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Pesses v. Angelica

Court of Appeals of Louisiana, Fifth Circuit

November 25, 2014

HAROLD PESSES
v.
NICHOLAS J. ANGELICA, M.D., LOUISIANA MEDICAL MUTUAL INSURANCE COMPANY AND JOSEPH W. HAUTH, M.D

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[Copyrighted Material Omitted]

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ON APPEAL FROM THE TWENTY-FOURTH JUDICIAL DISTRICT COURT, PARISH OF JEFFERSON, STATE OF LOUISIANA. NO. 675-994, DIVISION " B" . HONORABLE CORNELIUS E. REGAN, JUDGE PRESIDING.

EDWARD P. GOTHARD, ATTORNEY AT LAW, Metairie, Louisiana, COUNSEL FOR PLAINTIFF/APPELLANT.

PETER E. SPERLING, JOHN B. CAZALE, ATTORNEYS AT LAW, New Orleans, Louisiana, COUNSEL FOR DEFENDANTS/APPELLEES.

Panel composed of Judges Susan M. Chehardy, Jude G. Gravois, and Hans J. Liljeberg.

OPINION

JUDE G. GRAVOIS, J.

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[14-336 La.App. 5 Cir. 2] In this medical malpractice suit, plaintiff/appellant, Harold Pesses, appeals a trial court judgment finding that he failed to bear his burden of proof regarding the negligence of defendant/appellee, Dr. Nicholas J. Angelica, in failing to call for an emergency cardiac consultation, causing him the loss of a chance for a better medical outcome following a heart attack. For the reasons that follow, we reverse, award damages, and render judgment in favor of plaintiff.

FACTS AND PROCEDURAL HISTORY

On February 11, 2007, plaintiff, Harold Pesses, a 53-year-old man, presented to the emergency room at East Jefferson General Hospital (" EJGH" ) with chest pain. He reported to the emergency room physician that he ate an apple fritter earlier that day and feared that it was stuck in his esophagus.[1] The medical records show that the emergency room physician considered this a gastrointestinal (" GI" ) case and ordered a variety of tests to rule out a GI event. An endoscopy was performed, which located remnants of the fritter, but showed that there was no longer any obstruction. Plaintiff was administered a " GI cocktail" that temporarily [14-336 La.App. 5 Cir. 3] relieved some of his symptoms, though his pain did not fully abate.[2] An electrocardiogram

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(" EKG" ) was performed in the emergency room, as well as a cardiac enzyme workup (a blood test), which showed elevation in two of the four cardiac enzymes, but normal levels in the other two.

Because of these results and his continued complaints of chest pain, plaintiff was admitted to the hospital's telemetry floor around 8:50 p.m. that evening, specifically for cardiac monitoring in order to rule out a heart attack. This admission was made by Dr. Joseph Hauth, the emergency room physician, in consultation with defendant, Dr. Angelica, an internist and the on-call physician at EJGH that evening for " unreferred" patients.[3] Plaintiff saw a cardiologist, Dr. Clement Eisworth, approximately eight years earlier for an evaluation after his brother developed heart disease and required a stent in his 40s. However, plaintiff was not under the care of a cardiologist when he was admitted to EJGH.

Plaintiff continued to report chest pain throughout that evening and night.[4] Following plaintiff's admission, Dr. Angelica ordered repeat cardiac enzyme labs, an echocardiogram to be performed in the morning, and a cardiology consultation in the morning as well.

The record shows that the second cardiac enzyme labs were drawn later during that night at 1:36 a.m. The results, which were obtained around 2:50 a.m., now showed that all four cardiac enzymes were elevated beyond normal limits. A nurse contacted Dr. Angelica with these results, but according to his testimony, informed him only about the elevation of the Troponin level, one of the enzymes, but not the other three. He testified that he was told that otherwise, plaintiff's [14-336 La.App. 5 Cir. 4] condition was stable with no changes in the telemetric monitoring or vital signs, and with no worsening chest pain.

In response to the information received at 2:50 a.m., Dr. Angelica issued no new orders. Plaintiff's chest pain essentially resolved by daybreak that morning. He was evaluated around 8:30 a.m. by Dr. Gregory Tilton, a cardiologist, who performed an angiogram that afternoon.[5] The angiogram showed an occlusion (an obstruction) at the ostium (opening) of the first diagonal branch artery. Dr. Tilton declined to perform angioplasty, which is the placing of a stent to open the vessel. He was not called to testify, but his procedure notes, introduced into evidence, indicate that he felt angioplasty was not appropriate at that time because Mr. Pesses' heart muscle had already sustained permanent damage by the time of the angiogram, as indicated by test results and his findings, thus rendering a stent moot,[6] and also because the location of the obstruction in the diagonal vessel would be difficult to stent due to the high possibility of causing major damage to a larger vessel, the left anterior descending artery, which is located nearby.

Each expert physician who testified, either live or via deposition, said that plaintiff

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suffered a non-ST segment elevation myocardial infarction (" M.I." ) (" non-STEMI" ) (heart attack), as opposed to a ST segment elevation myocardial infarction (" STEMI" ). The latter appears differently in telemetric monitoring and involves large areas of muscle mass, whereas the non-STEMI variety ...


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