California Verdicts

Amount:

$38,614,587

Type:

Verdict-Plaintiff

State:

California

Venue:

San Francisco County

Court:

Superior Court of San Francisco County, San Francisco

Injury Type(s):

Case Type:

Medical Malpractice – Delayed Diagnosis, Delayed Treatment

Case Name:

Kody Paul Myrick, by and thru his Guardian ad Litem, Richard Eugene Myrick v. Catholic Healthcare West, Bakersfield Memorial Hospital, Pinnacle Emergency Physicians of Bakersfield, Stephen Helvie, M.D., Sahaphun Hansa, M.D., Caroline Han, M.D., Gary Hensley, M.D., and Does One through Fifty, Inclusive,
No. CGC-11-515329

Date:

May 17, 2013

Plaintiff(s):

Kody Myrick (Male, 19 Years)

Plaintiff Attorney(s):

Melinda T. Derish;
Walkup, Melodia, Kelly & Schoenberger;
San Francisco,
CA,
for
Kody Myrick ■ Conor M. Kelly;
Walkup, Melodia, Kelly & Schoenberger;
San Francisco,
CA,
for
Kody Myrick

Plaintiff Expert(s):

Kurt Miller;
M.D.;
Neurology;
Fresno,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Benny Gavi;
M.D.;
Internal Medicine;
Stanford,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Carol Hyland;
M.A.;
Life Care Planning;
Lafayette,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Steven Hetts;
M.D.;
Neuroradiology;
San Francisco,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Patrick Mason;
Ph.D.;
Economics;
San Francisco,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Raymond Ricci;
M.D.;
Emergency Medicine;
Irvine,
CA called by
Conor M. Kelly, Melinda T. Derish ■ Bradford Anderson;
M.D.;
Physical Medicine;
Bakersfield,
CA called by
Conor M. Kelly, Melinda T. Derish

Defendant(s):

Caroline Han, M.D., 

Gary Hensley, M.D., 

Sahaphun Hansa, M.D., 

Stephen Helvie, M.D., 

Catholic Healthcare West, 

Bakersfield Memorial Hospital, 

Pinnacle Emergency Physicians of Bakersfield

Defense Attorney(s):

Mark B. Connely;
Hall Hieatt & Connely LLP;
San Luis Obispo,
CA,
for
Sahaphun Hansa, M.D. ■ Chase W. Martin;
Hall Hieatt & Connely LLP;
San Luis Obispo,
CA,
for
Sahaphun Hansa, M.D. ■ None reported;

for
Caroline Han, M.D., Gary Hensley, M.D., Stephen Helvie, M.D., Catholic Healthcare West, Bakersfield Memorial Hospital, Pinnacle Emergency Physicians of Bakersfield

Defendant Expert(s):

Ted Vavoulis;
Economics;
Los Angeles,
CA called by
Mark B. Connely, Chase W. Martin ■ Wade Smith;
Neurology;
San Francisco,
CA called by
Mark B. Connely, Chase W. Martin ■ David Frecker;
Neurology;
Santa Barbara,
CA called by
Mark B. Connely, Chase W. Martin ■ Stacey Helvin;
Life Care Planning;
Anaheim,
CA called by
Mark B. Connely, Chase W. Martin ■ Michael Smolens;
Emergency Medicine;
Torrance,
CA called by
Mark B. Connely, Chase W. Martin ■ William Klein;
Internal Medicine;
Newport Beach,
CA called by
Mark B. Connely, Chase W. Martin

Insurer(s):

The Doctors Co. for Sahaphun Hansa, M.D.

