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Manning v. Bellafiore11/4/2005
ule out the various possibilities of Mr. Manning's afflictions. One prompt differential diagnosis was that of a stroke, defined as a lack of blood flow to the brain. To treat a stroke the healthcare provider must isolate the blockage. Dr. McNiece needed to rule out an aneurism. Although Dr. McNiece agreed that an angiogram is the "gold standard" for locating a blockage, he added that it was not commonly done as it is so invasive. A Magnetic Resonance Imaging exam ("MRI") was attempted on Mr. Manning on two different occasions. MRIs at South County Hospital were performed at that time in a trailer which was brought to the hospital via the MRI network.
During the first attempt at an MRI on March 4, 1998, Mr. Manning became nauseous, probably because of the confines of the closed machine. Dr. McNiece prescribed Ativan and Compazine. The second scan was not conducted until March 7, 1998, when the MRI trailer was returned to South County Hospital on its normal rounds. Mr. Manning received one milligram of Ativan which did not calm him enough so he could receive the MRI. A second dose of Ativan was given at the trailer which apparently did not calm him sufficiently. Dr. McNiece indicated that he was not at the trailer, and was not sure how much time had passed between doses, or before the MRI was given. It was not until March 7, 1998, that Dr. McNiece learned through a conversation with Dr. Bellafiore that anesthesia could be administered at the MRI site on the trailer.
Dr. McNiece acknowledged that Mr. Manning would need to go to another hospital for treatment if an aneurism or a tumor was found. Dr. McNiece stated that "time is important" and "it is important to get it [testing] done in a timely fashion." Mr. Manning's migraine continued from March 4, 1998 through March 7, 1998. Dr. McNiece testified that he did not track when the MRI machine would actually be at the hospital; he merely prescribed the new MRI. He also failed to monitor the effectiveness of the Ativan, claiming that he depended upon the nurses to monitor the patient's use of Ativan at the MRI site. Dr. McNiece recognized the importance of the MRI, as it would show the blockage or slowed flow of blood. With Dr. Bellafiore on March 5, 1998, they "together" wrote the order for an open MRI. Dr. McNiece did not explain the various options of anesthesia, sedation or angiogram. Dr. McNiece considered the angiogram to be dangerous. He claims he considered Mr. Manning's refusal to take the MRI as a refusal of treatment. Notwithstanding that an established hospital policy requires the recording of refusal of treatment; Dr. McNiece made no such record. Dr. McNiece claims he was unfamiliar with the hospital refusal policy.
Dr. Stephen Payne, an adult family practitioner testified next. Dr. Payne has been an Internist for over 20 years in the Cincinnati area and is Board Certified in internal medicine. In addition to his private practice, he participates in peer review and teaches residents in internal medicine. Dr. Payne testified that Dr. McNiece's treatment was below the standard of care for reasonably competent medical doctors. Dr. Payne concluded that the emergency record suggested sudden neurological problems and Dr. McNiece, as the leader of the team, was responsible to rule out stroke and the other differential diagnoses, enact a treatment plan, and order tests. When the initial plan failed, Dr. McNiece should have enacted a new plan in a timely manner. Dr. Payne concluded that the "patient is still at risk." The plan was to take an MRA and an MRI to provide good imaging of the brain and clot, and that seemed to be a logical plan. Unsuccessful efforts were made on two separate occasions to obtain these images but thereafter nothi
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