SAIRA HASHMI-ALIKHAN, M.D., HEALTH FIRST, INC., HEALTH FIRST PHYSICIANS GROUP, INC., CAPE CANAVERAL HOSPITAL, INC. AND CAPE CANAVERAL HOSPITAL FOUNDATION, INC., Appellants,
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.
FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND
DISPOSITION THEREOF IF FILED
from the Circuit Court for Brevard County, George W. Maxwell
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.
Appearance for Remaining Appellees.
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.
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
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."
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.
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, " 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.
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.
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
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 ...