Cowher v. Kodali

1

KAREN COWHER, ADMINISTRATRIX OF THE ESTATE OF JAMES L. COWHER, II, DECEASED v. SOBHAN KODALI, M.D., ST. LUKE'S UNIVERSITY HEALTH NETWORK AND ST. LUKE'S CARDIOLOGY ASSOCIATES Appellants

No. 1111 EDA 2020

No. J-A27035-20

Superior Court of Pennsylvania

January 31, 2023

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37

Appeal from the Judgment Entered April 7, 2020 In the Court of Common Pleas of Lehigh County Civil Division at No(s): No 2018-C-0264

Joseph D. Seletyn, Esq.

BEFORE: STABILE, J., NICHOLS, J., and COLINS J.^[*]

MEMORANDUM

COLINS, J.

This matter is an appeal by Appellants Sobhan Kodali, M.D., St. Luke's University Health Network and St. Luke's Cardiology Associates (collectively, Defendants) from a judgment entered on a jury verdict in favor of the plaintiff, Karen Cowher, Administratrix of the Estate of James L. Cowher, II, Deceased (Plaintiff) in a wrongful death and survival medical malpractice action. This case returns to us after our Supreme Court reversed this Court's original order of February 8, 2021 vacating the damages judgment on Plaintiff's survival claim and remanded the case to this Court for consideration of two issues raised by Defendants that we did not reach in our February 8, 2021 decision. Cowher v. Kodali, 283 A.3d 794, 810 (Pa. 2022). For the reasons set forth below, Defendants are barred under the Supreme Court's decision in this case from seeking relief on both of these remaining issues and we therefore affirm the judgment of the trial court.

This action arose out of the death of James L. Cowher, II (Decedent) from cardiac arrest at the age of 48. As set forth in our February 8, 2021 decision, the events surrounding Decedent's medical care and death are as follows:

In September 2015, Decedent had an episode of chest pain and underwent a stress echocardiogram test that was normal. On July 11, 2016, Decedent saw his primary care physician for episodes of chest pain that were becoming more frequent and severe and that radiated from the chest to his arms and were accompanied by some shortness of breath, nausea, and sweating. Decedent's primary care physician performed an electrocardiogram and had a test done for troponin, a chemical marker of heart damage, both of which were normal.

Decedent's primary care physician arranged for Decedent to be seen by an affiliated cardiology group, and defendant Dr. Sobhan Kodali, a cardiologist in that group, saw Decedent on July 13, 2016. Decedent reported to Dr. Kodali that for the last six months he had been experiencing chest pain that radiated to both arms, often with shortness of breath, dizziness, and tingling in his fingers. Decedent also reported to Dr. Kodali that he was regularly running for exercise without symptoms. Dr. Kodali was aware that Decedent had a family history of premature coronary artery disease, had high cholesterol, and was overweight. Dr. Kodali did not order or perform any tests other than an additional electrocardiogram, which was normal, and a lipid test, and concluded that Decedent's chest pain was "not cardiac," stating that "[n]o further evaluation is necessary at this time" and that "[o]verall the clinical picture is suggestive of anxiety/panic attacks."

On August 23, 2016, Decedent suffered cardiac arrest while jogging and died. The pathologist who performed an autopsy on Decedent found that Decedent had blockages of 80% and over 90% in the left main and left anterior descending coronary arteries and listed the cause of Decedent's death as "[f]avor cardiac arrhythmia secondary to ASCVD [arteriosclerotic cardiovascular disease]." The coroner reported the cause of Decedent's death as acute myocardial infarction due to severe coronary artery disease.

Cowher v. Kodali, No. 1111 EDA 2020, slip op. at 2-4 (Pa. Super. filed February 8, 2021) (citations omitted) (brackets in original).

On January 31, 2018, Plaintiff, Decedent's widow, brought this medical malpractice wrongful death and survival action against Defendants. In her complaint, Plaintiff averred that Dr. Kodali was negligent in failing to diagnose Decedent as having unstable angina and severe coronary artery disease, that Dr. Kodali's failure to diagnose and treat him for those conditions caused Decedent's death, and that St. Luke's Cardiology Associates (Associates), Dr. Kodali's practice group, and St. Luke's University Health Network (Health Network), the health network that owns Associates, were liable for Dr. Kodali's negligence. Amended Complaint ¶¶8-12, 15-28, 31, 34. Plaintiff's cardiology expert opined in his report that Dr. Kodali was negligent in failing to diagnose Decedent as suffering from unstable angina and in failing to recommend diagnostic testing, including cardiac catheterization, that would have shown Decedent's severe coronary artery disease, which could have been successfully treated by coronary bypass surgery, and that these deviations from the standard of care caused Decedent's death. Hayek 3/28/18 Report at 5-9. Plaintiff's cardiology expert also opined in that report that Decedent died from cardiac arrhythmia caused by severe left main and left anterior descending coronary artery disease and briefly stated that Decedent experienced conscious pain and suffering before his death. Id. At 8-9. Defendants filed motions in limine to preclude Plaintiff's cardiology expert from testifying that Decedent died of a cause other than acute myocardial infarction and to preclude him from testifying that Decedent experienced conscious pain and suffering, and the trial court denied both of these motions prior to trial.

