Reyes v. Yakima Health District

Judith Margarita Reyes, on her own behalf and on behalf of the Estate of Jose Luis Reyes, Deceased, and on behalf of her minor children, E.R. and L.M.R., Appellants, v. Yakima Health District, a public entity in the State of Washington; Christopher Spitters, M.D.; John Does Nos. 1-20, Respondents.

No. 33697-2-III

Court of Appeals of Washington, Division 3

February 14, 2017

UNPUBLISHED OPINION

Fearing, C.J.

We face again the question of whether a patient or patient's survivor presented essential expert testimony to defeat her physician's summary judgment motion in a medical malpractice case. Plaintiff Judith Reyes, who sues for the death of her husband, also asserts the tort of outrage. We affirm the trial court's summary judgment dismissal of both causes of action.

FACTS

We present the facts in a gloss favorable to Judith Reyes, since the trial court dismissed her claims on summary judgment.

Defendant Dr. Christopher Spitters is a physician who specializes, in part, in the prevention and treatment of tuberculosis. He acts as a consultant and contracts with defendant Yakima Health District.

Dr Rizwana Khan, a physician independent of the Yakima Health District, treated Jose Reyes for chest pains in April 2010. According to the health district, Dr. Khan ordered testing and imaging reports, and laboratory results showed positive tuberculosis cultures from Reyes' sputum sample. Additional sputum samples, analyzed by the Washington State Department of Health's Public Health Laboratory, tested positive for tuberculosis. A Yakima Health District physician then prescribed for Jose Reyes medications for the treatment of tuberculosis, including Isoniazid, also known as isonicotinylhydrazide (INH).

According to Judith Reyes and her expert, Jose Reyes did not suffer from tuberculosis. Reyes took the drugs nonetheless.

According to the Yakima Health District, the district sought to monitor Jose Reyes' liver function. Reyes failed to show for testing. After ingesting the prescribed drugs, Jose Reyes suffered from nausea, vomiting, dizziness, lack of energy and a loss of appetite. Reyes' skin also changed to a reddish-yellow shade.

In June 2010, Jose Reyes expressed a desire to discontinue taking the tuberculosis medications because of severe discomfort. One of the Yakima Health District practitioners insisted, however that he continue taking the medications. The health district threatened to incarcerate Reyes if he failed to ingest the medications.

Dr Christopher Spitters, on behalf of the Yakima Health District, provided medical care to Jose Reyes for the treatment of his tuberculosis in July and August 2010. In July 2010, Reyes' condition worsened. He became unable to walk, drive, or eat. He experienced body shakes, hand tremors, and confusion. His abdomen swelled. He complained to Yakima Health District care providers of his symptoms. Health district providers then discovered serious deviations in his laboratory results. On August 6, 2010, Jose Reyes died of liver failure.

According to Judith Reyes, after Jose Reyes' death, Dr. Christopher Spitters met with her and told her that the health district should have stopped prescribing the antituberculosis drugs in May 2010. Dr. Spitters added that the clinic should have tested her husband's liver periodically. Spitters also told Judith Reyes that the Yakima Health District accepted responsibility. Dr. Spitters declared: '"unfortunately I don't have a magic button to push it and turn back time and rectify things. I do accept that the prescribed medication damaged his [Mr. Reyes'] liver and kidneys.'" Clerk's Papers (CP) at 10 (alteration in original).

PROCEDURE

Judith Reyes filed suit against the Yakima Health District and Dr Christopher Spitters. Her complaint asserted causes of action for medical malpractice, the tort of outrage, and wrongful death against the health district and Dr. Spitters. The complaint also asserted, against the health district, the claim of negligent hiring, training and supervision.

Christopher Spitters and the Yakima Health District brought motions for summary judgment on the grounds that the statute of limitations bars Judith Reyes' claims, Reyes lacked standing to sue, and Reyes lacked expert medical testimony to support her claim of medical malpractice. In response to the summary judgment motions, Judith Reyes filed a declaration by expert witness Rosa Martinez, M.D. Dr. Martinez is a licensed physician in the State of Washington who owns an internal medical clinic in Yakima. She specializes in the areas of complex medical patients with chronic pain symptoms, geriatric patients, and internal medicine patients. Martinez declared:

I am well-qualified to identify liver disease problems, diagnosis of tuberculosis, and the proper care and treatment of these diseases, including the proper pharmaceutical protocol to avoid adverse side effects (such as occurred in the case of Jose Reyes, deceased).

