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Clark v. HCA8/25/2005
Lela Clark appeals the dismissal of her medical malpractice suit against Dr. Robert Moreno, Dr. Mariano Palacios, and Del Sol Rehabilitation Hospital (Del Sol). At issue are the qualifications of the expert witness and the adequacy of his report. Finding no abuse of discretion, we affirm.
FACTUAL SUMMARY
The following discussion is taken from the narrative contained within the expert report at issue. On or about May 7, 2003, Clark was evaluated at Del Sol Medical Center Emergency Department for chest pain, cardiac problems, nausea, and stomach pain. She was subsequently admitted to the Inpatient Rehabilitative Program at Del Sol Rehabilitation Hospital. "Physicians verbal orders" prescribed the twice daily 66 mg subcutaneous administration of Lovenox, an anticoagulant often used for deep venous thrombosis (DVT) prophylaxis in patients at risk. Lovenox is contraindicated for elderly patients with hypertension and renal insufficiency. Clark was 79 years old, suffered from hypertension, and was post-nephrectomy as a result of renal cancer.
On May 13, Clark had bruising in her abdominal area and large palpable lumps allegedly caused by the Lovenox. On May 17, she complained about pain in her right arm, and a bump was discovered in front of her right elbow. A vascular Doppler ultrasound of the right arm was negative for DVT, but a large amount of fluid was found in the right antecubital fossa.
On May 19, Clark was transferred to the acute care facility at Del Sol Medical Center under the supervision of Dr. Enrique Porras. The discharge summary from the rehabilitation facility indicated that the "patient developed compartment syndrome . . . ." Dr. Porras noted that Clark had a significant amount of pain and decreased range of motion. He diagnosed a hematoma of the right arm and hypertensive crisis due to pain and anxiety. His recommendation was to administer Vitamin K on a daily basis for three days, to continue the Lovenox, and to apply heat packs to the swelling. On May 20, a CT scan was consistent with the clinical suspicion of a hematoma.
On May 21, Dr. Maria Angelina Halsted evaluated Clark and suspected an infected hematoma. She noted that Clark was unable to extend her right arm, but there was no motor deficit in the right hand. Dr. Halstead recommended incision and drainage with decompression to ensure that Clark had not developed compartment syndrome. This procedure was performed the next day and revealed a large hematoma but "no evidence of compartment syndrome . . . with complete function of the hand and muscle on inspection." Clark was discharged on May 29, 2003. There was no mention of her range of motion upon discharge.
THE PLEADINGS
On August 29, 2003, Clark sued HCA, El Paso Healthcare Systems, Del Sol Rehabilitation Hospital, Dr. Moreno, and Dr. Palacios on a medical malpractice claim. The basis of the suit against all defendants was pled in the following particulars:
HCA and El Paso Healthcare Systems own and operate Del Sol. The nurses and staff at Del Sol had a duty monitor the status of Plaintiff for indications of an adverse reaction to the medications being administered by them. They had a further duty to administer all medications properly as instructed by the treating physicians. Dr. Moreno and Dr. Palacios had a duty to properly assess Plaintiff, to properly review the medical history of Plaintiff and properly prescribe medications that are not contraindicated for a patient with Plaintiff's history. As a result of the failures of the nursing staff of Del Sol, and most particularly, because of the failure of Dr. Moreno and Dr. Palacios to properly assess Plaintiff's medical histor
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