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Piro v. Chandler2/28/2001
d vessel in the brain due to a build up of pressure. This type of stroke is clearly related to hypertension and is the type of stroke with which people are most familiar. A thrombotic or embolic stroke occurs when something blocks the blood supply. Vascular disease, cholesteral, hypertension, and smoking are causes over time. Significantly, Dr. Mayeaux indicated that the receipt of blood products by itself is a known risk factor for thrombotic strokes. It was Dr. Mayeaux's opinion that Mr. Piro suffered a thrombotic stroke. This opinion was based on review of CT scans taken beginning on July 14, 1995. The first scan showed nothing. This ruled out the possibility of an hemmorrhagic stroke which would have been immediately apparent. However, it was apparent that a thrombotic stroke occurred when another scan was taken on July 17, 1995. When questioned about the specific role of hypertension in causing thrombotic strokes, Dr. Mayeaux explained that long-term hypertension has some bearing in the cause of thrombotic strokes in that high blood pressure can lead to the destabilization of plaques in blood vessels. He went on to state:
So if the question were to be posed, does it have no bearing, I would have to say no. If you're asking me is it one of many possible sources, I would have to say yes. If you're saying is it the most likely cause, I would have to say no.
Dr. Mayeaux concluded that, more probably than not, the delay in giving the Procardia to Mr. Piro did not play a clinically significant role in his stroke and that his stroke was probably not precipitated by hypertension. Dr. Mayeaux offered no opinion as to whether the breach in this instance increased the risk of incurring a thrombotic stroke. Dr. Mayeaux did opine that once Mr. Piro suffered the stroke, there was very little to be done to treat him due to his age and condition. In fact, Dr. Mayeaux explained that the chance of recovering from a serious stroke in the pontine area is less than five percent, and survival would likely leave the patient in a persistent vegetative state.
Dr. Richard Wilson Fincher also testified on behalf of the plaintiff. Dr. Fincher, a specialist in internal medicine, pulmonary care, and critical care, treated Mr. Piro for respiratory difficulties on July 14, 1995. Referring to it as a "blanket statement," Dr. Fincher stated that "elevated blood pressure can increase the risk of stroke." He also indicated that uncontrolled hypertension can worsen any stroke. With regard to the type of stroke suffered by Mr. Piro, Dr. Fincher indicated that scans taken on July 16,1995 showed an infarction in the pons area of the brain. There was no evidence of a bleed, which would have suggested an hemmorrhagic stroke. He opined that the infarction was most likely due to a clot. He also opined that those who have a stroke in the pons area have a greater than sixty percent mortality rate and that, as indicated by Dr. Mayeaux, survival is likely to be in a vegetative state.
The defense presented the testimony of Dr. James Wainwright Thompson, a practitioner of family medicine with experience treating patients who suffer from hypertension and who have suffered strokes. Dr. Thompson testified, as did the other experts, that Mr. Piro suffered a thrombotic stroke in the pons area of the brain caused by plaque blocking a blood vessel. He did not believe that the stroke was hemmorrhagic or that it was caused by acute changes in Mr. Piro's blood pressure. It was Dr. Thompson's opinion that elevated blood pressure over a significant period of time could extend a stroke, but he believed that the blood pressure would have to be higher than what Mr. Piro experienced. He suggested that the systolic pressure would ha
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