The case was tried to a jury from December 3, 2019 to December 9, 2019. Seven witnesses testified at trial: a neighbor who was present when Decedent's fatal event occurred, Plaintiff's cardiology expert, Plaintiff's economic expert, Plaintiff, Defendants' cardiology expert, Dr. Kodali, and Decedent's primary care physician.

The neighbor testified that she saw Decedent walking slowly, kneeling, and laying down, that Decedent said "I need help," and that Decedent appeared to be "in pain" and "not himself" and "was very distraught." N.T. Trial, 12/3/19, at 73-77. The neighbor also testified that Decedent was conscious for approximately three minutes before he passed out. Id. at 77-78.

Plaintiff's cardiology expert testified that Decedent was suffering from unstable angina and severe coronary artery blockages when he saw Dr. Kodali and that Decedent died from a cardiac arrhythmia caused by insufficient blood supply to the heart as a result of those coronary artery blockages. N.T. Trial, 12/3/19, at 152, 156-58, 166, 172-77, 186-89, 220.

Plaintiff's cardiology expert opined that, given the chest pain symptoms that Decedent reported, Dr. Kodali breached the standard of care in failing to diagnose Decedent's unstable angina and in failing to order cardiac catheterization, which would have revealed the blockages and resulted in bypass surgery, and opined that Decedent's untreated coronary artery disease caused his death. Id. at 143, 162-64, 169-71, 177, 190-202, 211-13, 215-20. He also opined based solely on the neighbor's testimony, without offering any medical analysis or reasoning, that Decedent experienced conscious pain and suffering at the time of his fatal cardiac event. Id. at 221.

Plaintiff's economic expert opined that the economic loss from Decedent's death, including all earnings, fringe benefits and value of the loss of his household services, totaled $1,070,145 to $2,700,498, depending on assumptions concerning age of retirement, salary increases, and economic conditions. N.T. Trial, 12/4/19, at 48-60. Defendants stipulated that Associates and Health Network were vicariously liable for Dr. Kodali's conduct. Id. at 9-14.

On December 9, 2019, the jury returned a verdict in favor of Plaintiff and against Defendants awarding Plaintiff $2,457,000 in wrongful death damages and $3,833,000 in damages on the survival claim. Defendants timely filed post-trial motions seeking a new trial, or alternatively a new trial on damages or a remittitur, and Plaintiff moved to add delay damages to the verdict. On April 7, 2020, the trial court denied Defendants' post-trial motions, granted Plaintiff's delay damages motion, and entered judgment in favor of Plaintiff and against Defendants in the amount of $6,631,642.70.

Defendants timely appealed and presented the following four issues for review:

1.Whether the trial court erred and abused its discretion in failing to vacate the verdict where Plaintiff failed to prove liability under her new, eleventh-hour cause of death theory by presenting expert testimony identifying a specific standard of care for treatment of cardiac arrythmia (as opposed to other coronary conditions), which Defendants breached and thus caused Plaintiff's harm?

2. Whether the trial court erred and/or abused its discretion in permitting Plaintiff's expert to testify to his assumptions regarding the purported pain and suffering decedent experienced?

3.Whether the trial court erred and abused its discretion in failing to vacate the Survival Act award where the record is devoid of evidence that decedent was conscious, able to feel pain or indeed felt pain immediately prior to death and, thus, any award for pain and suffering is against the weight of the evidence?

4. Whether the trial court erred and/or abused its discretion in denying Defendants' requests for a new trial on damages and/or remittitur, where the jury's Survival Act verdict award of $377,000 per minute (at best) for 2-3 minutes of pain and suffering is grossly excessive, unmoored from the record, and against the weight of the evidence?

Appellants' Brief at 5-6 (suggested answers omitted).

On February 8, 2021, this Court issued a decision in...