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The 'more likely than not' concept & experts' affidavits.

KRISHNAVENI KAREDLA(K)) BECAME PREGNANT WITH HER SECOND CHILD IN 2006. She visited Associates in Women's Health (AWH) on July 20, 2006, and it was noted that she had elevated blood pressure and protein levels. She had been given orders for bed rest. However, she reported that she attended a barbeque over the weekend before returning to AWH on July 24, with similar complaints. At that visit K was referred to a clinic for diagnostic tests, and was subsequently admitted to Abbott Northwestern Hospital (ANH). On July 25 and 26, K was monitored in the hospital, including periodic blood-pressure tests. On July 27, at 2:10 p.m., K became dizzy, and her blood pressure was recorded as 204/99. K complained of a headache, and was lethargic. It was "hard to assess her discomfort." Dr. Susan Dahlin was summoned to the hospital to perform a cesarean section to deliver K's baby. Dr. Dahlin arrived at 3:38 p.m., and found K unable to move her right arm or leg. Dr. Dahlin ordered the administration of Hydralazine, to reduce K's blood pressure. K gave birth to a healthy baby boy at 5:04 p.m. A CT scan at 6:03 p.m., showed that K had suffered a serious stroke, described by one of her doctors as a "massive left intracerebral hemorrhage ... and left to right shift." K was taken into surgery, her doctor noting that "[t]he likelihood of survival is regrettably small." K did survive. However, she was left with cognitive deficits and physical impairments.

K AND HER HUSBAND FILED SUIT FOR MEDICAL MALPRACTICE BASED ON THE FAILURE TO PROPERLY TREAT HER PREECLAMPTIC SYMPTOMS PRIOR TO HER STROKE. In addition to the affidavit of a medical expert's review filed with the complaint, the plaintiffs disclosed affidavits during discovery identifying Drs. Baha Sibai and Dr. Adrian Goldszmidt as medical experts who could testify in support of the plaintiffs' theory of causation. The affidavits stated that K's medical condition indicated the presence of severe preeclampsia because she had systolic blood pressures over 160 mm Hg on two occasions at least six hours apart. According to the plaintiffs' medical experts, the standard of care for severe preeclampsia required the administration of an antihypertensive medication to reduce systolic blood pressure to below 160 mm Hg . The medical experts opined that, because this blood pressure regulation was not done as the standard of care required, K's elevated blood pressures exerted untenable pressure on the blood vessels in her brain and caused her stroke. The defendants' motion for dismissal was granted. The plaintiffs appealed.

THE COURT OF APPEALS OF MINNESOTA REVERSED THE RULING OF THE LOWER COURT AND REMANDED THE CASE FOR TRIAL. The court found that there were two issues before it. The first was whether the trial court applied the correct standard of proof. The second was whether the trial court erred in determining the standard of care. First, the court ruled that: "In order to establish a prima facie case of medical malpractice in [Minnesota], a plaintiff must prove, among other things, that it is more probable than not that his or her injury was a result of the defendant health care provider's negligence. The court observed that the state's courts have never held that plaintiffs must prove their allegations to an absolute lack of doubt. Thus, the court agreed with the plaintiffs that the trial court had erred in holding plaintiffs to a standard of "undoubtedly" proving their case. Second, the court again agreed with the plaintiffs that the trial court erroneously determined that the standard of cared did not require the treatment indicated by the plaintiffs' experts, and thus the trial court erred by considering rebuttal evidence submitted by the defendants. The court observed that the plaintiffs correctly alluded to the ACOG Bulletin by citing an article which, in fact, set forth the standard of care. Accordingly, the court held, inter alia, that the trial court had committed error prejudicial to the plaintiffs. Thus, the court reversed the decision of the trial court and remanded the case.

THE PLAINTIFFS' THEORY OF CAUSATION WAS THAT ALTHOUGH THE FAILURE TO ADMINISTER ANTIHYPERTENSIVE MEDICATION DOES NOT INEXORABLY RESULT IN A STROKE, THE ADMINISTRATION OF THAT TREATMENT WILL, MORE LIKELY THAN NOT, PREVENT THAT RESULT. The court observed that the plaintiffs' expert affidavits reflected a considerable level of detail, which readily distinguished them from the insufficiently detailed affidavits in other cases. The court concluded that while these affidavits contained conclusions, restating and summarizing the information throughout the affidavits did not render the affidavits as merely conclusory. The trial court's alluding to the plaintiffs' affidavits as containing "only broad, conclusory statements regarding causation" was found to be in error by the court. Editor's Note: This case illustrates the importance of thorough and detailed medical experts' affidavits. Ordinarily, the most competent and experienced counsel are aware of the influence that well written and detailed affidavits can have on the outcome of cases. Karedla v. Obstetrics & Gynecology Associates, PA., A11 - 1423 MNCA (6/11/2012)-MN

A. David Tammelleo JD Editor & Publisher
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Author:Tammelleo, A. David
Publication:Medical Law's Regan Report
Geographic Code:1USA
Date:Sep 1, 2012
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