Wright v. Hirsch

572 So. 2d 783, 1990 WL 210515
Louisiana Court of Appeal·Decided December 20, 1990·No. 89-CA-0788·Published·Cited by 10 cases

Opinion

572 So.2d 783 (1990)

Valerie WRIGHT
v.
Bernard HIRSCH, M.D., New Orleans General Hospital and Insurance Corporation of America.

No. 89-CA-0788.

Court of Appeal of Louisiana, Fourth Circuit.

December 20, 1990.
Writ Denied March 1, 1991.

*784 Lemle, Kelleher, Kohlmeyer, Dennery, Hunley, Moss & Frilot, Michael J. Furman, New Orleans, for defendant-appellee.

Joseph W. Thomas, Angelique A. Reed, New Orleans, for plaintiff-appellant.

Allison H. Penzato, Metairie, for defendant-appellee New Orleans Gen. Hosp.

Before GARRISON, BARRY and BYRNES, JJ.

BYRNES, Judge.

This matter was remanded from the Louisiana Supreme Court which held that the trial judge did not abuse his discretion in denying plaintiff's motion for new trial based on jury misconduct. 560 So.2d 835. We shall now consider the remaining arguments on appeal of Valerie Wright's medical malpractice action against Dr. Bernard Hirsch, his insurer, Insurance Corporation of America, and New Orleans General Hospital (New Orleans General).

A review of the record shows that on October 25, 1983, Dr. Hirsch inserted an intrauterine device (IUD) known as a Copper-7 (CU-7) into Valerie Wright at the Sub-Specialty Clinic on the third floor of the New Orleans General Hospital. In April 1984, Dr. James E. Dopson confirmed that Ms. Wright was pregnant and scheduled an ultrasound test to determine the presence of the IUD. However, the ultrasound taken in September 1984 failed to show the location of the IUD. On October 23, 1984, Ms. Wright delivered a baby girl at Touro Infirmary. On April 25, 1985, Ms. Wright was admitted in the Emergency Room of New Orleans General and thereafter, on May 2, 1985, Dr. Edward Helm and Dr. Dopson performed an exploratory laparotomy, surgically removed the IUD protruding from Ms. Wright's rectum, and repaired a recto-vaginal fistula.

On December 13, 1985, Ms. Wright filed a complaint of medical malpractice with the office of the Commissioner of Insurance pursuant to LSA-R.S. 40:1299.41 et seq. A Medical Review Board comprised of Drs. Robert Little, Dwight L. McKenna, and William J. Woessner rendered the following opinion on January 2, 1987:

As to both defendants [Bernard Hirsch, M.D. and New Orleans General Hospital] there is a material issue of fact, not requiring expert opinion, bearing on liability or consideration by the court. The only issue of negligence is whether or not informed consent was obtained from the plaintiff. There are no other issues of negligence apparant to the Panel.

Subsequently, on December 12, 1986, Ms. Wright filed her malpractice action, claiming *785 that Dr. Hirsch negligently implanted the IUD and failed to advise plaintiff of all risks and instructions concerning the use of the IUD. She alleged that New Orleans General was negligent in referring her to Dr. Hirsch and in failing to discover that the IUD was no longer in place. At the close of plaintiff's case at trial in November 1988, the trial court granted a motion for directed verdict in favor of New Orleans General on the basis that there was no evidence in the record to sustain a judgment against the hospital. Thereafter, the jury returned with a verdict in favor of Dr. Hirsch.

On appeal, Ms. Wright presents the remaining arguments as follows: (1) the plaintiff's history of severe pelvic inflammatory disease (PID) presents an absolute contraindication for insertion of an IUD resulting in negligence ipso facto; (2) the jury erred in finding that informed consent is not required before insertion of an IUD; (3) the trial court erred in granting a motion for directed verdict in favor of New Orleans General; and (4) the trial court erred in not allowing testimony of a material witness discovered during trial.

HISTORY OF SEVERE PID

Although the record does not contain Ms. Wright's medical records from Charity Hospital, she indicated that she had suffered from severe pelvic inflammatory disease when she was hospitalized and administered antibiotics intravaneously for approximately two weeks at Charity. This occurred two years prior to insertion of the IUD by Dr. Hirsch. Plaintiff claims that the package insert provided by the IUD manufacturer classifies a history of severe PID not as a relative contraindication but as a contraindication resulting in negligence ipso facto where an IUD is inserted. Dr. Hirsch contends that plaintiff's history of PID did not preclude use of an IUD in plaintiff's case.

Dr. Sarah Lain, an expert in the field of obstetrics and gynecology, testified on behalf of Ms. Wright. Dr. Lain described the method used to insert the IUD and concluded that the IUD perforated Ms. Wright's uterine wall upon insertion rather than through migration. She testified that it was below the physician's standard of care to perforate the uterine wall upon insertion of an IUD. Dr. Lain opined that the plaintiff's history of severe PID precluded use of an IUD and it was below the standard of exercising good judgment for a physician to insert an IUD in Valerie Wright's case. Dr. Lain based her conclusion on the plaintiff's history but did not see Ms. Wright's Charity record. Dr. Lain agreed that if the pelvic infection had been acute at the time of insertion of the IUD, it would be discernible upon examination. Dr. Lain was provided with the results of Ms. Wright's cervical gonorrhea culture taken by Dr. Hirsch on October 25, 1983, the date on which he inserted the IUD. The culture report showed "no growth". Dr. Lain agreed that if a routine culture shows no growth, there is no bacterial infection at that time.

Dr. Dwight McKenna, a member of the Medical Review Panel called as a witness by Ms. Wright, was qualified as an expert in general surgery. Although he stated that a history of severe PID is an absolute contraindication, he qualified that statement by adding that it was contraindicated if there was acute, active infection at the time of insertion of the IUD. Dr. McKenna testified that the Panel did not have evidence available that indicated the extensiveness of Ms. Wright's history of PID. He also stated that he believed that the examining physician was the only person who could determine whether the history of PID was severe or was a relative contraindication.

Dr. James Dobson, called as plaintiff's expert in the field of obstetrics and gynecology, quoted Dr. Hirsch's written notation on Ms. Wright's medical record at trial as follows:

This is October 25th, '83. Temperature 93.7. Blood pressure 110/80. Weight a hundred and twenty-five pounds. Chief complaint, CC, that is once [wants] IUD. Also has twenty year old gravida I para I, AB-O, two years ago had PID. Child two years [months] old. No complications. *786 Physical examination within normal limits. Copper-T, CU-7, inserted easily.

Dr. Dobson stated that a history of PID is a relative contraindication, not absolute. He noted that he would want to know the patient's history and review the extent of the pelvic inflammatory disease before he inserted an IUD. He testified that personally he would not have inserted an IUD if the PID was quite severe where the patient had been given intravenous medication. On cross-examination, Dr. Dobson agreed that it was acceptable to put an IUD in a patient with a history of pelvic inflammatory disease two years prior to presentation depending upon the clinical situation and clinical judgment of the clinician. Dr. Dobson found no evidence of acute infection when he examined the patient in April and September of

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