Pizani v. Cranmer

493 So. 2d 134, 1986 La. App. LEXIS 8760
CourtLouisiana Court of Appeal
DecidedJune 2, 1986
DocketNo. 86-CA-1
StatusPublished
Cited by2 cases

This text of 493 So. 2d 134 (Pizani v. Cranmer) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pizani v. Cranmer, 493 So. 2d 134, 1986 La. App. LEXIS 8760 (La. Ct. App. 1986).

Opinion

CHEHARDY, Chief Judge.

Hazel Berthelot Pizani instituted this suit for medical malpractice against Dr. John I. Cranmer, a urologist, West Jefferson General Hospital, and the Purdue Frederick Company, the manufacturer of a chemical which was used during a bladder operation on the plaintiff.

Prior to suit, pursuant to the Louisiana Medical Malpractice Act, LSA-R.S. 40:1299.41 et seq., a 3-member medical review panel was formed to evaluate plaintiff’s claim. The panel concluded that neither the doctor nor the hospital failed to meet the applicable standard of care and that the conduct of which plaintiff complained was not a factor in her injuries.

Thereafter plaintiff instituted this suit in the district court. She requested a trial by jury. A bifurcated trial was necessary because the hospital is owned and operated by Hospital Service District No. 1 of the Parish of Jefferson and in accordance with LSA-R.S. 13:5105, a jury trial is prohibited against political subdivisions of the state. Consequently the jury was called upon to determine the liability, if any, of the doctor and the drug manufacturer, and the liability of the hospital, if any, was to be determined by the judge.

At the conclusion of plaintiff’s case the manufacturer made a motion for a directed verdict as to its liability. The motion was granted and the suit was dismissed with prejudice as to that defendant. The case was continued against the doctor and the hospital.

Following trial on the merits the jury returned a verdict of no negligence on the part of the doctor. The trial court found the hospital was negligent and that its negligence was a proximate cause of plaintiff’s injuries.

Accordingly, judgment was rendered in favor of plaintiff against West Jefferson General Hospital in the sum of $65,000 general damages, and $42,864 in special damages, with interest from date of judicial demand. By amended judgment it was provided that interest was to run from November 14, 1980, the date of mailing the complaint to the Commissioner of Insurance by certified mail.

The hospital has appealed from this judgment and plaintiff has answered the appeal.

[136]*136The record reflects the following facts:

In 1980 Mrs. Pizani consulted Dr. Cranmer for bladder problems. She had been urinating hourly in large volumes, and involuntarily while standing, sneezing or coughing. She had had a previous bladder problem in 1977 following a hysterectomy, but following treatment by her gynecologist, Dr. T. Richard Smith, the matter had resolved itself.

When consulted in 1980 Dr. Cranmer prescribed a drug which proved ineffective. When plaintiffs condition did not improve she was admitted to West Jefferson General Hospital on September 14, 1980 for diagnostic tests. It was determined that plaintiff’s bladder capacity was below normal and there was a loss of the urethral bladder angle. Cranmer recommended a surgical procedure known as a Marshall Mar-chetti Krantz (MMK), which would suspend the bladder at an angle and enable plaintiff to retain urine. The surgery was performed on September 22.

Following the operation plaintiff continued to have bladder spasms, and on the fourth or fifth post-operative day the doctor performed a second cystogram test to determine why Mrs. Pizani was not improving. The test indicated plaintiffs bladder was irritated and its capacity was substantially reduced. The doctor was at a loss to understand what had happened. In carefully reviewing the procedure and returning to examine the operating room he was of the opinion that the probable cause of plaintiffs problems was that Betadine Scrub, instead of Betadine solution which he had called for, had been injected into plaintiffs bladder, causing the irritation and the subsequent shrinking of plaintiffs bladder capacity from a low-normal 275 cc’s to 60 cc’s, or 2 ounces.

Dr. Cranmer consulted Dr. Rodney Ap-pell, a urologist with a subspeciality of urodynamics. He explained the problem and his conclusion was that it had probably resulted from injection of the wrong chemical. Dr. Appell conducted a series of uro-dynamic tests on plaintiff utilizing a variety of medications in various dosages and groupings.

Plaintiff continued to complain of the need to urinate frequently. Appell was of the opinion that this was due to irritation of certain nerve endings of the bladder. He recommended a procedure whereby a 6% solution of Phenol would be injected into the base of the bladder. This procedure involves minimal risk and has a 50% success rate in reducing irritability of the nerve endings. If successful this would completely relieve plaintiff’s frequency problems. Plaintiff is considering the procedure, but is reluctant to undergo a procedure which would instill another chemical in her bladder at this time.

She continues to consult Dr. Appell and her bladder capacity now is approximately what it was when she initially consulted Dr. Cranmer in 1980. However, she urinates every 2 or 3 hours.

It is plaintiff’s position that during the MMK procedure Betadine Scrub, a mixture of Povidone-Iodine with a detergent additive, was instilled into her bladder instead of the proper solution, Betadine and saline (50% each), to distend the bladder during her surgery. She claims the stronger solution permanently damaged her bladder. Both solutions were manufactured by the Perdue Frederick Company and sold to the hospital in gallon containers. The hospital transferred the chemicals to smaller properly sterilized glass containers. Each of the smaller bottles was marked to show the contents.

It is conceded that the doctor called for Betadine solution, and not Betadine Scrub during the operation.

In this court the hospital contends the trial court erred in finding: (1) the improper solution was used, and (2) that the instillation of either solution into plaintiff’s bladder was responsible for her injuries.

Relative to appellant’s first contention, plaintiff, the doctor and four hospital employees were present in the operating room during the MMK procedure. The employees were the circulating nurse, Sumeta [137]*137Yokyongskul, and three operating room technicians, Regina Allen, Linda Bocage and Theodore Johnson.

Dr. Cranmer testified that prior to the surgery 3 tests were performed on plaintiff, a cystourethoscopy, a cystogram, and a bilateral ultragram pylogram. The test results indicated her kidneys were normal, the bladder capacity was 275 cc’s, she had no urethral reflex, and she had a loss of vessel bladder angle which was contributing to her stress incontinence.

Since the bladder angle was too straight, the urine flowed out easily. If the urethra were elevated near the bladder neck, it would tend to hold the urine in. The MMK surgery was intended to elevate the bladder angle. The operation also elevates the sides of the bladder to give it additional support.

During the procedure a Betadine solution is injected to distend the bladder. It is used for color contrast between clear fluid or water, and also for its anti-bacterial effect. The Betadine solution is mixed with normal sterilized salt water. It comes from a sterile, small bottle poured into a sterile metal pan, and the Betadine solution is poured into the same pan. The hospital staff prepares the mixture during the operation!

Dr. Cranmer was standing by the staff as they made and poured the mixture. He saw it poured, but did not inspect the solution.

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Related

Pizani v. Cranmer
494 So. 2d 1173 (Supreme Court of Louisiana, 1986)

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Bluebook (online)
493 So. 2d 134, 1986 La. App. LEXIS 8760, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pizani-v-cranmer-lactapp-1986.