from the Fifth Judicial District Court for the Parish of
Richland, Louisiana Trial Court No. 44, 267B Honorable James
M. Stephens, Judge
WATSON, BLANCHE, WILSON & POSNER Counsel for Appellants
By: Randall L. Champagne Joseph G. “Jerry”
KING & LANDRY, L.L.P. Counsel for Intervenor By: Brady D.
BREITHAUPT, DUNN, DUBOS, Counsel for Appellee SHAFTO &
WOLLESON, L.L.C. By: Patrick S. Wolleson Russell A. Woodard,
BROWN, COX, and DREW (Ad Hoc), JJ.
Johnson ("Mrs. Johnson") brought a medical
malpractice action against defendants, Tyrone Tucker, M.D.
("Dr. Tucker") and Richland Parish Hospital
("RPH"), for the death of her husband, Robert
Johnson ("Mr. Johnson"). The appointed Louisiana
Medical Review Panel found Dr. Tucker did not breach the
applicable standard of care while treating Mr. Johnson. A
jury trial followed the medical review panel's decision.
The jury unanimously found that Dr. Tucker breached the
applicable standard of care, which they found to be the
proximate cause of Mr. Johnson's death. The defendants
appeal the jury's findings. For the following reasons, we
13, 2011, Mr. Johnson visited his family physician, Dr.
José Enriquez, at his clinic located at RPH. Mr.
Johnson complained of shortness of breath, chest tightness,
and right leg pain, which worsened when walking. Dr. Enriquez
sent Mr. Johnson to the RPH emergency department. Mr. Johnson
was accompanied to the emergency department by a nurse with a
note listing the reasons for the transfer as chest tightness,
hypoxia (shortness of breath), and a history of asthma. Dr.
Tucker was the emergency department's physician on duty
and examined Mr. Johnson.
Mr. Johnson arrived in the emergency department at 10:06
a.m., his chief complaints were of chest pain and right leg
pain. The emergency room nurse noted Mr. Johnson's leg
pain began one week prior to his arrival in the emergency
department. Dr. Tucker examined Mr. Johnson's chest and
ordered a complete blood count (CBC) with differential,
complete metabolic panel, brain natriuretic peptide (BNP)
test, thyroid stimulating hormone (TSH) test,
electrocardiogram (EKG), chest X-ray, cardiac monitor, oxygen
at two liters per nasal cannula, pulse oximeter, heparin
lock, and cardiac enzymes. The CBC, EKG, and chest X-ray were
all normal. TSH and BNP were within normal limits. The
cardiac enzymes were negative. His metabolic panel tests were
within normal ranges except the blood urea nitrogen and
lactate dehydrogenase, which were slightly elevated.
first assessment, Dr. Tucker's impression was Mr. Johnson
had "chest pain, rule out unstable angina, more
consistent with costochondritis." Dr. Tucker's
treatment plan was to monitor Mr. Johnson over the next
several hours and then obtain a second set of cardiac enzymes
six hours after the first set. If the second set of enzymes
came back negative, Mr. Johnson would be discharged. While in
the emergency room, Mr. Johnson was given aspirin,
nitroglycerin paste, Toradol, intravenous fluids, and
second set of cardiac enzymes was obtained and the results
were negative. Dr. Tucker testified that he associated Mr.
Johnson's leg pain with polyarthritis, although he did
not specify this diagnosis in the medical record. Dr. Tucker
testified he examined Mr. Johnson and stated there was no
discoloration or swelling in the leg. Dr. Tucker noted in Mr.
Johnson's medical record on the muscular skeletal exam
that Mr. Johnson was "within normal limits." Mr.
Johnson's pain was worse when walking, which Dr. Tucker
found to be more consistent with arthritic pain. Dr. Tucker
noted hypertension in Mr. Johnson's chart. He visited Mr.
Johnson at 5:00 p.m., discharging him with instructions to
follow up with his primary care physician in the morning.
Johnson left RPH at 5:37 p.m. After arriving home, Mr.
Johnson collapsed in the presence of Mrs. Johnson. At about
6:20 p.m., Northeast Louisiana Ambulance received a call from
Mrs. Johnson stating Mr. Johnson was not breathing.
Paramedics arrived at Mr. Johnson's home around 6:26 p.m.
They found Mr. Johnson lying on the floor while family
performed cardiopulmonary resuscitation (CPR). Mr. Johnson
was apneic and did not have a pulse. Paramedics continued CPR
and administered multiple doses of epinephrine, atropine, and
bicarbonate. Paramedics were able to obtain a chemical rhythm
and transported Mr. Johnson to RPH.
p.m., paramedics arrived at RPH with Mr. Johnson. Mr. Johnson
was unresponsive upon arrival and a code blue was immediately
issued. Despite resuscitation efforts, Mr. Johnson was
pronounced dead at 7:02 p.m. An autopsy was ordered and
revealed Mr. Johnson's cause of death to be multiple
small peripheral emboli (PE) in the left lung and a large
saddle embolus obstructing the left pulmonary artery.
April 24, 2012, Mrs. Johnson filed a request for review with
the Division of Administration and requested the formation of
a Medical Review Panel proceeding. Mrs. Johnson requested the
Medical Review Panel determine whether Dr. Tucker breached
the appropriate standard of medical care in the diagnosis and
treatment of Mr. Johnson and whether this breach caused Mr.
Johnson's death. In August 2012, plaintiff appointed Dr.
Thoma to the medical review panel.
attorney chairman of the medical review board sent a letter
to Dr. Thoma notifying him of his appointment and forwarding
to him the oath that all panelists must sign, as required by
the Medical Malpractice Act. The oath must be signed in the
presence of a notary and states, "I, [Todd Thoma, M.D.]
do solemnly swear that I will faithfully perform the duties
of a medical review panel member in the matter styled,
[Robert Johnson, et al versus Dr. Enriquez, Dr. Tucker,
Richland Parish Hospital, Delhi Rural Health Clinic, PCF file
No. 2012-00429] to the best of my ability and without
partiality or favoritism of any kind. I acknowledge that ...