On the evening of July 31, 2010, plaintiff Kody Myrick, 19, a recent high school graduate, was with his father herding cattle on a ranch in Bakersfield, when he suddenly slumped over and had difficulty speaking. Myrick’s father immediately drove him to the emergency room at Bakersfield Memorial Hospital, a community hospital and primary stroke center. Myrick was triaged in the emergency room approximately one hour after the onset of his symptoms, and the E.R. nurse noted a primary complaint of "possible stroke." Myrick was examined by the emergency room physician, Caroline Han, M.D., who noted that Myrick was flaccid in all four extremities and unable to talk. Han subsequently ordered a non-contrast CT scan of the brain, which was read by a radiologist as showing a small infarct of indeterminate age in the left thalamus. Blood tests for infection (complete blood count with differential) were performed, and Myrick’s electrolyte and glucose levels were checked, all of which proved normal. A toxicology screen was also negative. Han later telephoned Sahaphun Hansa, M.D., to transfer responsibility for Myrick at midnight. Hansa, a hospitalist and pulmonologist, was at home while he was covering the night shift as the on-call hospitalist for Bakersfield Memorial Hospital. Hansa admitted that his telephone conversation with Han lasted between one and five minutes, that he understood no neurology consultation had been obtained yet, and that although he lived near the hospital, he decided not to go in to evaluate Myrick. There was conflicting testimony at trial between Hansa and Han as to what Hansa was told during the phone call about Myrick’s physical examination and the C.T. scan findings, but Hansa admitted that he did not ask any questions about the findings either. Following the phone conversation, Hansa decided to admit Myrick to the hospital without evaluating him in person and without requesting an emergency neurology consultation. Hansa gave admission orders over the telephone to admit Myrick to the neurology floor with the diagnosis of "possible stroke." Pursuant to Hansa’s orders, Myrick was transferred from the emergency department to the hospital floor, and Myrick was not seen by Hansa or any other physician for the rest of the night. During the night the stroke symptoms waxed and waned such that Myrick regained a normal Glascow Coma Scale and the ability to move one side of his body. However, the next morning, at approximately 8:00 a.m., Myrick’s neurologic condition deteriorated, and he became obtunded and aspirated. An angiography was obtained and revealed that the basilar artery was occluded. By the time the stroke was properly diagnosed, Myrick had suffered significant permanent damage to his brain stem. Myrick sued Hansa; Han; the emergency room physician’s medical group, Pinnacle Emergency Physicians of Bakersfield; Bakersfield Memorial Hospital; Catholic Healthcare West; an internist, Gary Hensley, M.D.; and a neurologist who was the director of the hospital’s stroke program, Stephen Helvie, M.D. Myrick alleged that the defendants failed timely treat his condition and that this failure constituted medical malpractice. Prior to trial, Hensley was dismissed from the case, and Han, Helvie, Bakersfield Memorial Hospital, Catholic Healthcare West and Pinnacle Emergency Physicians of Bakersfield all settled with Myrick. Thus, the matter proceeded to trial against Hansa only. Plaintiff’s counsel contended that Myrick’s stroke should have been at the top of the differential diagnosis for a patient with an acute onset of profound neurologic abnormalities and a C.T. scan that showed a small stroke. Counsel also contended that the standard of care required emergency neurology consultation and that a C.T. angiogram should have been performed on an emergency basis. At trial, plaintiff’s counsel presented evidence that both Han and Hansa failed to follow Bakersfield Memorial Hospital’s protocols for the rapid evaluation of a potential acute stroke. The plaintiff’s emergency room expert testified that Han should have ordered intravenous tissue plasminogen activator (tPA), a protein involved in the breakdown of blood clots, and obtained an emergency neurology consultation. The plaintiff’s internal medicine expert testified that Hansa breached the standard of care by failing to perform an emergency workup to determine if Myrick was having an acute stroke, by ordering a drug that was not the standard of care for acute stroke, and by failing to obtain an emergency neurology consult, which was available at the hospital through a teleneurology system that had neurologists on-call 24 hours a day. The plaintiff’s neurology expert testified that had a competent neurologist been called, the neurologist would have recognized that Myrick’s symptoms were indicative of a posterior circulation stroke, ordered an immediate C.T. angiography, and arranged for emergency transfer to a comprehensive stroke center that had stroke neurologists and interventional radiologists — services that were not available at Bakersfield Memorial Hospital. The expert also testified that a C.T. angiography would have demonstrated the basilar artery was occluded by thrombus, which required an urgent thrombectomy by an interventional radiologist. The plaintiff’s interventional neuroradiology and neurology experts testified that Myrick had a stroke in evolution, with a waxing and waning course, and that had Myrick undergone a thrombectomy to remove the blood clot prior to 8:00 a.m., much of the permanent ischemic injury to the brain stem would have been prevented, such that he could have lived and worked independently. Hansa’s counsel contended that Han had tried to call a neurologist, but that no hospital neurologist would return her call. Counsel also contended that Han believed that the teleneurologist, who had only started the month before, was only for the potential use of tPA, which Han had ruled out. Counsel further contended that this was discussed with Hansa and that Hansa was told that there was no neurologist available. Hansa’s counsel argued that under these circumstances, Hansa admitted Myrick for observation, consisting of 2-hour neurology checks, and put Myrick on stroke prophylaxis, including anticoagulation, pending further evaluation, if necessary, in the morning. Hansa testified that he did not know Myrick was undergoing a stroke, and that because Myrick’s vital signs were stable, there was no need for an emergency neurology consultation. Hansa’s counsel argued that Helvie failed to detect an occlusion of the basilar artery on Myrick’s non-contrast C.T. scan, thereby misleading both Han and Hansa. Counsel also disputed causation, arguing that by the time Hansa accepted transfer from Han, Myrick’s stroke was already completed. Thus, counsel contended that Myrick suffered no further brain injury while under Hansa’s care. In addition, Hansa’s counsel argued that it would have been impossible to transfer Myrick to a tertiary care center for the thrombectomy procedure. The defense’s stroke neurology expert, who was the director of the University of California, San Francisco Medical Center, testified that he would not have accepted Myrick for transfer, as Myrick would not have met the criteria for a mechanical thrombectomy. He also testified that mechanical thrombectomy was still an "experimental" procedure and that even in San Francisco, had this occurred in San Francisco and not Bakersfield, it was almost impossible to arrange an inner city transfer in under six hours.

