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McIntyre v. Smith5/25/2000
This is an appeal by Charlene R. McIntyre, et al. (McIntyre) of a directed verdict rendered on behalf of C. Jack Smith, M.D., and Collom & Carney Clinic Association (C&C;. McIntyre contends that the trial court erred in granting a directed verdict for Smith because there was legally sufficient evidence that Smith was negligent and that his negligence was the proximate cause of Virgil McIntyre's death. We sustain the sole point of error, and reverse and remand for a new trial on Smith's alleged negligence.
On January 8, 1996, Virgil was hospitalized as a result of severe abdominal pain. Over the next few days, he was treated by a variety of doctors and underwent a series of surgeries, but his condition failed to improve. It was ultimately determined that Virgil would need to undergo kidney dialysis. In preparation for dialysis, on January 19, 1996, Dr. H. Randall Schmidt, a board-certified general surgeon, inserted a central venous Quinton catheter into Virgil's chest. In order to insert the catheter into the chest, Schmidt used a guide wire, commonly called a "J-wire," and a dilator. If this type of catheter is properly placed, the tip of the catheter should be in the superior vena cava, a large vein in the chest. Schmidt confirmed correct placement of this catheter by successfully aspirating blood from the catheter, and by ordering and reviewing a chest x-ray of the catheter placement. Unless Virgil's condition improved, dialysis was to begin the following day, supervised by a nephrologist (a kidney specialist).
The next day, January 20, 1996, Smith was the nephrologist on duty. Smith examined Virgil and ordered dialysis around 1:30 in the afternoon. However, he received a telephone call around 2:30 or 3:00 indicating that the dialysis nurse could not get the catheter to work. Smith ordered a chest x-ray and compared this x-ray to the one that Schmidt had taken the day before. Smith determined that the catheter had not moved, and he then attempted to manipulate the catheter in an effort to aspirate blood. This attempt was unsuccessful, so Smith decided to replace the catheter. After the new catheter was in place, Smith again was unsuccessful in his attempt to aspirate blood, and he ordered a third chest x-ray. From evaluating the new x-ray with the prior two, he determined that the second catheter was in the same location as the first. Since Smith believed that Virgil needed dialysis, he decided to remove the chest catheter and insert a third catheter in Virgil's leg. This catheter did function properly, and Smith administered Heparin, a blood thinner, and began dialysis. After observing Virgil for three to five minutes, Smith spoke with the family and then left for another hospital to treat another critical patient.
As soon as he reached the second hospital, he testified that he received a call from the dialysis nurse telling him that McIntyre's blood pressure had dropped and that he was experiencing shortness of breath and chest pains. Smith ordered the nurse to administer additional fluids and to do some blood work, rather than take an additional chest x-ray, which the nurse had suggested. When the blood work was available, it showed that Virgil's hematocrit level had decreased, and Smith told the nurse that he would return as soon as possible. However, approximately ten minutes later, before Smith had left the other hospital, he received a third call telling him that Virgil had gone into cardiac arrest.
Emergency surgery was performed on Virgil, and four liters of blood were removed from his chest. The surgeons who performed this procedure found a hole in the innominate vein in the location where the first and second Quinton catheters were placed.
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