Dr. prescribed Coumadin & failed to monitor pt. death resulted.
In 2000, Carol Davis, a Certified Nurse Practitioner, began working with Dr. Gillis at Lister Healthcare in Florine, Alabama. Dr. Gillis was Davis' "primary supervising collaborating physician." In that role, he supervised the treatment Davis provided to patients, but, he was not required to be physically present when she rendered treatment. Florine's medical records indicated that Davis treated her numerous times over the years. On August 29, 2005, Dr. Gillis diagnosed her with atrial fibrillation. He placed her on Coumadin. He maintained it was his practice to advise patients that Coumadin can be "a very dangerous drug unless taken appropriately." Consequently, Coumadin dosage is periodically monitored using the International Normalized Ratio (INR). Dr. Gillis maintained that the therapeutic range for patients with atrial fibrillation is between 2.0 and 3.0. Dr. Gillis stated that he gave Davis instructions regarding the dangers of Coumadin, and the need for frequent monitoring; however, records did not indicate that the instructions were given to her. Dr. Gillis stated that his practice was to make a notation in the patient's records regarding the instructions he gave. He had no independent recollection of instructing Florine in the use of Coumadin. Florine was instructed to return to the lab at Lister Healthcare on August 31 to have her INR checked and begin the process of establishing the proper dosage and to return to the lab in one week to have her INR rechecked. Florine followed the directions given to her, returning to the lab on September 7, 2005. Although blood was drawn, the INR test was not done on the drawn blood. On that same day, Dr. Gillis saw Florine and gave her a stress test. He did not follow-up on why the INR test was not performed. The next INR test was not performed until November 14. 2005, which, he acknowledged, was "way too much time between INRs." Florine's test on November 14 showed INR results of 34.2, which Dr. Gillis noted was at an "extremely dangerous" level. Florine returned to Dr. Gillis' office on November 15, at which time she had an INR of 44.77; however, there was a note attached to the results indicating that a "'mixing study" (according to the court, there was nothing in the record which indicated what was meant by the use of this term) had been done and that Florine's INR was actually .89. Davis took the report to Dr. George Evans, who was covering Dr. Gillis' patients while he was out of town. He told Davis to refer Florine to a hematologist. She told Florine that if she had any problems to go to a hospital. On November 16, she was brought to Shoals Hospital, and, at that time she was nonresponsive. Testing indicated that she had sustained a subdural hematoma. She died later that same day. Joey Frazier, in his capacity as Executor of the Decedent's Estate, filed suit against Dr. Gillis for medical malpractice. Dr. Gillis filed a motion for summary judgment, which was granted by the trial court on the grounds that his alleged negligence had not been the proximate cause of the patient's death. The plaintiff appealed.
THEALABAMACOURTOFCIVILAPPEALS REVERSED THE JUDGMENT ENTERED BY THE TRIAL COURT AND REMANDED THE CASE BACK TO THE TRIAL COURT.
The court held, inter alia, that "a particular defendant's negligence need not be the sole cause of injury in order for an action to lie against the defendant; it is sufficient that the negligence concurred with the other causes to produce injury." Accordingly, the court determined that the trial court had erred in granting summary judgment for Dr. Gillis and remanded the case to the trial court for trial.
THE COURT RULED THAT IF A JURY FINDS THAT DR GILLIS WAS NEGLIGENT IN HIS TREATMENT OF THE DECEDENT, CAUSING HER INR TO BECOME DANGEROUSLY ELEVATED, THEN IT CAN FIND THAT HIS NEGLIGENCE BEGAN A CHAIN OF EVENTS THAT ULTIMATELY RESULTED IN THE PATIENT'S DEATH.
The court found that the trial court erred in finding that if a jury found Dr. Gillis negligent, then the superseding intervening negligence of Dr. Evans, and Nurse Davis in treating the decedent absolved Dr. Gillis of any liability. The court keyed in on the expert testimony of Dr. Richard Hays, a family practitioner who prescribes Coumadin for his patients diagnosed with atrial fibrillation. He testified that, because of the wide variance in effective doses of Coumadin in individuals, and because the drug is so dangerous, "it is extremely important to monitor the patient at the start so that you know that they are on the proper dose and make sure they get stabilized because they may even-it may change within the first several weeks." Dr. Hays further testified that the standard of care requires that laboratory tests be performed to assure that the patient is taking the proper dosage and that the patient's INRs fall within the therapeutic range. He also stated that the standard of care can not be met without physician involvement and that the standard is breached when the physician has no role in the monitoring of the patient's INRs. Frazier v. Gillis, 21002002 ALCIV (8/5/2011)-A L
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|Publication:||Medical Law's Regan Report|
|Date:||Aug 1, 2011|
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