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Hillcrest Baptist Medical Center v. Wade8/3/2005
This is a medical malpractice case involving heart damage resulting from a delayed angioplasty. Penny Wade sued Hillcrest Baptist Medical Center, two emergency room doctors, and their employers, under Chapter 74 of the Texas Civil Practice and Remedies Code. Hillcrest challenged the sufficiency of Wade's expert reports for failure to include the causation element as to Hillcrest and its nursing staff. The trial court denied Hillcrest's motion to dismiss. Hillcrest appeals in two issues: (1) trial court abused its discretion in denying Hillcrest's motion to dismiss; and (2) Wade would not be entitled to a thirty-day extension to cure any deficiency in her expert reports.
We will overrule the first issue and affirm the judgment, so we do not reach the second issue.
BACKGROUND
Facts
On February 4, 2002 at 3:45 a.m., Wade, a thirty-eight year old woman, went to Hillcrest Emergency Department complaining of a cough and chest pains. At 3:52, she was triaged by a triage nurse, who noted that she smoked a pack of cigarettes a day but did not note Wade's positive family history of coronary artery disease. Approximately 30 minutes later, a treating night-shift nurse assessed Wade but did not place Wade on a cardiac monitor. At 5:07, Dr. Norwid, an emergency room physician, saw Wade, and he ordered an electrocardiogram ("EKG") and lab tests. Wade was then transferred to a bed with a cardiac monitor and an acute myocardial infarction (AMI) protocol was initiated. The EKG, performed at 5:26, was described by Dr. Norwid as "worrisome." The EKG had deep Q waves and a bit of ST elevation from V1 though V4. Dr. Norwid left at the end of his shift and turned Wade's care over to Dr. Welter, another emergency room physician. At 5:40, a Nitroglycerin drip was reducing Wade's pain from an "eight out of ten" to a "three out of ten." By 6:15, her pain was down to a "one out of ten."
At 7:00, a treating day-shift nurse assumed care of Wade from the treating night-shift nurse. At 7:31, a second EKG was performed, and additional blood for lab tests was drawn at 8:40. The second EKG demonstrated changes from the earlier EKG; there was now ST segment elevation in the lateral leads. The cardiac enzymes were also remarkably elevated. Wade was then sent for a CT scan without a cardiac monitor and without a registered nurse trained in Advanced Cardiac Life Support (ACLS). Between 9:15 and 10:30, Wade vomited twice and her blood pressure dropped slightly. She was treated with Phenergan and a saline bolus.
A cardiologist was reviewing EKGs in the heart station, and after reviewing Wade's EKGs, was concerned and proceeded to the emergency room. The cardiologist saw Wade at 11:10, and she was taken to the cardiac catheterization lab at 12:05 p.m. where angiograms demonstrated a 100% occlusion of the left anterior descending coronary artery. The occluded artery was treated with balloon angioplasty and stenting. According to Wade's physician-experts, Wade now has significantly impaired cardiac ejection fraction, requires an implantable cardioverter/defibrillator, and may possibly require a heart transplant in the future.
The relationship of the defendants in the underlying medical malpractice case is not entirely clear from the record. It appears that Hillcrest's liability would be based on, at a minimum, any negligence by its nursing staff, which will be the subject of our inquiry.
Expert Reports
Wade filed three expert reports from two physicians and one nurse.
Nurse Nelson-Richardson Expert Report
Nurse Nelson-Richardson is an emergency nurse. She explains in her report that the national stan
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