Samuel v. Baton Rouge General Medical Center

757 So. 2d 43, 98 La.App. 1 Cir. 1669, 2000 La. App. LEXIS 321, 2000 WL 282364
CourtLouisiana Court of Appeal
DecidedFebruary 18, 2000
DocketNo. 98 CA 669
StatusPublished
Cited by4 cases

This text of 757 So. 2d 43 (Samuel v. Baton Rouge General Medical Center) 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
Samuel v. Baton Rouge General Medical Center, 757 So. 2d 43, 98 La.App. 1 Cir. 1669, 2000 La. App. LEXIS 321, 2000 WL 282364 (La. Ct. App. 2000).

Opinions

DGUIDRY, J.

This appeal challenges a trial court’s finding that a doctor committed malpractice by giving his patient inadequate discharge instructions. Finding this determination to be neither manifestly erroneous nor clearly wrong, we affirm.

FACTUAL AND PROCEDURAL BACKGROUND

This malpractice litigation stems from the treatment of Alfred Samuel by Dr. Terry Jones, a vascular surgeon. At the time, Mr. Samuel had end stage renal disease, or chronic kidney failure, which required continual dialysis treatment. He also suffered from hypertension which made his heart three times the normal size.

In order to receive dialysis treatments, hemodialysis catheters, or access grafts, were inserted into Mr. Samuel’s arms. The access grafts were inserted during surgical procedures at the VA Hospital in New Orleans in October of 1990, and at [45]*45Our Lady of the Lake Regional ■ Medical Center in Baton Rouge. During an access surgical procedure, grafts (typically made from plastics) are inserted between an artery and a vein so that blood may be diverted from the artery through the graft into the vein. Over time, the arterial flow toughens the vein, enabling it to withstand repeated punctures of at least two needles per dialysis treatment, typically three times a week.

Mr. Samuel first saw Dr. Jones for vascular access problems in January of 1991. On February 4, 1991, Dr. Jones inserted a graft in Mr. Samuel’s left upper arm. It was discovered that the upper left arm graft had become infected and clotted, necessitating that Dr. Jones surgically remove it.

Mr. Samuel was admitted to the Baton Rouge General Medical Center for removal of the upper left arm graft and all forearm grafts. Dr. Jones performed the surgery on the afternoon of April 2, 1991. In removing the upper arm graft, Dr. Jones made an incision dissecting the graft from the brachial artery site first, the vein site second, and he made a third longer incision directly over the graft site. | ^During the course of the procedure, pus was encountered which flowed into the area. Dr. Jones irrigated the area and proceeded to remove the graft. The incisions were closed with sutures and a staple. Part of the wound was left open to allow for drainage. A pressure dressing was applied to his arm, consisting of bandages wrapped with gauze and an ace bandage. The pressure dressing is used to reduce swelling and to stop bleeding from occurring.

The following day, at about 2:00 p.m., Mr. Samuel began to bleed from the left upper arm area. Emma Young, the nurse in charge of his dialysis treatment, noted that his bandage and his bed linens were saturated with blood. Nurse Sylvia Robertson removed the dressing and observed a steady stream of blood pouring out of the upper arm graft which she characterized as arterial blood. Nurse Robertson and other nurses applied direct pressure on the site for about 20 minutes, the bleeding was brought under control, and a new pressure dressing was applied. Nurse Young, who observed the bleeding incident, attested that there was nothing out of the ordinary going on at the time; rather, the nurses were talking among themselves during the incident.

,. Later that evening, a second bleeding incident occurred at approximately 9:00 p.m., when Mr. Samuel bled again from the left arm graft. Nurse Delores Allen applied pressure for about 8 minutes, then applied a new pressure dressing. She no-tifiéd one of Dr. Jones’ partners, who ordered that Mr. Samuel be given two units of blood.

