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Patient was given too much morphine, doctor argued






Dallas County


Dallas County District Court, 134th

Injury Type(s):


Case Type:

Wrongful Death; Medical Malpractice – Nurse, Hospital, Delayed Treatment, Post-Operative Care

Case Name:

Ann Philips, Individually and on behalf of the Estate of Robert Philips, M.D., Deceased, Laura Philips, Robert Philips, III, and William Philips v. Brian Gogel, M.D., Kristen Casenave, M.D. and Medical City Hospital,
No. DC-13306


March 24, 2017



Ann Philips (Female), 

Laura Philips (Female), 

William Philips (Male), 

Robert Philips, III (Male), 

Estate of Robert Philips (Male, 71 Years)

Plaintiff Attorney(s):

James L. Mitchell;
Payne Mitchell Law Group, LLP;
Ann Philips, Laura Philips, William Philips, Robert Philips, III, Estate of Robert Philips

Plaintiff Expert(s):

Trevor Rabie; M.D.; Pulmonology; Houston,
TX called by:
James L. Mitchell


Brian Gogel, 

Kristen Casenave, 

Medical City Hospital

Defense Attorney(s):

Edward P. Quillin;
Quillin Law Firm, P.C.;
Brian Gogel, Kristen Casenave, Medical City Hospital

Defendant Expert(s):

Scott Yates;
Internal Medicine;
The Colony,
TX called by:
Edward P. Quillin


On April 2, 2013, plaintiffs’ decedent Dr. Robert O. Philips Jr., 71, a medical doctor, presented to surgical oncologist Dr. Brian M. Gogel at Medical City Hospital in Dallas for evaluation of a pancreatic mass. Philips had a medical history of, among other things, atrial fibrillation and was taking Coumadin. On April 9, Gogel performed a distal subtotal pancreatectomy and splenectomy without complication. Dr. Kristen Casenave, an internist, was consulted later that day to manage Philips’ atrial fibrillation and other medical issues. At 7 a.m. on April 10, Gogel saw Philips and documented that he looked good and his pain was "OK." Gogel saw nothing concerning. At 10:12 a.m., Casenave documented that Philips’ pain was tolerable. His hemoglobin was within normal range. Casenave wrote an order to restart Lovenox twice a day. On April 12, Gogel saw Philips at 9 a.m. and noted there was blood in the post-operative Jackson-Pratt drain. Philips’ hemoglobin dropped dangerously low from a measurement of 12.9 to 8.7, which indicated internal bleeding. Gogel ordered the Lovenox to be held, and two units of packed red blood cells to be transfused. Another hemoglobin test was ordered and to be reported to Gogel after the transfusion was finished. This transfusion began at 11:05 a.m. and ended at 3:25 p.m. The hemoglobin was drawn at 3:52 p.m. and showed that hemoglobin increased to 9.8. At 10:49 a.m., Casenave observed that Philips was fatigued and she was concerned about low hemoglobin and that he was still receiving Coumadin. On April 13, Philips received 2 milligrams of morphine at 1:20 a.m. and 5:42 a.m. Dr. Cathy Hernandez was covering for Casenave who was off duty for the weekend. Around 8:30 a.m., Gogel evaluated and reported that Philips was doing "OK." Between 9:45 a.m. and 10 a.m., a nurse observed that Philips’ speech was slurred and he was unable to form words. At 1:45 p.m., the nurse gave Philips an additional 4 milligrams of morphine. Shortly thereafter, Philips became agitated, quit breathing and turned blue. A code was called which continued through 2:50 p.m. Philips was unable to be resuscitated and died. The autopsy concluded that the cause of death was a multifactorial combination of blood-fluid loss, which constituted a physiological trigger leading to arrhythmia and circulatory collapse. Ann Philips, individually and on behalf of her husband’s estate, and children Laura Philips, Robert Philips III and William Philips sued Gogel, Casenave and Medical City Hospital for medical malpractice. The family claimed that Gogel and Casenave were negligent in failing to recognize Philips’ fluid volume deficit and treat it in a timely manner. The family also alleged that Medical City’s nurse was negligent in inappropriate over-administration of narcotic medication. The family settled with the hospital and Gogel. The trial proceeded against Casenave only. The plaintiffs’ pulmonology expert opined that had Gogel and Casenave timely recognized Philips’ internal bleeding and provided treatment, he would have survived. The expert opined that Philips’ autopsy showed that his death was caused by blood loss. The defense argued that Philips was being closely monitored by both Casenave and Gogel, and his post-operative complications were properly treated as they arose. The defense’s internal medicine expert opined that although Philips’ condition worsened on April 12, he remained stable. He opined that after transfusing 4 units of packed red blood cells, Phillips was stable, had stopped bleeding and was going to recover. He also opined that Casenave was not caring for Philips on the day he died. Casenave was adamant that Philips died because he was given too much pain medication. The defense presented at trial a breakdown of the amount of morphine administered on April 13 as follows: 1:20 a.m., 2 milligrams; 5:42 a.m., 2 milligrams; 8:03 a.m. 2 milligrams; 10:28 a.m., 2 milligrams; 11:09 a.m., Norco 7.5 milligrams via two tablets; 1:45 p.m. 4 milligrams. The defense’s internal medicine expert further opined that Philips’ blood pressure readings were 83/60 at 10:20 a.m., 99/50 at 11:52 a.m. and 96/65 at 12:41 p.m.; that the pain medication was administered in the face of concerning hypotension; and that in addition, the hemoglobin level of 10 at 6:30 a.m. is not consistent with hypovolemia. He also opined that Casenave saw the patient every day, adjusted medications accordingly, followed Gogel’s instructions regarding Lovenox and Coumadin, and ordered the right amount of saline to be given with the blood transfusion.


Philips’ wife and children sought to recover damages for past and future loss of companionship and mental anguish.


The jury rendered a defense verdict, finding that Casenave was not negligent.

Trial Information:


Dale Tillery





Trial Length:


Trial Deliberations:


Jury Vote:


Jury Composition:

2 male/ 10 female

Editor’s Comment:

This report is based on information that was provided by defense counsel. Plaintiff’s counsel did not respond to the reporter’s phone calls.