Wojcicki ex rel. Estate of Wojcicki v. Caragher

18 Mass. L. Rptr. 581
CourtMassachusetts Superior Court
DecidedNovember 16, 2004
DocketNo. 000124
StatusPublished
Cited by1 cases

This text of 18 Mass. L. Rptr. 581 (Wojcicki ex rel. Estate of Wojcicki v. Caragher) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wojcicki ex rel. Estate of Wojcicki v. Caragher, 18 Mass. L. Rptr. 581 (Mass. Ct. App. 2004).

Opinion

Kottmyer, J.

Plaintiff, Edmund Wojcicki, Individually and as Executor of the Estate of Sherry Wojcicki, brought this wrongful death action against Joan Caragher, M.D. The plaintiff alleged that Dr. Caragher was negligent in the care she rendered to Sherry Wojcicki on July 2, 1999, when Mrs. Wojcicki was brought to the emergency room of the Addison Gilbert Hospital after suffering a severe stroke. Trial commenced on November 17, 2003, and concluded with a jury verdict in favor of Dr. Caragher on November 26, 2003.

On December 9, 2003, plaintiff filed a motion for new trial on the grounds that Fred W. Hochberg, M.D., an expert who testified on behalf of the defendant, gave false and misleading testimony. On February 23, 2003, the Court allowed plaintiffs motion for a new trial and awarded reasonable costs, including attorneys fees, incurred by plaintiff in connection with the trial of the case. Thereafter, counsel for Dr. Hochberg filed an appearance and further proceedings were held at the request of Dr. Hochberg.

HISTORY OF RELEVANT PROCEEDINGS A. Plaintiffs Theory of the Case

The plaintiff s theory of the case, supported by the requisite expert testimony, was that Dr. Caragher departed from the standard of care applicable to physicians practicing the specialty of emergency medicine when she failed either to offer thrombolytic therapy (tissue plasminogen activator or t-PA) to Mrs. Wojcicki or promptly to transfer her to another hospital where she could receive such therapy. Mrs. Wojcicki had had [582]*582a recurrence of breast cancer in 1999, when she was diagnosed with an eight-centimeter mass in her breast. She received two courses of chemotherapy with the final dose administered on July 1, 1999, the day before she was brought to the emergency room. Mrs. Wojcicki had not undergone a gadolinium MRI (a contrast study of the brain), a Ct Scan of the brain or node sampling in connection with the recurrence.

B. The NINDS Study

At trial, plaintiff offered in evidence and relied heavily on an article entitled “Tissue Plasminogen Activator for Acute Ischemic Stroke,” published in the New England Journal of Medicine on December 14, 1995. The article reported the results of a study consisting of two trials conducted at various medical centers throughout the country by The National Institute of Neurological Disorders and Stroke t-PA Stroke Study Group (“The NINDS Study”). The publication of the results of the NINDS Study had a significant impact on the treatment of stroke patients in emergency rooms in that it was believed by many neurologists to show that administration of t-PA to victims of severe stroke within three hours of the onset of the stroke decreased the impairment caused by the stroke. At the same time, administration of t-PA carries a significant risk of death due to intracranial hemorrhage and it is therefore essential to screen patients carefully before administering t-PA.

Evidence developed during post-trial hearings established that physician-investigators screened candidates for inclusion in the NINDS Study trials using a list entitled “Exclusion Criteria,” that consisted of a series of statements. Patients to whom any one or more of the statements applied were excluded from the Trials. The Exclusion Criteria included the following statement: “Patient has a serious medical illness that is likely to interfere with this trial.” No statement in the Exclusion Criteria pertained specifically to cancer.

Those patients who were included in the Trials filled out a “Baseline Medical History Form,” some time after they had been included in the Study. That form posited the question: “Has any physician ever diagnosed the patient as having a malignancy?” Fifly-nine of the six hundred twenty-four patients included in the Study responded affirmatively to this question. The only information detailing the type of cancer and the temporal relationship between the diagnosis of a malignancy and inclusion in the Study is likely, but not necessarily, contained in the medical records for that patient kept by the participating medical center at which the patient received treatment. The publicly available data relating to the Study was contained on a CD-ROM that could be obtained from the National Technical Information Service. The CD-ROM contains data reflecting that fifty-nine of the participants in the Study had been diagnosed by a physician as having a malignancy, but no other detail as to the type of cancer, the date of diagnosis or the status of the cancer on the date the patient received treatment for stroke at the participating medical center. Thus, one cannot determine the type of cancer or whether it was active on the date of inclusion in the Study by reviewing the publicly available data, although one can determine by reading the CD-ROM that fifty-nine of the patients included in the Trials had at same point been diagnosed with cancer.

C. Trial Testimony of Dr. Hochberg

Dr. Fred Hochberg, a neuro-oncologist at Massachussets General Hospital (“MGH”), was called as an expert witness by the defendant. He testified that the consults with physicians concerning the treatment of patients “who present with acute ischemic stroke in the face of underlying cancer” and renders advice to physicians with regard to questions involving the use of thrombolytics in “ischemic stroke in the face of underlying cancer.”

The following testimony was elicited by David Gould, counsel for Dr. Caragher, on direct examination:

Q: Dr. Hochberg, are you familiar with the NINDS Study that was published in December of 1995?
A: Yes.
Q: And as part of this study, Dr. Hochberg, based on your review of it together with your knowledge, training, and experience, as a neurologist, were there any patients included in that study who presented with cancer?
A: No.
Q: Were there any patients who are [sic] part of that study who presented with breast cancer?
A: There were no patients with breast cancer in the NINDS, either part one or part two of that study.

(11/24/03 Tr. at 13)

On cross-examination, Dr. Hochberg responded as follows to questions asked by Marc Breakstone, counsel for plaintiff:

Q: Now, how many patients in the NINDS Study had a bad back?
A: No one knows. They never published it.
Q: How many patients in the NINDS Study had a hip replacement?
A: No one knows.
Q: How many patients in the NINDS Study has male pattern baldness?
A: It’s getting close to home, sir. None.
Q: . . . How many patients in the NINDS Study had arthritis?
A: No one knows.
Q: How many patients in the NINDS Study had cancer?
A: Zero.
Q: No one knows?
A: Excuse me, Zero.
[583]*583Q: You’re telling the ladies and gentlemen of this jury that this study indicates how many patients had cancer?
A: That’s correct
Q: Okay. Let’s . . .

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Related

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20 Mass. L. Rptr. 591 (Massachusetts Superior Court, 2006)

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Bluebook (online)
18 Mass. L. Rptr. 581, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wojcicki-ex-rel-estate-of-wojcicki-v-caragher-masssuperct-2004.