Mr. Samuel remained in the hospital for observation until April 6th. He had no other bleeding episodes, received his dialysis treatment successfully, was eating well and all of his vital signs were normal. He was discharged by Dr. Jones at 9:30 a.m. In a discharge summary compiled by Dr. Jones, it is noted that Mr. Samuel had been given instructions on how to hold pressure in the area should bleeding occur and was told to call if there were any problems.

|4Mr. Samuel was picked up from the hospital about noon by his nephew. Mr. Samuel spent the night at his sister’s home. The following afternoon, Mr. Samuel informed his sister that he bled while she was away from home but was able to control it by wrapping a towel around his arm.

Mr. Samuel returned home on Sunday, April 7. According to his wife, Joyce, Mr. Samuel bled again that evening, pressure was applied to control it and the site was wrapped with gauze. No one called Dr. Jones or any other medical professional to report the two bleeding incidents.

The next morning, Mrs. Samuel left home to take her daughter to school and fill a prescription. She stated that she was [46]*46gone twenty or thirty minutes. When she returned home, she found, her husband dead, lying in a pool of blood. •.

Mr. Samuel died sometime between 9:30 a.m. and 10:00 a.m as a result of hemorrhaging from the incisions in his left arm. Dr. Robert Batson, a vascular surgeon, believed that Mr. Samuel died from an infection of the brachial artery which caused erosion or disintegration of the bra-chial artery at the site of Dr. Jones’ suture.

In this wrongful death action filed by Mrs. Samuel and her two daughters against Dr. Jones and his corporation, Vascular Surgery Associates of Baton Rouge, Inc., the plaintiffs did not allege that the surgical procedure utilized by Dr. Jones was improper, or that anything Dr. Jones did during the surgery caused Mr. Samuel to bleed to death following his discharge from the hospital. Rather, they alleged Dr. Jones was negligent in his post-operative treatment of Mr. Samuel in three respects. First, they claimed Dr. Jones was negligent for failing to take Mr. Samuel back into surgery after each of the bleeding incidents on April 3rd to explore the upper left arm graft site: Secondly, they posited that Dr. Jones should have kept Mr. Samuel in the hospital an extra day for observation because the discharge nurses did not remove the pressure dressing as instructed the night [.^before his discharge. Lastly, they charged that Dr. Jones failed to give proper discharge instructions to Mr. Samuel and/or his family members regarding the danger of bleeding and what to do in the event that bleeding occurred.

The trial judge found as a fact Dr. Jones did not err in treating Mr. Samuel’s bleeding incidents with observation rather than another surgery. The judge also rejected the claim that Mr. Samuel was discharged too soon, finding no evidence his death would have been prevented had he remained in the hospital another day for observation.

The judge did find, however, that the discharge instructions given to Mr. Samuel were inadequate and constituted a breach of care. Specifically, the judge found the instructions were deficient because Mr. Samuel had not been warned about the seriousness of a potential bleeding episode and was not told to have someone at home with him at all times. Mr. Samuel was found to be 50% at fault in causing his own death, on the basis that, despite having two bleeding incidents after leaving the hospital, Mr. Samuel failed to call the doctor or return to the hospital as instructed.

Dr. Jones and Vascular Surgery Associates appealed, challenging the finding of fault on the part of Dr. Jones. Plaintiffs answered the appeal, contesting the 50% fault allocation to Mr. Samuel.

MOTION TO STRIKE

In their brief, plaintiffs contend that the trial judge erred in failing to find that Dr. Jones’ decision not to take -Mr. Samuel back into surgery was a breach of the standard of care.

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Related

Washington v. Waring
142 So. 3d 40 (Louisiana Court of Appeal, 2014)
Morella v. Board of Commissioners
988 So. 2d 266 (Louisiana Court of Appeal, 2008)
Samuel v. Baton Rouge Gen. Med. Center
798 So. 2d 126 (Louisiana Court of Appeal, 2000)

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Bluebook (online)
757 So. 2d 43, 98 La.App. 1 Cir. 1669, 2000 La. App. LEXIS 321, 2000 WL 282364, Counsel Stack Legal Research, https://law.counselstack.com/opinion/samuel-v-baton-rouge-general-medical-center-lactapp-2000.