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Hashmi-Alikhan v. Staples

Florida Court of Appeals, Fifth District

March 29, 2018

SAIRA HASHMI-ALIKHAN, M.D., HEALTH FIRST, INC., HEALTH FIRST PHYSICIANS GROUP, INC., CAPE CANAVERAL HOSPITAL, INC. AND CAPE CANAVERAL HOSPITAL FOUNDATION, INC., Appellants,
v.
GERALDINE J. STAPLES, AS PERSONAL REPRESENTATIVE OF THE ESTATE OF GLENN STAPLES, RANDALL B. RIGDON, M.D., RANDALL B. RIGDON, LLC, DANIEL J. CALABRESE, P.A., FIRAS R. MUWALLA, M.D., ET AL., Appellees.

         NOT FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND DISPOSITION THEREOF IF FILED

          Appeal from the Circuit Court for Brevard County, George W. Maxwell III, Judge.

          Wilbert R. Vancol and Mary Jaye Hall, of McEwan, Martinez, Dukes & Hall, P.A., Orlando, for Appellants.

          Christopher V. Carlyle, of The Carlyle Appellate Law Firm, Orlando, for Appellee Geraldine J. Staples, as Personal Representative of the Estate of Glenn Staples.

          No Appearance for Remaining Appellees.

          EISNAUGLE, J.

         Appellants, Saira Hashmi-Alikhan, M.D., Health First, Inc., Health First Physicians Group, Inc., Cape Canaveral Hospital, Inc., and Cape Canaveral Hospital Foundation, Inc., appeal the trial court's order granting a new trial in favor of Appellee, Geraldine Staples, as Personal Representative of the Estate of Glenn Staples, based upon the finding that the jury's verdict was contrary to the manifest weight of the evidence. In its order, the trial court concluded that Appellants' expert witnesses "gave more general opinions, and were not as knowledgeable to the hematological intricacies of the case." We reverse because the record does not support the trial court's reasons for granting a new trial.

         Appellee's husband, Glenn Staples, a sixty-year-old male, presented to the emergency room at Cape Canaveral Hospital at 5:00 p.m. on February 9, 2010, with a platelet count of 1000. A platelet count of 10, 000 is considered critically low, a normal count is about 250, 000 for a sixty-year-old. At such a low platelet count, life-threatening and organ-threatening bleeds are a concern because the human body cannot adequately form blood clots with so few platelets. By 7:30 p.m., Mr. Staples was diagnosed with acute immune (or idiopathic) thrombocytopenia purpura ("ITP"), a blood disorder that required treatment to halt his body's destruction of platelets.

         Mr. Staples' treating physician, Dr. Alikhan, examined Mr. Staples and consulted with Dr. Muwalla, an on-call hematologist, to assist in managing her patient's rare blood disorder. Dr. Muwalla elected to return to the hospital to personally examine Mr. Staples. At Dr. Muwalla's recommendation, Dr. Alikhan ordered that Mr. Staples receive prednisone, a corticosteroid, and intravenous immunoglobulin ("IVIG"), to treat Mr. Staples' ITP. Dr. Alikhan did not order a platelet transfusion for Mr. Staples, and Dr. Muwalla only recommended a platelet transfusion in the event of a "life-threatening hemorrhage."

         Mr. Staples was admitted to the hematology floor of the hospital at 8:40 p.m. His nurse commenced administering IVIG at 10:20 p.m.; however, he experienced an adverse reaction to the IVIG within fifteen minutes (sweating and vomiting), so the nurse discontinued the IVIG and notified Dr. Muwalla. Dr. Muwalla ordered the nurse to restart the IVIG as soon as Mr. Staples stabilized. Around midnight, the nurse called Dr. Muwalla again to report on her inability to restart the IVIG due to Mr. Staples' continuing condition. In response, Dr. Muwalla ordered the nurse to discontinue the IVIG. The nurse conceded she never administered the ordered prednisone to Mr. Staples. The following morning at 5:37 a.m., Mr. Staples was found unresponsive and without a pulse, which was about twelve and a half hours after he presented to the emergency room. Although efforts to resuscitate Mr. Staples were partially successful, he was significantly compromised, never regained consciousness, and was declared brain dead at 9:45 a.m. A CAT scan of Mr. Staples' brain showed a catastrophic intracerebral hemorrhage, and he was pronounced dead at 4:16 p.m. His cause of death was acute cerebral hemorrhage from thrombocytopenia.

         During a two-week jury trial, the parties presented expert testimony on the standard of care applicable to Dr. Alikhan, Dr. Muwalla, and the nurse who administered the IVIG. Appellee offered expert testimony that Mr. Staples' condition was treatable, and that Dr. Alikhan and Dr. Muwalla breached the standard of care by (1) failing to order that the IVIG be administered at a reduced rate initially to reduce the risk of an adverse reaction, (2) failing to order both IVIG and prednisone "stat, "[1] and (3) failing to order a platelet transfusion for Mr. Staples. On the other hand, Appellants offered expert testimony that (1) all three health care professionals met the standard of care, and (2) given Mr. Staples' extreme condition, there was nothing that could have saved his life.

         Importantly, although a great deal of the evidence and argument at trial pertained to IVIG and prednisone, the experts on both sides agreed that IVIG and prednisone take at least twenty-four hours to take effect, and usually longer. Therefore, given that Mr. Staples suffered a catastrophic intracerebral hemorrhage about twelve and a half hours after presenting to the hospital, and was declared brain dead about seventeen hours after presentation, the experts agreed that platelets were the only treatment that could have saved Mr. Staples' life. This testimony was uncontroverted.

         The experts could not agree, however, on the propriety of ordering a platelet transfusion. Appellants' expert testified that there are medical risks to ordering platelets, and that platelets should only be ordered in the event of a life-threatening bleed, which the experts agreed Mr. Staples did not have when he was examined by Dr. Alikhan and Dr. Muwalla. In contrast, Appellee's expert opined that the only proper course of action was to order platelets "stat" immediately upon Mr. Staples' admission. Appellee's expert conceded that there are medical risks associated with a platelet transfusion, but opined that the risk of not administering platelets outweighed the risks of doing so.

         The jury returned a defense verdict. In response, Appellee filed a motion for a new trial, arguing that the jury's verdict was against the manifest weight of the evidence. The trial court ultimately agreed and granted the motion. On appeal, Appellants argue that the trial court abused its discretion in granting a new trial because the record does not reflect that Appellants' expert witnesses testified ...


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