Confidential settlement
The family of a retired steelworker settled their wrongful death case against a surgeon and a critical care physician for a confidential amount.
Leboes Combs, a 60-year-old diabetic and retired steelworker, entered the hospital on June 15, 1998 with an ulcer on his great toe and vascular insufficiency. When he died on June 27, the surgeon told the family his death was probably caused by a heart attack, although the plaintiffs noted that the autopsy failed to show any acute myocardial infarction.
The plaintiffs' experts testified that Combs died from a combination of improper and untimely treatment of post-operative bleeding and non-septic SIRS, or systemic inflammatory response syndrome, which led to multiple organ failure. The plaintiffs also questioned the surgeon's qualifications and claimed he was not board certified in vascular or general surgery.
St. Louis attorney Stephen M. Glassman represented the plaintiffs. After spending $900 on a surgeon with good credentials but little time, Glassman was told not to pursue the case. He gave his nursing consultant credit for advising him to track down the right expert.
"Our nurse insisted that we take the time and spend the money necessary to retain a top-notch vascular surgeon who would perform a comprehensive review of the case," said Glassman.
"We did so, and this consultant not only zeroed in on the subtleties of the case, but walked us through the details of some rather complex vascular procedures.
"As a result, we were able to handle the outstanding experts hired by the defense, and get them to affirm many of the vulnerabilities in the case, which ultimately brought about the settlement," he said.
Defense experts disputed that Combs had SIRS because he had no sustained fever, had a normal respiratory rate, normal oxygen saturation and normal blood pressure throughout the day before he died.
Defense attorney Stephen G. Reuter, who represented the critical care physician, noted that the family testified in deposition that they were conversing with Combs and that he appeared to be improving that afternoon and evening.
The defense experts concluded that Combs died from an unanticipated cardiac arrhythmia, caused by small vessel coronary disease, common in diabetics.
Combs had two operations while hospitalized. On June 19 he underwent a complex popliteal-to-dorsal pedis bypass graft, which the surgeon told him would enable him to avoid an amputation. The plaintiffs claimed the surgeon failed to tell Combs that the long-term success rate of this type of graft was about 15 percent.
By June 22, Combs' leg became cold, taut, blistered and swollen. The surgeon diagnosed compartment syndrome and 20 hours later performed a second operation consisting of an embolectomy and fasciotomies. However, the plaintiffs claimed the standard of care required this surgical intervention at six hours. The plaintiffs also claimed that the surgeon should have explored the wound for the sources of the bleeding or performed a below-the-knee amputation.
On June 25 Combs suffered several seizures, and more blood and saline were ordered.
Plaintiffs' experts said that the 5:00 a.m. lab reports on June 26 showed deterioration and indicated possible infection and renal failure. The plaintiffs claimed the critical care physician saw, but failed to examine Combs, and that because he was then transferred from the intensive care unit to the step-down unit, the critical care physician never reviewed his chart or evaluated him.
The plaintiffs faulted the surgeon and critical care physician's failure to order any laboratory studies or tests to investigate the conflict between his improving clinical appearance and deteriorating lab results. They claimed the critical care physician left that evening without informing his replacement of Combs' history of surgeries, bleeding and seizures.
At midnight on June 26, the ICU nurse found that Combs' blood pressure had fallen and blood was squirting from his wounds but no physician was informed. Combs was found unresponsive with blood pressure of 60/30 at 4:10 a.m. and could not be resuscitated.
St. Louis attorney Brent Baldwin, who represented the surgeon, said that the defense experts believed that Combs' diabetes had led to microvascular disease in his heart.
Baldwin also noted that the degree and existence of bleeding prior to death was disputed, but that the parties agreed that no doctor was told of the bleeding.
"It is hard to blame the bleeding episode on a doctor who was never told," Baldwin said in an email to Missouri Lawyers Weekly.
Mediation resulted in a confidential partial settlement with a third undisclosed defendant.
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Facts of the Case
Type of Action: Medical malpractice/ wrongful death
Type of Injuries: Death
Court/Case Number/Date: St. Louis County Circuit Court/02CC-3156/Feb. 7, 2007
Caption: Elnora Combs, et al. v. a vascular surgeon and a critical care physician.
Judge, Jury or ADR: Mediation
Name of Judge: Colleen Dolan
Verdict or Settlement: Confidential settlement
Special Damages: $50,000 medical expenses for last illness, funeral
Allocation of Fault: N/A
Last Demand: Confidential
Last Offer: N/A
Attorneys for Plaintiff: Stephen M. Glassman, The Glassman Law Firm, St. Louis
Attorneys for Defense: Brent Baldwin, Lathrop & Gage, St. Louis; Stephen Reuter, Lashley & Baer, St. Louis
Insurance Carriers: Medical Assurance and Medical Protective
Plaintiff's Experts: Dr. Kim Hodgson (vascular surgery) Springfield, Ill.; Dr. Grover Hutchins (pathology) Baltimore, Md.; Christopher Veremakis (critical care) St. Louis; Kimberly Moore (registered nurse) Detroit, Mich.
Defendant's Experts: Dr. Brian Rubin (vascular surgery) St. Louis; Dr. George Matuschak (critical care) St. Louis; Dr. David McKinsey (infectious disease) Kansas City; Dr. Michael Cox (critical care) St. Louis; Dr. Jon Ritter (pathology) St. Louis,
May 21, 2007