CP at 109.

In her declaration, Dr. Rosa Martinez averred that she reviewed medical records concerning the care and treatment of Jose Reyes. Based on a review of Reyes' death certificate, Martinez opined that Jose Reyes never suffered from tuberculosis, but he died from complications due to chronic liver disease. The declaration further stated, based on reasonable medical certainty:

(b) Jose Reyes did suffer from chronic liver disease, and was at risk for catastrophic liver failure if he were treated with medicines contraindicated for liver disease....

(c) Jose Reyes presented to Yakima Health District and Dr. Spitters with clinical symptoms of liver failure that should have been easily diagnosed by observation of the patient....

(d) The failure of Yakima Health District and Dr. Spitters to accurately diagnose Jose Reyes' liver disease and liver deterioration due to prescribed medications to treat tuberculosis that were contraindicated for Jose Reyes were direct and proximate causes of Mr. Reyes' liver failure and death....

(e) The actions of Yakima Health District and Dr. Spitters constitute medical negligence in the care and treatment of Jose Reyes. The Yakima Health District and Dr. Spitters have breached the standard of care for a health care facility and physician acting in the same or similar circumstances in the State of Washington... .

(f) In April, 2010 Mr. Reyes started taking the medicine prescribed by the Yakima Health District, and this medicine was for the treatment of tuberculosis. Mr. Reyes did not have tuberculosis. He was never found to be suffering from tuberculosis. The medicine which was negligently prescribed was INH, RIFAMPIN, PZA, EMB and vitamin B-6 (there is no objection to the prescription for vitamin B-6). However, the most seriously contraindicated prescription was INH, as it clearly should not be administered to a patient with liver problems.

(g) Mr. Reyes had liver disease. A month after he started the antituberculosis drug regimen he suffered from the side effects, exacerbated by his liver problems. Those side effects included nausea, vomiting, dizziness, lack of energy and loss of appetite. His skin color changed to a reddish-yellow tinge, and it was a significant change of skin tone.

(h) In June, 2010 Mr. Reyes was experiencing strong discomfort due to the anti-tuberculosis drug regimen, and he expressed a desire to discontinue the medication. However, officials at the Yakima Health District insisted Mr. Reyes sign a contract to continue the anti-tuberculosis drug regimen, including the very dangerous drugs that could kill Mr. Reyes because of his liver problems.

(k) Towards mid-July, 2010 Mr. Reyes could no longer bear the pain and severe symptoms he suffered from these dangerous anti-tuberculosis drugs that he had been forced to ingest by the defendants. Mr. Reyes presented himself at Yakima Health District facilities, and at about the same time YHD discovered the errors the health care providers had committed in this case. It took serious laboratory deviations to get the physicians' attention, however. This, despite the clinical presentation that clearly called for a correct diagnosis.

(l) See the following matrix, which profoundly points to severe liver deterioration, and no indication of secondary symptoms associated with tuberculosis. Merely observing the patient, without any laboratory confirmation, would clearly have proved severe liver toxicity.

[Matrix omitted.]

5. Jose Reyes expired due to the failures of Dr. Spitters and Yakima Health District to observe the standard of care for health care institutions and physicians acting in the same or similar circumstances in the State of Washington. He lost his opportunity to live an extended life due to the negligence of these defendants.

CP at 109-13.

The trial court granted the Yakima Health District's and Dr. Christopher Spitters' summary judgment motions to dismiss the medical malpractice claim because Judith Reyes failed to provide competent expert testimony on the issues of standard of care, causation, and damages. During the summary judgment hearing, the trial court questioned the sufficiency of the testimony regarding the standard of care in Dr. Rosa Martinez's declaration. The trial court commented:

In other words, what did Dr. Spitters do that violated the standard of care? She doesn't say that. There was a horrible result. There's sort of an ambiguous, and I want to say ambiguous as to whom. You know, they misdiagnosed. They gave him this toxic treatment for tuberculosis which, in her opinion, kills him because he doesn't have to be. He has a liver disease, but who does that? It's not in here.

Report of Proceedings (May 5, 2015) at 30-31.

The Yakima Health District later moved for summary judgment on Judith Reyes' claims for wrongful death, the...