Saunders v. Dickens

103 So. 3d 871, 2012 WL 4448820, 2012 Fla. App. LEXIS 16174, 37 Fla. L. Weekly Fed. D 2274
CourtDistrict Court of Appeal of Florida
DecidedSeptember 27, 2012
DocketNos. 4D09-5302, 4D10-2062
StatusPublished
Cited by12 cases

This text of 103 So. 3d 871 (Saunders v. Dickens) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Saunders v. Dickens, 103 So. 3d 871, 2012 WL 4448820, 2012 Fla. App. LEXIS 16174, 37 Fla. L. Weekly Fed. D 2274 (Fla. Ct. App. 2012).

Opinion

ON MOTION FOR REHEARING

TAYLOR, J.

On consideration of appellant’s motion for rehearing, we withdraw the previous opinion and substitute the following.1

In this medical malpractice action, appellant Ruby Saunders, individually and as personal representative of the Estate of Walter Saunders, timely appeals a final judgment entered on a defense verdict in [875]*875favor of appellee, Willis Dickens, M.D. (“Dr.Dickens”). Appellant also appeals a final judgment of attorney’s fees entered in favor of Dr. Dickens. We affirm the underlying final judgment, but reverse the attorney’s fee judgment and remand for further proceedings.

This case arises out of Dr. Dickens’s alleged negligence in failing to diagnose and treat Walter Saunders’s cervical cord compression, a condition which eventually caused Mr. Saunders to suffer from quadriplegia.

Mr. Saunders first presented to Dr. Dickens, a neurologist, on July 7, 2003, with symptoms that Dr. Dickens’s physical examination showed were consistent with lumbar stenosis. Dr. Dickens ordered an MRI of Mr. Saunders’s brain and lumbar spine. He did not order a cervical MRI.

The radiology report stated that the lumbar spine MRI showed severe stenosis (or narrowing) of the spinal canal in the lumbar region. According to Dr. Dickens, neurologists defer to neurosurgeons on the subject of whether surgery should be done and the type of surgery required. On July 9, 2003, Dr. Dickens requested a neuro-surgical consultation with Dr. Guillermo Pasarin. Later that month, Dr. Pasarin examined Mr. Saunders and operated on his lumbar spine to relieve the lumbar stenosis.

On September 11, 2003, Dr. Pasarin reported that Mr. Saunders’s condition had not significantly improved. Dr. Pasarin thus ordered an MRI of Mr. Saunders’s lower back, mid-back, and neck. According to Dr. Pasarin, Mr. Saunders did not have any issues of upper extremity dysfunction, even at that time. The new MRIs showed an incomplete decompression and continuing pressure on the lowest level of the spine, which meant that the lumbar surgery had not been successful. These MRIs also showed that Mr. Saunders had pressure on the spinal cord in the neck, or cervical myelopathy. On October 3, 2003, Mr. Saunders reported to Dr. Pa-sarin that his arms and hands had progressively worsened since the July surgery. Dr. Pasarin determined that Mr. Saunders had cervical myelopathy.

Based on the new MRIs and the clinical findings, Dr. Pasarin recommended that Mr. Saunders have cervical decompression surgery. Dr. Pasarin felt that the surgery should be performed within the next thirty days. Although Mr. Saunders was cleared for the surgery on November 6, 2003, Dr. Pasarin failed to schedule him for surgery in the month of November. In December 2003, Mr. Saunders developed a deep venous thrombosis, which prevented him from undergoing surgery. He was thereafter never able to have the cervical surgery.

Mr. Saunders and his wife (“plaintiffs”) initially sued Dr. Pasarin, Broward Neurosurgeons, LLC, and Broward General Medical Center, alleging that their negligence in failing to properly diagnose and treat his cervical cord compression in July 2003 combined to render Mr. Saunders paraplegic.2 Later, plaintiffs added Dr. Dickens as a defendant in the lawsuit. Mrs. Saunders filed a claim for loss of consortium.

