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Dioresly Lora v Palmdale Regional Medical Center

Case Report - Verdict $15,026,260 gross, $7,444,538 present cash value after MICRA reductions Diroresly Lora v. Palmdale Regional Medical Center

Case Number: MC0230074 Judge: Victor Chavez, Dept. 96, LASC

Plaintiff Attorney: Bruce Fagel, Law Offices of Bruce G. Fagel & Associates, Beverly Hills Defense Attorney: Joseph Farchione, Lamar Jost, Wheeler, Trigg & O'Donnell,, Denver, Colorado Richard Harris, Dummit, Buchholz & Trapp, Los Angeles Plaintiff Experts: Andrew Wachtell, MD, Pulmonology, Los Angeles Donald Mills, MD, Anesthesiology, Newport Beach Barry Pressman, MD, Neuroradiology, Los Angeles Arthur Kowell, MD, Neurology, Los Angeles (did not testify) Richard Adams, MD, Rehabilitation Medicine, Long Beach Barbara Greenfield, RN, Life Care Planning, Pasadena Peter Formuzis, PhD, Economist, Irvine Defense Experts: Arthur Theodore, MD, Pulmonology/Critical Care, Boston. Mass Edwin Amos, MD, Neurology, Santa Monica Patricia Waldron, RN, Nursing Care, Eureka Russell Klein,MD, Pulmonology, Newport Beach (did not testify) Alan Knutsen, MD, Allergy Medicine, St. Louis (did not testify Paul DeSessa, Resp. Therapist, Charlotte NC (did not testify) Amy Sutton, RN, Life Care Planning, Orange (did not testify) David Weiner, Economist, Los Angeles (did not testify)

Insurance: Ace for first $2 million (Universal Health Services, Inc. as owner of Hospital for excess)

Facts: Plaintiff, age 26, with a history of childhood asthma, went to Defendant Palmdale Regional Medical Center on the night of Nov. 8, 2011, with difficulty breathing and was seen in the Emergency Room. She had a history of multiple prior ER visits and hospitalizations for asthma. After treatment in the ER with three breathing treatments with some improvement, the ER physician called the hospitalist on-call who decided to admit the plaintiff to the telemetry unit of the hospital with a diagnosis of an exacerbation of asthma. The hospitalist ordered continuous oxygen saturation monitoring and supplemental oxygen to keep the oxygen saturation at or above 92%. When the patient was transferred to the telemetry floor at around 3:00 AM on Nov. 9, 2011, she was attached to cardiac telemetry monitoring, but not to an oxygen saturation monitor. Over the next 30 hours, the patient had six more breathing treatments with oxygen saturation measurements, and vital signs taken every four hours, all of which showed oxygen saturations above 92%. On morning of Nov. 10, nurse testified that plaintiff asked for a breathing treatment and nurse called for respiratory therapist and then went to room where she discovered the plaintiff to be non-responsive with difficulty breathing. Respiratory therapist came in to room and attempted breathing treatment as nurse called for Rapid Response Team which brought a second respiratory therapist into room who took over bag-mask ventilation and ICU nurse who brought EKG monitor into room which showed a normal rate and rhythm. ICU nurse checked pulse and testified that there was a thready pulse which was then lost and a Code Blue was called. Respiratory therapist drew blood for an arterial blood gas before Code Blue was called which showed a pH of 7.05 with a PCO2 of 91 and PO2 of 223. Two additional ICU nurses, another respiratory therapist and ICU physician responded within 30 seconds to Code Blue and within 3 minutes plaintiff was intubated and Epinephrine and Atropine were given which resulted in return of heart rate and blood pressure. Plaintiff was then moved to ICU where she remained comatose and on ventilator until Dec. 19, 2011, when she was moved to a rehabilitation hospital in Lancaster where she was weaned from the ventilator. Plaintiff was then moved to a skilled nursing facility in March 2012.

After the complaint was filed, Plaintiff moved for an early priority trial date based on the interests of justice since her condition had deteriorated in the nursing facility. The Court granted a priority trial date for Nov. 15, 2012, but transferred the case to Downtown LASC long-cause department which then set a trial date of Feb. 28, 2013.

Plaintiff contentions: Plaintiff's experts testified that the hospital nurses were negligent for not properly monitoring the plaintiff in conformity with the doctor's orders. They also testified that the nurses and respiratory therapists were negligent for not calling a Code Blue when they found the patient non-responsive with difficulty breathing. Plaintiff's experts also claimed that had hospital properly monitored patient respiratory difficulty would have been evident in time to prevent cardio-pulmonary arrest and that delay in calling a Code Blue was a substantial factor in causing plaintiff's injuries.

Defendant contentions: Nurses and respiratory therapists were not negligent since they checked on plaintiff 27 times between admission to the telemetry unit and the morning of the cardiac arrest and when they checked plaintiff's oxygen saturations none were found to be below 92%. Nurse properly called for a breathing treatment when she found the plaintiff with difficulty breathing and a Code Blue was not required until plaintiff's pulse was lost. Defendant's causation expert testified that the ABG showed that the plaintiff was well oxygenated and the cause of the arrest was not due to asthma and that oxygen saturation monitoring would not have prevented the arrest which was caused by an unpredictable, un-preventable, anaphylactic allergic reaction to the antibiotic Zithromax that was given to the plaintiff intravenously just prior to her arrest. Defendant's life expectancy expert testified that plaintiff had a 6-8 years life expectancy from the date of the incident, or 5.8 additional years from the date of the trial.

Injuries: Severe hypoxic brain injury with resultant persistent vegetative state

Special Damages: Past medical care - $538,316, Future medical care costs - $6,227,792 present cash value based on a 12 year life expectancy, Future loss of earnings, $1,783,873. Defendant claimed future medical care costs - $2,991,179 present cash value based on life expectancy of 5.8 years, and future loss of earnings of $1.2 million.

Settlement discussions: Mediation held in Oct. 2012 before Jay Horton, Esq. Plaintiff demanded $8.25 million, Defense made no offer. After first week of trial defense offered $2 million, which was rejected. On last day of trial Defense offered $4 million, which was then withdrawn before jury began deliberations.

Jury Verdict: $15,026,260 including $3,072,856 in non-economic damages, $538,316 for past medical care costs, $6,135,047 in future medical care costs with $4,872,349 present cash value, $5,280,041 in future loss of earnings with $1,783,873 present cash value. The jury separately found 9.2 year life expectancy. Jury Poll - 12-0 negligence, 11-1 causation and damages Trial length - 15 days, jury out 1 ½ days Date of Verdict - March 22, 2013 Hearing to enter judgment set for April 9, 2013, at which time plaintiff intends to challenge the reduction of non-economic damages under CC Sec. 3333.2