Phinney v. Paulshock, et al.

CourtDistrict Court, D. New Hampshire
DecidedJune 4, 1998
DocketCV-97-45-JD
StatusPublished

This text of Phinney v. Paulshock, et al. (Phinney v. Paulshock, et al.) is published on Counsel Stack Legal Research, covering District Court, D. New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phinney v. Paulshock, et al., (D.N.H. 1998).

Opinion

Phinney v . Paulshock, et a l . CV-97-45-JD 06/04/98 P UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE

Linda S . Phinney, et a l . v. Civil N o . 97-45-JD Craig L . Paulshock, et a l . O R D E R

Plaintiffs’ motion for sanctions (document n o . 51) and defendants’ motion to strike (document n o . 59) arise out of a medical malpractice action concerning the death of Kenneth J. Phinney on March 1 9 , 1996 during surgery for a brain aneurism. Plaintiffs assert that Kenneth Bouchard, who is the attorney for both Atlantic Anesthesia (“AA”) and D r . Craig Paulshock (collectively “defendants” 1 ), impermissibly coached a deponent during her deposition. Plaintiffs also assert that defendants and/or their attorney wrongly failed to comply with legitimate discovery requests, and that defendants and/or their attorney fabricated evidence. Defendants seek to strike these allegations from the record and seek Rule 11 sanctions. The court conducted a hearing into the matter on March 2 0 , and from March 31 to April 3 , 1998.

1 There are several defendants in the underlying case that are not the objects of plaintiffs’ sanctions motion. Hereinafter, for convenience’s sake when I refer to “defendants” I mean only AA and D r . Paulshock. I . Background A . Undisputed Facts in the Underlying Case Kenneth Phinney was a 38 year old married father of two minor children. He and his family lived in Eliot, Maine. He worked at the Portsmouth Naval Shipyard.

On the evening of Saturday, March 1 6 , 1996, M r . Phinney complained of a very severe headache. Feeling no better the next day, he went to the emergency room of Wentworth-Douglass Hospital in Dover, N.H. He was admitted and a brain aneurism was diagnosed.

Mr. Phinney went into surgery for a craniotomy to repair the aneurism at approximately 11:00 a.m. on Tuesday, March 1 9 , 1996. The lead neurosurgeon was D r . Clinton Miller, assisted by D r . Carlos Palacio. The anesthesiologist was D r . Craig Paulshock, an employee and shareholder of AA. He was assisted by nurse anesthetist Elise Jackson, an employee of AA. After the operation was underway, D r . Paulshock left the operating room (“OR”) leaving Nurse Jackson responsible for the anesthesia. Shortly before 1:50 p.m., nurse anesthetist Patricia Daley, another AA employee, entered the OR to assist with the procedure. At 1:50 p.m., Nurse Jackson intravenously administered Nimodipine, an oral medication, in a dosage suitable for oral administration.2 At 2:03 p.m. M r . Phinney experienced a

precipitous drop in blood pressure accompanied by electro-

mechanical disassociation. At 2:10 p.m. a “code” was called,

indicating that the patient was in cardiac arrest and setting

into motion a concerted resuscitation effort.

Dr. Paulshock returned to the OR as the crisis ensued.3

Upon his entry into the OR, Nurse Jackson informed him that she

had administered Nimodipine to the patient.4 D r . Paulshock’s

partners, D r . Nathan Jorgensen and D r . James Tobin, responding to

the code, entered the OR shortly thereafter. D r . Jorgensen

inserted a subclavian triple lumen central venous pressure

(“CVP”) catheter into the patient, in part to search for an air

embolism that could be causing the arrest.5 He subsequently

2 Who said what to whom concerning the appropriateness of administering Nimodipine intravenously are disputed facts in the underlying case but of little relevance to the sanctions motion. It is undisputed, however, that Nurse Jackson administered an overdose of Nimodipine and that cardiac arrest can result from such an overdose. 3 There is some discrepancy as to precisely when D r . Paulshock returned to the OR. In his “Quality Assurance” statement, Dr. Paulshock stated that he initiated the code. At the hearing, OR Nurse Elaine Starkey testified that she initiated the code. 4 What Nurse Jackson said to D r . Paulshock, and what D r . Paulshock said in reply, are disputed facts that are relevant to the sanctions motion, and will be discussed fully below. 5 What D r . Jorgensen found and what he and others saw are disputed facts that are relevant to the sanctions motion and will

3 inserted a “Swan-Gantz” catheter for the same purpose. Mr.

Phinney was pronounced dead at 2:40 PM.

B . Evidence Relevant to the Allegations of Sanctionable Conduct6

1 . The Presence or Absence of a Finding of Aerated Blood

One allegation of defendants’ sanctionable conduct concerns

a written statement by D r . Jorgensen that he aspirated six or

seven syringes of frothy blood from M r . Phinney via the CVP

catheter. A finding of true aerated blood could indicate the

existence of a venous air embolism, which could explain M r .

Phinney’s cardiac arrest.7 Plaintiffs allege that Jorgensen’s

statement that he withdrew aerated blood consistent with a venous

air embolism was fabricated by defendants either with or without

the assistance of Attorney Bouchard.

be discussed fully below. One issue is whether D r . Jorgensen truly believed that the “frothy” blood he claims to have withdrawn was “aerated” blood characteristic of a venous air embolism. 6 The following section summarizes evidence relating to plaintiffs’ allegations that defendants and/or Attorney Bouchard: (1) fabricated a finding of aerated blood; (2) hid discoverable documents; (3) coached Nurse Daley to change her deposition testimony; and (4) made coaching objections and statements during Nurse Daley’s October 2 7 , 1997 deposition. These facts also bear upon defendants’ motion to strike. To the extent that there are discrepancies in the evidence presented, I have presented them in this section and will discuss their significance later. 7 Evidence of a venous air embolism would tend to exculpate AA of fault by offering an explanation for Mr. Phinney’s death other than the overdose of Nimodipine administered moments before by Nurse Jackson.

4 Attorney Bouchard testified that he was engaged to defend AA within days of M r . Phinney’s death. He learned from D r . Paulshock soon after his engagement about the potential defense of an air embolism. He asked D r . Paulshock to record his recollections of the circumstances surrounding M r . Phinney’s death, and asked him to relay that request to his partners as well. D r . Paulshock testified that he made that request by note to his partner, D r . Jorgensen.

In a memorandum dated April 1 , 1996, D r . Jorgensen purported

to record his role in the events surrounding M r . Phinney’s death

(“Jorgensen memorandum”). The memorandum states that:

[b]ecause venous air embolism is a potential cause of arrest in a patient undergoing a craniotomy, I placed a subclavian triple lumen CVP into the right superior vena cava/ atrium. I began to aspirate from the port to the distal lumen using a 20 cc syringe. I was able to aspirate frothy blood. There was air noted in the clear portion of the distal port lumen continuously as I aspirated. This seemed to confirm the likely diagnosis of venous air embolism. The central line was aspirated until no more air returned - six to seven 20cc syringes with a 50 /50 blood air mix.

Plaintiff’s Exhibit N o . 1 (hereinafter “Notebook”) 8 , tab 1 .

At the top of the memorandum, written in a manner to suggest

that Jorgensen’s memorandum was responsive, is a handwritten note

stating “Nathan - please report your observations involving the

8 This exhibit is a red notebook submitted by plaintiffs containing most of the documents relevant to this inquiry. It is subdivided by tabs bearing numbers, letters or subject headings.

5 events in the case of K. Phinney on 3-19-96. Your statement will be filed in anticipation of litigation involving m e , Atlantic Anesthesia, etc. Thanks.

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