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Clark v. HCA8/25/2005
Point of Error One.
ADEQUACY OF THE REPORT
In Point of Error Two, Clark complains that the trial court erred in finding that the expert report was inadequate. In their motions challenging the expert report, Appellees argued that the report did not properly set out the standard of care, breach, or causation.
The Report
Dr. Pacheco reviewed the medical records from Del Sol Rehabilitation Hospital from May 7 until May 19 and the records from Del Sol Medical Center from May 19 until May 29. We have already detailed his narrative of events in our factual summary. After narrating this sequence of events, Dr. Pacheco turned to the standard of care. Rather than stating his personal knowledge of the applicable standard of care, he set out nine text boxes containing excerpts from different publications. Because of the unusual format, we quote it verbatim:
STANDARD OF CARE
A recently published Hospital Medicine Consensus Reports issued a consensus panel statement on the 'Prophylaxis of Venous Thromboembolism (VTE) in the Hospitalized Medical Patient.' It states that all medical inpatients should be screened and considered for VTE prophylaxis. Subsequently, there follows a risk factor assessment based on whether the patient has restricted mobility AND at least one VTE risk factor (such as age greater than 40, heart failure, chronic lung disease). If these criteria are met then pharmacologic prophylaxis for VTE is indicated provided there are no exclusion criteria for such. Possible exclusion criteria include uncontrolled hypertension, significant renal insufficiency (creatinine clearance <30 ml/minute), among others. If the patient is a candidate for prophylaxis the recommended enoxaparin (Lovenox(r)) dosage is 40 mg SQ once daily.
Melde SL. Enoxaparin-induced retroperitoneal hematoma. Ann Pharmacother 2003; 37(6): 822-4
Alford et al reported on the occurrence of a '...a compartment syndrome caused by a hematoma which resulted from noninvasive blood pressure monitoring during thrombolytic therapy...'
Alford JW, Palumbo MA, Barnum MJ. Compartment syndrome of the arm: a complication of noninvasive blood pressure monitoring during thrombolytic therapy for myocardial infarction. J Clin Monit Comput 2002. 17 (3-4):13-6
On the diagnosis of compartment syndrome of the upper extremity, Seiler et al commented that '...careful attention to the details of the history and physical examination can assist in the development of a usaeful working diagnosis. Testing ITPs (Intracompartmental Pressure) is the best method available to help confirm the diagnosis...'
Seilar JG, Casey PJ, Binford SH. Compartment syndromes of the upper extremity. J South Orthop Association 2000 Winter. 9(4):233-47
'...Accute compartment syndrome can have disastrous consequences... unusual pain may be the only symptom of an impending problem...after 8 hrs, the damage (to the muscle) is irreversible ...fasciotomy generally should be done when tissue pressure rises past 20 mmHg below diastolic pressure...'
Whitesides TE, Heckman MM. Acute compartment syndrome: Update on Diagnosis and Treatment. J AM Acad Orthop Surg 1996; 4(4):209-218
Kam et al "Evaluated the accuracy of commonly accessed medical textbooks in their description of the presenting sign/symptoms of acute compartment syndrome... (and found that) ... there are only three (symptoms) pain, paresthesia, paresis which are important...
Kam JL, Hu M, Peiler LL, Yamamoto LG. Acute compartment syndrome signs and symptoms described in medical textbooks. Hawaii Med J 2003; 62(7):142-4
'...High c
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