Myrick was originally diagnosed with "locked in" syndrome, consisting of paralysis and the inability to speak, but with normal cognitive function. However, he ultimately suffered a catastrophic brain stem injury. Myrick subsequently spent three weeks at Bakersfield Memorial Hospital, paralyzed in all four limbs and unable to talk, before being transferred to Santa Clara Valley Medical Center, where he spent three months undergoing intensive rehabilitation with speech, occupational and physical therapy. Over the next year, he regained partial use of one hand. Myrick claimed that his permanent injuries include spastic quadriparesis, loss of balance, and profound speech impairment. He claimed that as a result, he requires 24-hour attendant care and is restricted to a wheelchair. In addition, plaintiff’s counsel contended that an implanted baclofen pump would be warranted to treat Myrick’s spasticity problems. The parties stipulated that Myrick’s past medical costs paid by Medi-Cal amounted to $370,587. Thus, plaintiff’s counsel asked the jury to award Myrick economic damages consisting of $116,419 for his past wage loss, $3,247,980 for his future wage loss, $230,655 for his past attendant care, and $33,111,900 for his future life care costs. Plaintiff’s counsel did not ask for an explicit amount of non-economic damages, but advised the jurors to use their common sense and experience in reaching a fair amount. Hansa’s counsel did not dispute the reasonableness and necessity of Myrick’s past medical care, but presented a different life care plan to the jury. Counsel conceded the necessity of most items in Myrick’s plan, but disputed the plaintiff’s pricing of certain items, including the cost of future attendant care, arguing that Myrick could be cared for at a group home. Hansa’s counsel also disagreed with Myrick’s alleged future necessity for an intrathecal baclofen pump, arguing that treating Myrick with doses of oral baclofen was sufficient. Thus, Hansa’s counsel suggested that if the jury did not return a defense verdict and reached the question of damages, it should award Myrick $3 million in total damages.

The jury found that Hansa was negligent, and it apportioned 40 percent liability to him. It also apportioned 30 percent liability to Han and 30 percent liability to Bernard Maristany, M.D., a non-party radiologist who interpreted Myrick’s initial non-contrast CT scan. In addition, the jury found that Myrick’s damages totaled $38,614,587, with a total present cash value of $12,357,587. Post-trial, plaintiff’s counsel filed a memorandum of costs, including expert witness costs and prejudgment interest. Hansa’s counsel moved to reduce Myrick’s non-economic damage award pursuant to MICRA and for periodic payments of Myrick’s future economic damages. The court agreed to reduce Myrick’s general damages, per MICRA, to $100,000. In addition, after taking into account the prior settlements and offsets, the total present cash value of Myrick’s damages amounted to $4,596,375. Hansa’s counsel also moved for a new trial based on an alleged instructional error, but the motion was denied. As a result, Hansa is appealing the judgment based on the alleged judicial error in verbally misinstructing the jury in relationship to a juror question and based on an alleged lack of substantial evidence of causation. Hansa’s counsel claimed the causation issue was whether plaintiff’s counsel proved there was a reasonable likelihood that Hansa could have found a facility that would have taken Myrick at 2 a.m. on Sunday, Aug. 1, 2010, and which had the capability to perform the interventional procedure (which, at the time, was probably only UCLA, Cedars-Sinai, Stanford and UCSF), even if Hansa had ordered a neurology consult, the neurologist had ordered a CT angiogram, and the CT angiogram had been read appropriately by Maristany (who actually misread the CT scan). Counsel claimed that this would require someone at that facility to accept Myrick, arrange transport from Bakersfield, and have Myrick arrive well before 8 a.m. and perform the procedure. Hansa’s counsel asserted this was not realistic, noting that the defense’s stroke neurology expert, who was the director of the UCSF Medical Center, even testified that he would not have accepted the transfer in 2010 and that that even in San Francisco, it is almost impossible to arrange an inner city transfer in under six hours.

Kody Myrick $370,587 Personal Injury: Past Medical Cost; $66,000 Personal Injury: Past Lost Earnings Capability; $2,686,000 Personal Injury: Future Lost Earnings Capability; $130,000 Personal Injury: past attendant care; $33,112,000 Personal Injury: future life care costs; $2,250,000 Personal Injury: non-economic damages

Judge:

James J. McBride

Demand:

$1 million (policy limits) to Hansa

Offer:

Waiver of costs and malicious prosecution (C.C.P. § 998)

Trial Length:

10
 days

Trial Deliberations:

2.5
 days

Jury Vote:

12-0 on negligence of Hansa; 12-0 on causation as to Hansa; 11-1 on damages; 12-0 on negligence of Han; 12-0 on causation as to Han; 12-0 on negligence of Maristany; 12-0 on causation as to Maristany; 10-2 on apportionment of fault

Jury Composition:

6 male/ 6 female

Post Trial:

~~

This report is based on information that was provided by plaintiff’s counsel and Hansa’s counsel. Counsel for the remaining defendants was not asked to contribute.