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Primary care doc solely to blame for patient’s death: surgeon






San Diego County


Superior Court of San Diego County, Vista

Injury Type(s):

other-death; other-septic shock; gastrointestinal/digestive-gastrointestinal complications

Case Type:

Wrongful Death; Medical Malpractice – Surgeon, Failure to Test, Failure to Refer, Delayed Treatment, Failure to Diagnose

Case Name:

Janet Reynolds, individually, and as Successor in Interest of James E. Reynolds, deceased v. Thomas E. Rastle, M.D.; Graybill Medical Group Inc.; and John T. Steele, M.D.,
No. 37-2015-00004509-CU-PO-NC


September 18, 2018



Janet Reynolds , 

Estate of James E. Reynolds (Male, 62 Years)

Plaintiff Attorney(s):

Amy R. Martel;
Chihak & Martel;
San Diego,
Janet Reynolds, Estate of James E. Reynolds

Plaintiff Expert(s):

Adrian Ortega; M.D.; Colon & Rectal Surgery; South Pasadena,
CA called by:
Amy R. Martel ■ Timothy Lanning; M.A.; Economics; Santa Ana,
CA called by:
Amy R. Martel


John T. Steele, 

Thomas E. Rastle, 

Graybill Medical Group Inc.

Defense Attorney(s):

Barton H. Hegeler;
Hegeler & Anderson;
San Diego,
John T. Steele ■ None reported; for
Thomas E. Rastle, Graybill Medical Group Inc.

Defendant Expert(s):

David Weiner;
Los Angeles,
CA called by:
Barton H. Hegeler ■ Edward Phillips;
General Surgery;
Los Angeles,
CA called by:
Barton H. Hegeler


Doctors Co. for Steele


On Sept. 5, 2013, plaintiff’s decedent James Reynolds, 62, a carpenter, underwent an emergent left inguinal hernia repair by Dr. John Steele, the on-call surgeon at Palomar Medical Center, in Escondido. Reynolds then presented to Steele on Sept. 24, 2013, for a routine follow-up visit following the surgery. It was determined that Reynolds was recovering as expected. On Nov. 20, 2013, Reynolds returned to Steele with complaints of abdominal pain. After getting a history and performing an examination, Steele determined that Reynolds’ complaints were unrelated to his hernia surgery. Steele then personally telephoned Reynold’s primary care physician at Graybill Medical Group Inc., Dr. Thomas Rastle, whom Reynolds had seen since the early 2000s and for most of his adult life. Steele asked Rastle to see Reynolds for his current complaints and perform the necessary workup, since Rastle was his long-standing, primary care physician. Rastle indicated he would direct Reynolds care. On Dec. 8, 2013, Reynolds passed away from septic shock due to a small bowel obstruction. The decedent’s wife, Janet Reynolds, acting individually and on behalf of her husband’s estate, sued Steele, Rastle and Graybill Medical Group. Rastle and Graybill Medical Group settled out of the case before trial. (Neither Steele nor his medical group had any relationship with Rastle’s group.) Plaintiffs’ counsel contended that Steele failed to diagnose and treat the decedent for the small bowel obstruction and that based upon the decedent’s signs and symptoms, Steele should have personally referred the decedent for imaging studies of his abdomen, rather than sending him to Rastle. Counsel also contended that a radiographic study would have demonstrated a small bowel obstruction that could have been addressed. The plaintiffs’ expert colon and rectal surgeon opined that it was Steele’s responsibility to order imaging of the decedent’s abdomen and that if imaging had been performed, a bowel obstruction would have likely been identified and treated. The defense’s surgery expert opined that Steele’s care and treatment of the decedent on Nov. 20, 2013 was reasonable and that Steele did not deviate from the standard of care. He also testified that a general surgeon under similar circumstances would be reasonably expected to direct a patient’s further work up to the primary care physician. The expert testified that Steele appropriately performed a post-operative examination of the decedent’s incision and groin, and that Steele believed that the surgery was successful. The expert also testified that after Steele ruled out complications due to the hernia repair, it was reasonable for Steele to allow Rastle to provide primary care to the decedent, which Rastle agreed. The expert surgeon further testified that while a partial bowel obstruction may have been possible on Nov. 20, 2013, the decedent was not exhibiting any signs or symptoms that would have indicated to Steele that the decedent was unstable or acutely ill. In addition, he opined that after the decedent was stabilized and discharged to follow-up with Rastle, Steele had no duty to re-establish a doctor-patient relationship with the decedent and that by the time the decedent presented to the emergency department on Dec. 8, 2013, it was unfortunately too late to prevent the decedent’s death. The defense’s surgery expert opined that responsibility for the decedent’s death was with Rastle and that Rastle was unable to articulate an explanation for allowing the decedent to be discharged from his office on Dec. 5, 2013. At the time of discharge, the decedent was allegedly demonstrating signs and symptoms of progressive septic shock, including ongoing abdominal pain, weakness, profoundly low blood pressure, and a low heart rate. The expert opined that the patient’s symptoms mandated evaluation in an emergency department, but that Rastle failed to refer the decedent. The expert further opined that if Rastle responded appropriately to clear evidence of progressive septic shock, the decedent likely would have survived. Steele’s counsel noted that Rastle saw the decedent on Nov. 21, 2013 and Dec. 5, 2013, that Rastle asked for no further input from Steele, and that Rastle made judgments regarding the decedent’s condition and necessary care. However, counsel contended that Rastle performed an abdominal examination on Nov. 21, 2013 that was recorded as entirely normal, but that the examination was inconsistent with the plaintiffs’ expert colon and rectal surgeon’s contention that imaging at that stage would have demonstrated an obstruction. Steele’s counsel noted that the plaintiffs’ expert opined that Rastle violated the standard of care and that Rastle’s negligence was responsible for the decedent’s untimely death. Counsel specifically noted that the plaintiff’s expert was critical of Rastle’s management of the decedent and that the expert opined that it was “extraordinarily ill-advised and a mistake” to send the decedent home on Dec. 5, 2013. The plaintiffs’ expert also opined that Rastle was negligent in electing to treat a hypotensive patient, rather than sending him directly to an emergency department, and that Rastle’s omissions led to the decedent’s death. In addition, the expert opined that if Rastle had correctly sent the decedent for necessary lifesaving treatment on Dec. 5, 2013, the decedent likely would have survived.


James Reynolds died from septic shock on Dec. 8, 2013. He was 62. He was survived by his wife, Janet Reynolds, then a 64-year-old carpenter. The decedent’s wife sought recovery of $250,000 in general wrongful death damages, based on the MICRA cap. She also sought recovery of $2,857.90 in funeral expenses. The plaintiffs’ expert economist opined that the value of Ms. Reynolds past and future loss of household services, which was provided by the decedent, totaled $469,329. The defense’s expert economist opined that Ms. Reynolds’ potential economic loss, based on the loss of household services, totaled $219,114.


The jury rendered a defense verdict. It found that Steele was not negligent in the treatment of the decedent.

Trial Information:


Ronald F. Frazier





Trial Length:


Trial Deliberations:


Jury Vote:


Jury Composition:

6 male/ 6 female

Editor’s Comment:

This report is based on information that was provided by plaintiffs’ and defense counsel.