Plaintiffs settled with all defendants except Dr. Dickens. The ease proceeded to trial in late 2009. Plaintiffs presented the expert testimony of a spinal surgeon and a neurologist. They also introduced the deposition testimony of the defense experts.

[876]*876The neurologist for plaintiffs testified that thé standard of care required a neurologist diagnosing Mr. Saunders to cover all of the areas that could be responsible for the- symptoms, including the brain, the neck, the thoracic spine, and the lumbar spine. He further testified that Dr. Dickens breached the standard of care by failing to order an MRI of Mr. Saunders’s neck after his initial evaluation in July 2003.

.The surgical expert for plaintiffs testified that had Mr. Saunders received a neck operation to remove the compression when Mr. Saunders first presented to Dr. Dickens in July 2003, Mr. Saunders would not have become quadriplegic. To have the best outcome, the cervical cord surgery should have been done as soon as possible after the diagnosis.

The defense, on the other hand, presented expert testimony that Dr. Dickens met the standard of care and that all of Mr. Saunders’s gait problems in July 2003 were related to his lumbar disc disease. The defense also introduced the deposition testimony of Dr. Pasarin, which (unbeknownst to the jury) was given when Dr. Pasarin was still a defendant in the case. Dr. Pasarin believed that Mr. Saunders suffered from two problems occurring at two different times: in July 2003, Mr. Saunders was suffering from lumbar disc disease, and in September 2003, Mr. Saunders began suffering from cervical cord compression. Dr. Pasarin acknowledged that once the cervical compression condition was diagnosed on October 3, 2005, neck surgery needed to be done “in a timely fashion,” meaning within a month.

Dr. Pasarin testified that the upper extremity findings in Dr. Dickens’s July 7 note would not have prompted him to order an MRI of the neck. He also testified that had Dr. Dickens ordered a cervical MRI at that point, and the radiographic findings were identical to those ultimately seen in the September 27 films, Dr. Pasa-rin would still not have performed neck surgery if his exam did not find upper extremity dysfunction.

At the close of the evidence, Dr. Dickens moved for a directed verdict, arguing essentially that Dr. Pasarin’s testimony made it impossible for the plaintiffs to prove that Dr. Dickens’s negligence was a cause of harm to Mr. Saunders. The trial court denied the motion, reasoning that the issue was for the jury.

Before deliberations, the plaintiffs requested a special jury instruction based on this court’s decision in Letzter v. Cephas, 792 So.2d 481 (Fla. 4th DCA 2001). The trial court denied the request. The jury instructions included the standard instruction on apportionment of fault and the standard “concurring cause” instruction.

During closing argument, defense counsel argued that there was no causation, relying on Dr. Pasarin’s testimony that he would have done nothing different if he had seen an MRI of Mr. Saunders’s cervical spine in July 2003. Defense counsel argued that the plaintiffs needed to prove that “[b]ut for Dr. Dickens not doing the MRI, the neck MRI, Dr. Pasarin would have operated on Mr. Saunders’s neck in July. That is what the plaintiffs claim must be and it hasn’t remotely come close.” Counsel for plaintiffs objected that this was not a correct statement of the law and later argued that defense counsel was improperly shifting the burden of proof on the issue of Dr. Pasarin’s negligence, which was an affirmative defense that Dr. Dickens had the burden to prove.

The jury returned a verdict finding no negligence on Dr. Dickens’s part that was a legal cause of loss, injury, or damage to Mr. Saunders. The trial court entered a final judgment in accordance with the ver-[877]*877diet and subsequently entered a final fee judgment against the plaintiffs.

On appeal, plaintiffs raised four arguments: (1) the trial court should have struck Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
103 So. 3d 871, 2012 WL 4448820, 2012 Fla. App. LEXIS 16174, 37 Fla. L. Weekly Fed. D 2274, Counsel Stack Legal Research, https://law.counselstack.com/opinion/saunders-v-dickens-fladistctapp-2012.