Vargas, M.D. v. Gutierrez

176 So. 3d 315, 2015 Fla. App. LEXIS 12726
CourtDistrict Court of Appeal of Florida
DecidedAugust 26, 2015
Docket14-0048 & 13-1923
StatusPublished
Cited by5 cases

This text of 176 So. 3d 315 (Vargas, M.D. v. Gutierrez) 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
Vargas, M.D. v. Gutierrez, 176 So. 3d 315, 2015 Fla. App. LEXIS 12726 (Fla. Ct. App. 2015).

Opinion

ROTHENBERG, J.

Jose Luis Vargas, M.D., and Jose Luis Vargas, M.D., P.A. (collectively, “Dr. Vargas”) appeal.the trial court’s denial of their motion for a directed verdict and, in the alternative, for a new trial. We affirm the denial of Dr. Vargas’s motion for a directed verdict but reverse and remand for a new trial based on the plaintiffs’ violation of the “one expert per specialty” rule and for materially misrepresenting the evidence in closing arguments, both of which unfairly and materially prejudiced Dr. Vargas and denied him his right to a fair trial.

FACTUAL BACKGROUND

Monica Gutierrez (“Monica”) and her parents (collectively, “the plaintiffs”) brought this action against Dr. Vargas for his alleged negligent failure to timely diagnose Monica’s kidney disease, which ultimately led to renal failure, dialysis, and multiple kidney transplants. The jury entered a verdict in favor of the plaintiffs in the amount of $4,101,776.

The following facts are undisputed. Monica Gutierrez (“Monica”) was born in August 2000, and Dr. Vargas was Monica’s primary pediatrician for the first six years of her life. During that six-year period, Monica’s parents brought Monica to Dr. Vargas for several routine checkups. During these checkups, Dr. Vargas took urine samples from Monica consistent with typical practice. The urinalyses from these samples revealed elevated levels of protein in Monica’s urine — a potential indicator of kidney disease — in five separate tests over the first three years of Monica’s life. Dr. Vargas did not follow up on these test results, believing that each of the samples had been contaminated with bacteria because Monica was still in diapers. Record testimony established that it is quite common for infants to have bacterial contamination of their urine samples due to constant contact with bacteria in their diapers. Although Monica was small and underdeveloped for her age, she otherwise exhibited no symptoms of any illness and appeared healthy. After a sixth urine specimen showed no elevated protein levels, no further urine samples were collected or tested during the following three years when Monica was between the ages of three and six.

During September 2006, however, Monica began exhibiting abnormal symptoms, including periodic episodes of swelling around her eyes and in her legs, excessive drinking and urination, and abnormal weight gain of six pounds over a one-month period of time. Dr. Vargas was not notified of these symptoms, and no treatment was sought until October 2006 when Monica’s condition worsened and her parents brought her to Miami Children’s Hospital (“MCH”). At that point, Monica had an elevated temperature and swelling of her lower extremities, and she was suffering from renal (kidney) failure.

Monica was immediately examined by Dr. Paredes, a pediatric nephrologist, who took a kidney biopsy and sent the tissue sample to Dr. Victor Pardo, a pathologist at MCH, for examination and diagnosis. Dr. Pardo examined several tissue slides from the kidney biopsy and noted elevated *319 levels of Clq protein. Based on these findings, Dr. Pardo diagnosed Monica with “Diffuse Proliferative Immunecomplex Glomerulonephritis.” Dr. Pardo finalized his conclusions in a written report that was sent to Dr. Paredes, but Dr. Pardo never saw or administered care to Monica or spoke directly to Dr. Paredes. Importantly, Dr. Paredes never made a formal diagnosis of the underlying disease that caused the kidney failure or offered any opinion regarding the onset or duration of Monica’s kidney disease.

Due to the severity of the damage to Monica’s kidneys, Dr. Paredes placed Monica on dialysis until a kidney donor could be located. Approximately seven months later, Monica underwent successful kidney transplant surgery, and her diseased kidneys were removed. Following the transplant, one of the removed kidneys was sent to a different pathologist at MCH, Dr. Philip Ruiz, for further examination. Dr. Ruiz noted in his report that the tissue on the kidney was severely scarred to the point that he could not accurately diagnose what disease had caused the damage, but he opined that the kidney had failed due to a chronic immune complex disease. Similar to Dr. Pardo, Dr. Ruiz did not ever see or administer care or treatment to Monica, did not communicate with Dr. Paredes, and did not offer an opinion as to the cause, identity, or duration of Monica’s kidney disease. While Monica’s kidney transplant was successful, she will likely need dialysis and additional kidney transplants during her lifetime.

Monica and her parents brought a medical malpractice suit against Dr. Vargas in 2008, alleging that Dr. Vargas should have followed up on Monica’s positive urine samples and that, if he had done so, Monica could have been treated for her disease and been able to avoid dialysis and kidney failure. The plaintiffs allege that Monica's kidney failure is the result of a disease called Clq nephropathy, which takes years to cause the type of damage to Monica’s kidneys that she had at the time of her admittance to MCH and should have been discovered by Dr. Vargas before the disease caused end-stage renal failure.

Clq nephropathy is a very rare disease that causes Clq proteins to build up in the kidneys, which damages and scars the kidneys over time. Clq nephropathy is a recently discovered form of kidney disease that is often referred to as a “silent killer” because Clq patients can display no symptoms right up to the point of renal failure. Indeed, there are often no outward indications that anything is wrong with Clq patients until they have reached late-stage kidney disease with swelling, high blood pressure, high cholesterol, and occasionally fever. One of the only ways to accurately diagnose Clq nephropathy is to have the patient submit to a biopsy of her kidney and to have a pathologist examine the tissue to determine if there are elevated levels of Clq protein in the patient’s kidney samples.

Conversely, Dr. Vargas contends the disease that destroyed Monica’s kidneys was not the chronic, longstanding disease of Clq nephropathy, but rather a faster-moving disease called Rapidly Progressive Glomerulonephritis (“RPGN”). Dr. Vargas also contends that even if the underlying disease was in fact Clq nephropathy and Dr. Vargas had correctly diagnosed the illness, there was nothing that Dr. Vargas could have done to prevent Monica’s renal failure and the resulting dialysis and kidney transplants. In other words, Dr. Vargas claims that the dialysis and kidney transplants were inevitable due to the nature of Monica’s disease, and any action or inaction on his part did not cause Monica’s injuries.

*320 These issues were hotly disputed at trial, ■ and both ■ sides sought to introduce testimony from .various medical experts regarding both the diagnosis and the treatment of the disease. 1 Thus, Dr. Vargas filed a motion in limine to prevent the plaintiffs from presenting cumulative expert testimony regarding the timing and diagnosis of the disease, specifically arguing that Drs. Pardo and Ruiz should not be permitted to render expert opinion testimony on that subject and should be confined to offering factual testimony- as “treating' physicians.” Judge • Platzer, who was presiding over the case at the time, granted Dr. Vargas’s motion in part and limited both sides to “one expert per specialty,” Judge. Platzer’s.

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Related

Monica A. Gutierrez, etc. v. Jose Luis Vargas, M.D., etc.
239 So. 3d 615 (Supreme Court of Florida, 2018)
Martin v. Jorge Jose Sowers, M.D.
District Court of Appeal of Florida, 2017

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Bluebook (online)
176 So. 3d 315, 2015 Fla. App. LEXIS 12726, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vargas-md-v-gutierrez-fladistctapp-2015.