Stephens v. Rakes

235 W.Va. 555

775 S.E.2d 107

Delilah STEPHENS, M.D., Defendant Below, Petitioner

v.Charles RAKES, Personal Representative of the Estate of Gary Rakes, Plaintiff Below, Respondent.

No. 13–1079.

Supreme Court of Appeals of West Virginia.

Submitted Feb. 25, 2015.

Decided June 16, 2015.

Thomas P. Mannion, Esq., Andrew D. Byrd, Esq., Mannion & Gray Co., L.P.A., Charleston, WV, for the Petitioner.

Alex J. Shook, Esq., Andrew G. Meek, Esq., Hamstead, Williams & Shook, PLLC, Morgantown, WV, for the Respondent.

Opinion

BENJAMIN, Justice:

The instant action is before the Court upon the appeal of Petitioner Delilah Stephens, M.D., from a September 9, 2013, order of the Circuit Court of Mercer County that denied her motion for judgment as a matter of law, or in the alternative, motion for a new trial, following an adverse jury verdict. Dr. Stephens also appeals orders denying her motions for summary judgment on the amended complaint of Respondent, Charles Rakes (hereinafter “Mr. Rakes”), as personal representative of the Estate of Gary Rakes (hereinafter “the decedent”). Upon review of the parties' arguments, the record before us on appeal, and applicable legal precedent, we affirm the circuit court's orders.

I.FACTUAL AND PROCEDURAL BACKGROUND

This medical malpractice action arises from medical treatment received by decedent Gary Rakes at the Bluefield Regional Medical Center (“BRMC”) between September 3, 2010, and September 5, 2010. The decedent, who was then sixty-five years old, suffered from several chronic health problems including obstructive sleep apnea, COPD¹ , and chronic hypercapnia, a condition which caused him to retain excess carbon dioxide (CO2 ) in his blood and to become confused and agitated.

According to medical records from October of 2008 and March and June of 2010, the decedent was previously admitted to BRMC with acute respiratory distress caused by excess CO2 retention that caused decreased mental and respiratory function. During his admission in June of 2010, Dr. Stephens was listed as the decedent's attending physician. During the course of that hospital stay, a pulmonologist was consulted to manage the decedent's lung issues, multiple arterial blood gas (“ABG”) levels were obtained to monitor his CO2 levels, and he received a bi-level positive airway pressure (“BiPAP”) treatment and breathing treatments such as bronchodilators to help him expel excess CO2 from his lungs. The decedent was successfully treated and released. The decedent was given a BiPAP portable ventilator to use at home to treat the condition and help expel CO2 from his blood.

Subsequently, during the early morning hours of September 3, 2010, the decedent presented to BRMC with an exacerbation of the same chronic lung problems for which he had been treated during his June 2010 visit. Dr. Stephens was again listed as attending physician. The Admission History and Physical of September 3, 2010, noted that his allergies included Seroquel, Ativan, and Aldactone.² However, the decedent was given two different anti-psychotic sedatives during his admission because of his confusion and altered mental state.³ He was first given 5 mg of Haldol on September 3, 2010, which was ordered by Dr. Jorieth Jose, the admitting intern. Dr. Stephens consulted with Dr. Jose regarding the administration of this medication. According to the record, the Haldol did not appear to effectively sedate the decedent. Approximately two hours later, Dr. Toni Muncy, the chief resident, ordered that the decedent be given 100 mg of Seroquel, even though his admitting records noted the prior adverse reaction to this drug. Shortly after the administration of Seroquel, the decedent became more disoriented, agitated, and combative. The record reflects that he refused to wear his oxygen mask and stay in his room. The decedent was then placed flat on his back in soft wrist restraints. He subsequently became “quite sedated,” resting quietly. The medical records indicate that Dr. Stephens signed off on Dr. Muncy's order for the administration of Seroquel and took no further action.⁴

On September 4, 2010, a neurological consult by Dr. Khalid Razzaq was ordered due to the decedent's altered mental status.⁵ Dr. Razzaq ordered that the decedent be administered 25 mg of Seroquel that afternoon. The decedent remained sedated most of the day and night of September 4, 2010, and never fully awakened.⁶ He also remained in wrist restraints lying flat on his back during this time. Although the decedent's initial ABG's revealed that he had excessively high CO2 levels in his blood, no follow-up ABG studies were ordered to continue to monitor his CO2 levels once he was admitted. The record further reflects that a pulmonologist was not consulted at any point during the decedent's admission. Additionally, although the decedent required a BiPAP when he slept, the record reveals that a BiPAP was not ordered until 10:00 pm on September 4, 2010, despite the fact that he was heavily sedated during the course of his hospital stay. During the early morning hours of September 5, 2010, the decedent developed tachyarrhythmia, QRS widening, bradycardia, and asystole. He died at 7:00 am.

