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Morris v. Rainwater

Court of Appeals of Louisiana, Second Circuit

January 11, 2017

JOSHUA MORRIS AND JEREMY WATSON Plaintiffs-Appellants
v.
DIRK RAINWATER, M.D., LOUISIANA MEDICAL MUTUAL INSURANCE COMPANY, AND JACKSON PARISH SERVICE DISTRICT NO. 1 D/B/A JACKSON PARISH HOSPITAL Defendants-Appellees

         Appealed from the Second Judicial District Court for the Parish of Jackson, Louisiana Trial Court No. 33, 085 Honorable Charles Glen Fallin, Judge

          MYRT T. HALES, SR. JOSHUA L. STRICKLAND OSCAR L. SHOENFELT, III BERTHA ITURRALDE TAYLOR Counsel for Appellants

          HUDSON, POTTS & BERNSTEIN By: Gordon L. James Margaret H. Blackwell Counsel for Appellees

          Before CARAWAY, LOLLEY and PITMAN, JJ.

          LOLLEY, J.

         In this medical malpractice case, plaintiffs, Joshua Morris and Jeremy Watson, appeal a judgment from the Second Judicial District Court, Parish of Jackson, State of Louisiana, wherein a jury found in favor of defendant, Dr. Dirk Rainwater, M.D. For the following reasons we affirm the judgment of the trial court.

         FACTS

         On June 13, 2011, at approximately 1:15 p.m., Charlotte Leach, then a 50-year-old white female, presented in the Jackson Parish Hospital ("JPH") emergency room in Jonesboro, Louisiana, with complaints of a headache and abdominal pain which had begun three days prior. Leach was triaged by the nursing staff, and her vitals upon arrival were: blood pressure 64/41 mm Hg; pulse of 91 beats per minute; respirations of 22 breaths per minute; and temperature 97.9 degrees Fahrenheit. At approximately 1:30 p.m., Leach was assessed by Dr. Dirk Rainwater, the physician on duty in the JPH emergency room.

         Dr. Rainwater ordered blood and urine cultures, multiple laboratory tests, and multiple radiographic tests on Leach. Several of these came back abnormal: her white blood cell count was high; her glucose was low, indicating she was hypoglycemic; blood urea nitrogen and creatinine were elevated, indicating dehydration. Leach's critically high creatinine level and white blood cell count were cause for concern. A drug screen was positive for benzodiazepines, and urinalysis revealed a urinary tract infection. Based on these results, Dr. Rainwater ordered intravenous fluids every six hours, Protonix 40 mg every four hours, and one dose of Rocephin, an antibiotic. Although vitals were continuously monitored, the single dose of intravenous Rocephin was the only antibiotic administered to Leach during the two days she stayed in JPH under Dr. Rainwater's care.

         All radiographic studies of the chest, brain, sinuses, and abdomen were essentially normal. The results of an ultrasound of the abdomen showed some biliary sludge suggestive of possible extrahepatic biliary obstruction (blockage of the normal flow of bile from the liver to the intestinal tract). Based on these laboratory tests and reports, Dr. Rainwater made a primary diagnosis of hypotension (i.e., low blood pressure) and a secondary diagnosis of abdominal pain. Leach was given pain medication and admitted to JPH for observation. Dr. Rainwater was also the acting hospitalist, and Leach remained under his care during overnight observation.

         Leach's blood pressure rose slightly after admittance to JPH. The night of June 14, Dr. Rainwater arranged for Leach's transfer to Louisiana State University Hospital - Shreveport ("LSUHSC") in the morning. Although Leach remained hypotensive, during the 42 hours from admittance to departure for LSUHSC, the JPH blood pressure chart shows that, upon departure, Leach's blood pressure was raised to 96/60, but still within the hypotensive range. Vitals taken before Leach's departure also show lowering of her creatinine level, but it still remained high, and improvement in white blood cell count to within normal range. As she departed from JPH and Dr. Rainwater's care, Leach continued to complain of a headache and abdominal pain.

         Leach arrived at LSUHSC at approximately 12:30 p.m. on June 15, 2011. A detailed history and updated vitals were obtained by LSUHSC staff. The initial evaluation at LSUHSC found Leach to be in mild distress, with mild diffuse coarse breath sounds, and her abdomen was soft with diffuse tenderness and positive bowel sounds. She was diagnosed with abdominal pain, gram negative rod bacteremia, pyuria (white blood cells in urine-sometimes indicative of a urinary tract infection), extrahepatic bowel duct obstruction, recent hypotension, and thrombocytopenia (low blood platelet count). Leach received intravenous antibiotics and various adjustments were made to Leach's treatment regimen while she was at LSUHSC. On June 16, Zosyn was discontinued and Primaxin 250 mg was started. On June 17, additional antibiotics were added to treat a bacterial infection. A CT scan of the abdomen taken at LSUHSC revealed cirrhosis (liver disease), splenomegaly (enlarged spleen), and possible pneumatosis intestinalis (gas cysts in the bowel wall). The radiologist did not compare the scan taken at LSUHSC to the liver scan taken at JPH two days prior.

         Over the next few days at LSUHSC, Leach's condition continued to decline. She suffered from increased intracranial pressure, uncontrolled seizure activity, and her liver began to fail. On June 21, after 6 days at LSUHSC, ventilator support for Leach was discontinued at her family's request, and she died shortly thereafter. Leach's cause of death is listed as multiple organ failure, sepsis, and cirrhosis.

         Almost a year after their mother's death, Joshua Morris and Jeremy Watson filed a complaint alleging the care provided to Leach by JPH and Dr. Rainwater failed to meet the accepted standard of care. This complaint was heard by a medical review panel ("MRP") composed of Dr. Brian Caskey, Dr. Don Bell, and Dr. Philip Conner. After reviewing Leach's medical records and the submitted depositions by Dr. Rainwater and plaintiff expert, Dr. Walter Simmons, the MRP found JPH did not fail to meet an acceptable standard of care. However, the MRP concluded Dr. Rainwater had deviated from the standard of care required of an emergency room physician, stating:

In order to address her complaints, [Dr. Rainwater] ordered appropriate lab work and studies to be performed on her in seeking to determine exactly what was going on with this patient. She was a patient he was somewhat familiar with as a result of several other presentations to the hospital emergency room.
The lab work that he ordered indicated that she had a significant elevated level in her white count and also determined that she was suffering from a UTI. In our view, Dr. Rainwater should have ordered more aggressive antibiotic therapy at that point and the administration of antibiotics with careful monitoring should have been continued until her transfer to LSU-Shreveport. It is clear to us that he recognized the patient was not improving at the rate that would be expected. Additionally, we believe that his failure to recognize that this patient was in septic shock was a clear deviation from the accepted standard of care.
These failures were deviations from the accepted standard of care for an emergency room physician under the circumstances in this case. We conclude that these deviations resulted in the alleged resultant damages, ...

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