2010
Docket2005-320-Appeal
StatusPublished
Cited by7 cases

This text of 991 A.2d 399 (Manning v. BELLAFIORE) is published on Counsel Stack Legal Research, covering Supreme Court of Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Manning v. BELLAFIORE, 991 A.2d 399, 2010 R.I. LEXIS 41, 2010 WL 1438922 (R.I. 2010).

Opinion

OPINION

Chief Justice SUTTELL,

for the Court.

The defendant, Peter J. Bellafiore, M.D., appeals from a Superior Court order granting the motion for a new trial sought by the plaintiff, Kathryn Manning. 1 This wrongful death and medical malpractice action arises out of the tragic and premature death of Michael Manning. After a lengthy trial, a jury found in favor of Dr. Bellafiore. The trial justice granted the plaintiffs motion for a new trial, both as a sanction for what he considered Dr. Bellaf-iore’s “flagrant discovery abuse[s]” and because he found the jury’s verdict to be against the fair preponderance of the evidence. For the reasons set forth in this opinion, we affirm the order of the Superi- or Court.

I

Facts and Travel 2

On March 4, 1998, Kathryn Manning’s husband fell in his bathroom after losing consciousness. At the time, Mr. Manning was forty years old and the father of four young children. When his wife found him, Mr. Manning was unable to sit up or open his eyes, and he had a mild facial droop on his right side. He was taken to South County Hospital where he was treated by emergency-room personnel. An initial computerized tomography (CT) scan revealed normal blood flow. Doctor Bellaf-iore, a neurologist who was on call at South County Hospital, examined Mr. Manning several hours after his admission to the emergency room. By that time, Mr. Manning’s condition had improved somewhat, and Dr. Bellafiore contacted Donald McNiece, M.D., Mr. Manning’s primary-care physician, to obtain his medical history. Although Dr. McNiece was Mr. Manning’s admitting physician, he deferred to *401 Dr. Bellafiore in providing Mr. Manning’s treatment.

Doctor Bellafiore established a differential diagnosis for Mr. Manning, which is essentially a list of considered causes of a given symptom or symptoms. Among the sources of Mr. Manning’s symptoms contemplated by this differential diagnosis were complex migraine, aneurysm, tumor, and stroke. Doctor Bellafiore recommended that Mr. Manning undergo a magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of the circle of Willis 3 to determine whether Mr. Manning was suffering a stroke and, if so, to locate the blockage of blood flow to the brain. 4 Doctor Bellafiore also prescribed aspirin as an antiplatelet medication.

Mr. Manning first attempted to undergo an MRI/MRA the day he was admitted to South County Hospital. Unfortunately, he had a claustrophobic reaction and became nauseous while inside the closed MRI/ MRA machine, and he was unable to complete the test. Doctor Bellafiore prescribed the antianxiety medication Ativan and the antinausea medication Compazine for Mr. Manning, but his second attempt to undergo an MRI/MRA later that same day also was unsuccessful. In the hope of mitigating Mr. Manning’s claustrophobia, Dr. Bellafiore attempted to arrange a so-called “open architecture MRI” for Mr. Manning to undergo at Rhode Island Hospital. Doctor Bellafiore’s efforts were frustrated because the MRI machine was being repaired. The radiologist at Rhode Island Hospital initially believed those repairs would be completed by the afternoon of March 5, 1998, but when he called back, Dr. Bellafiore learned that the open MRI machine would be down for repairs indefinitely.

' At 3 a.m. on March 6, 1998, Mr. Manning began complaining about a severe headache. He also began experiencing a visual impairment resembling a “white veil.” Doctor Bellafiore ordered a second CT scan to determine whether the loss of vision could be attributed to swelling in the brain, and the test results indicated “a new prominent segmental abnormality in the left occipital lobe[.]” This confirmed that Mr. Manning had suffered a stroke two days earlier, but the test did not show any increased cranial pressure. 5

At approximately 9 a.m. on March 7, 1998, Mr. Manning suffered a second, catastrophic stroke. Mr. Manning was airlifted to Massachusetts General Hospital (MGH), where he was immediately treated by Christopher Putman, M.D. After examining the results of an advanced CT scan, 6 Mr. Manning’s treatment team de *402 termined that he had likely suffered a stroke caused by a blockage in the basilar artery in his brain. Doctor Putman performed an angiogram and discovered that Mr. Manning’s left vertebral artery was almost completely blocked. He then used several microcatheter treatment balloons to partially expand the artery. Upon reaching the basilar artery, Dr. Putman discovered a clot, which he identified as the cause of the stroke. Doctor Putman attempted to break apart the clot using the clot-buster Urokinase; and, after that was only minimally effective, he inflated several balloons, which dislodged the clot. The clot traveled into another portion of Mr. Manning’s brain, and Dr. Putman determined that the risks of further treatment in this region were too great. Unfortunately, Mr. Manning steadily lost brain function and on March 9, 1998, life support was withdrawn and he died.

Mrs. Manning filed a civil action against Drs. Bellafiore and McNiece, as well as South County Hospital, alleging negligence and wrongful death. After extensive discovery, trial began on January 4, 2004. At trial, plaintiff contended that the standard of care required Mr. Manning’s physicians to conduct an MRI/MRA examination within twenty-four hours of his first stroke. According to plaintiff, Dr. Bellafiore breached this standard of care by failing to accomplish the MRI/MRA examination promptly, and by failing to apprise Mr. Manning of alternative means to accomplish imaging, such as adequate sedation, after it became clear that Mr. Manning’s claustrophobia would otherwise prevent him from completing the test in a closed MRI/MRA machine. Moreover, plaintiff contended that if Dr. Bellafiore was unable to complete the MRI/MRA examination at South County Hospital, Mr. Manning should have been transferred to a tertiary care hospital 7 that performed conventional cerebral angiograms. Additionally, plaintiff argued that Dr. Bellaf-iore breached the standard of care by failing to administer the clot-buster Heparin after Mr. Manning was admitted.

A great deal of the testimony elicited at trial pertained to Dr. Bellafiore’s unsuccessful efforts to obtain an MRI/MRA test for Mr. Manning. 8 Doctor Bellafiore acknowledged that an MRI was an important diagnostic tool for ruling out possible causes of Mr. Manning’s symptoms, as well as for determining whether there was any damage to his brain tissue, which is an indication of an interruption of blood flow. Moreover, an MRA could pinpoint where in the arteries the damage had occurred, which is crucial for determining the cause of a stroke.

Doctor Bellafiore testified that he was involved in the initial efforts to obtain a closed MRI/MRA on March 4, 1998, through the Rhode Island Medical Resonance Imaging Network. 9 He testified that after Mr.

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Cite This Page — Counsel Stack

Bluebook (online)
991 A.2d 399, 2010 R.I. LEXIS 41, 2010 WL 1438922, Counsel Stack Legal Research, https://law.counselstack.com/opinion/manning-v-bellafiore-ri-2010.