On the death certificate, Dr. Stephens wrote that the decedent died as a result of “Acute on Chronic Hypercapnic Respiratory Failure due to or as a consequence of Adverse Drug Reaction to Seroquel.” Dr. Stephens wrote in the Death Summary that the decedent had not been using a BiPAP at the hospital because the proper settings were unknown, and that the decedent was sedated most of the night and most of the day on September 4, 2010.

Following the decedent's death, his family filed the instant medical malpractice action alleging that Dr. Stephens, Dr. Razzaq, Dr. Muncy and other employees of Health Services of the Virginias Inc. deviated from the standard of care by prescribing and administering excessive doses of Haldol and Seroquel to the decedent, ignoring documented allergies, contraindications, and black box label warnings, and by willfully and recklessly failing to take any measure to investigate or rectify the reasons for his prolonged state of unconsciousness, proximately causing his death. As discussed in further detail below, Mr. Rakes alleged that Dr. Stephens became aware that the decedent had been given Seroquel by Dr. Toni Muncy and Dr. Khalid Razzaq, but failed to take any countermeasures. Mr. Rakes also alleged that Dr. Stephens ordered, or was at least aware that, the decedent was administered Haldol, a drug that was contraindicated given his condition, by Dr. Jorieth Jose, the admitting intern.

In his deposition testimony, Mr. Rakes' expert witness, Dr. Kenneth Scissors⁷ , opined that the decedent's proximate cause of death was ventilator failure resulting from the “excessive administration of the sedatives Haldol and Seroquel in the setting of underlying chronic lung disease.” Dr. Scissors opined that Dr. Stephens deviated from the standard of care that she herself helped to establish for the decedent at BRMC given his prior admissions there; that Dr. Stephens should have ordered breathing treatments for the decedent's respiratory problems when he was admitted on September 3, 2010; that Dr. Stephens failed to timely order adequate CPAP or BiPAP treatment on September 3, 2010, and during the day of September 4, 2010; that Dr. Stephens failed to provide appropriate BiPAP settings for when the order was actually made on the night of September 4, 2010; that Dr. Stephens failed to follow the decedent's ventilator status with repeat ABG's after the initial test indicated acute and chronic CO2 retention with acute and chronic respiratory acidosis ; that Dr. Stephens ordered 5mg of Haldol, a very high dose, for the decedent in the setting of known acute and chronic CO2 retention without providing ventilator support and ABG monitoring; that Dr. Stephens permitted the decedent to remain heavily sedated in an obtunded state even after she examined him on September 4, 2010; that Dr. Stephens failed to consult with a pulmonary specialist to address the decedent's severe acute and chronic pulmonary disorders and provide appropriate ventilator support and monitoring measures; and therefore, Dr. Stephens acted recklessly. According to Dr. Scissors, the decedent's prolonged sedated state caused by Seroquel and Haldol, the failure to repeat the ABG test to monitor his CO2 levels, the failure to obtain a pulmonologist consult, and the failure to timely administer appropriate BiPAP caused the decedent's death.

Mr. Rakes' expert pulmonologist, Dr. Jeffrey Schwartz, testified that the decedent should have been on BiPAP when he was admitted; that Dr. Stephens could have checked prior records to determine the appropriate BiPAP settings for the decedent; that a pulmonologist could have helped to determine the appropriate BiPAP settings if one had been consulted; and that Dr. Stephens' deviation from the standard of care caused the decedent's death.

Following discovery, Dr. Stephens filed two motions for summary judgment: one regarding proximate causation and one regarding punitive damages. In her first motion for summary judgment, Dr. Stephens argued that her actions did not proximately cause the decedent's death. To the extent that the circuit court did not grant Dr. Stephens' motion for summary judgment on the entire amended complaint, she filed a subsequent motion for summary judgment on Mr. Rakes' punitive damages claim. Subsequent to the close of discovery, the parties filed numerous motions in limine. Dr. Stephens filed a motion in limine to preclude any testimony that she ordered and administered Seroquel to the decedent and that the order and administration of Haldol alone was the cause of the decedent's death. On the first day of trial, the circuit court entered an order denying Dr. Stephens' motions for summary judgment and granting Dr. Stephens' motion in limine precluding any testimony that she ordered and administered Seroquel...