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Manning v. Bellafiore11/4/2005
's vision loss was, he acknowledged it was never documented. Dr. Bellafiore admits his failure to discuss the likelihood of an artery tear with Mr. Manning or his wife.
Dr. Bellafiore recognized that South County Hospital did not perform cranial neurosurgery or angioplasty of such arteries in March of 1998, although his differential diagnosis could require such treatments.
Dr. Bellafiore continued his testimony by indicating he had no choice but to complete the MRI on Mr. Manning as an outpatient, as Mr. Manning no longer desired to enter a closed machine. Dr. Bellafiore stressed the importance of the MRI as the only way to determine the cause of the stroke. He described his writing of the note of March 5, 1998, with Dr. McNiece, calling for a prompt MRI. He claimed that Mr. Manning flatly rejected sedation for the MRI, but he never documented the refusal or discussed it with Mrs. Manning. Dr. Bellafiore claimed he did not know the hospital policy requiring documentation for refusals of treatment.
On February 3, 2004, Dr. Daniel Hanley testified for the Mannings as a Board Certified Neurosurgeon. He is a Professor at Johns Hopkins and the University of Maryland. He reviewed Mr. Manning's hospital records and was struck by the early onset of Mr. Manning's vision limitations and neck pain. Dr. Hanley found Dr. Bellafiore's differential diagnoses appropriate, but indicated that they required prompt imaging of the vertebra basilar artery system. The standard of care required the highest degree of imaging available to be completed within 24 hours, given the high probability of mortality which he estimated to be at 50%.
Dr. Hanley summarized that physicians "don't want to leave it in a hypothetical state" so they "want to obtain a gold standard evaluation." As Mr. Manning condition had not improved, it was clear he had a stroke by mid-morning of March 4 1998. While imaging could be done by the MRA/MRI, a CT scan of the head and neck area, or an angiogram was appropriate alternatives. As no imaging was completed in the first 24 hours after the March 4, 1998 onset, Dr. Hanley concluded that this was a violation of the standard of care. Dr. Hanley further concluded that if such imaging was done, and the blockage could be promptly treated with a blood thinner or possibly with angioplasty. If imaging could not be completed on Mr. Manning, Mr. Manning should have been transferred in order to complete the test.
Dr. Hanley testified that Dr. Bellafiore "chooses the most benign of diagnosis and accepts them without evidence." He referred to March 5, 1998, when there was still no imaging and hence the treatment was continuing, without knowing which vasculature was affected. There was no angiogram. Mr. Manning was still being treated beneath the standard of care. When the Ativan was not sufficient to calm Mr. Manning for the MRI, the physicians needed to discuss the risk existing and chart the risk. Moreover, if Mr. Manning was refusing treatment, the standard of care further required that another family member be brought into the conversation. No other family member was consulted nor was there documentation of the refusal of treatment.
Dr. Hanley's testimony was virtually impenetrable on cross-examination. He was explanatory and logical in his testimony. He was consistent, credible and clear throughout.
Dr. Bellafiore returned to the stand on February 4, 2004. He now discussed the different types of sedatives which are available for an MRI. He stated that he had been confused on this subject at his deposition. Dr. Bellafiore recognized that it was Mr. Manning's choice to undergo imaging. He admitted that he did not discuss his choices with oth
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