Court: Supreme Court of Louisiana; July 14, 2000; Louisiana; State Supreme Court
Mary Fusilier, along with her husband Lloyd Fusilier Sr. and their minor son, brought a medical malpractice suit against Dr. Edward Dauterive Jr. for injuries sustained during surgery at Iberia General Hospital. The Supreme Court of Louisiana reviewed whether the jury erred in finding Dr. Dauterive not negligent and not responsible for the injuries. After evaluating the evidence, the Court determined the jury was manifestly erroneous in its conclusions regarding negligence and the failure to inform the plaintiff of material risks. Consequently, the Court reversed the appellate decision affirming the jury's verdict and remanded the case for a damages assessment.
The procedural history revealed that in 1989, an ultrasound detected a gallstone in Mary Fusilier's gallbladder, but she initially opted against surgery. By May 1990, after experiencing worsening symptoms, she consulted Dr. Dauterive, who recommended conservative treatment. When symptoms intensified, surgery was advised but delayed due to her congestive heart failure. On November 9, 1990, after stabilization, she underwent a laparoscopic cholecystectomy. Although the surgery started without complications, Dr. Dauterive later discovered he had inadvertently perforated Mrs. Fusilier's aorta, duodenum, and mesentery, leading to significant blood loss and multiple subsequent injuries. To manage her critical condition, extensive blood products were administered, and a colostomy was performed. Post-surgery, she experienced a complicated recovery, marked by a recurrence of heart failure and development of adult respiratory distress syndrome, necessitating prolonged ventilatory support and further blood transfusions.
After unsuccessful attempts to remove Mrs. Fusilier from the ventilator, doctors performed a tracheostomy and inserted a feeding tube. Following her recovery, she was discharged on December 24, 1990, but was readmitted five days later with serious complications, including sepsis and internal herniation. She underwent multiple surgical procedures and remained hospitalized until January 18, 1991, before being transferred to a skilled nursing facility until February 14, 1991.
It was later revealed that Dr. Dauterive had no prior experience performing laparoscopic gallbladder surgery on humans, having only attended a two-day training that included a single day of hands-on work with animal procedures. On October 25, 1991, the plaintiffs filed a claim with the Medical Review Panel, which concluded on August 6, 1992, that the defendants did not deviate from the standard of care required. The panel noted Dr. Fernandez's role as an assistant without direct treatment responsibility, confirmed the adequacy of the hospital's equipment and credentialing, and stated that Dr. Dauterive had obtained proper consent and demonstrated appropriate surgical skill. The panel classified the complications experienced by Mrs. Fusilier as known risks that were managed correctly.
On November 6, 1992, the plaintiffs filed a petition for damages against Dr. Dauterive, Dr. Fernandez, and Iberia General Hospital, alleging deviations from accepted medical standards and claiming various failures related to care and consent. The trial court granted summary judgment in favor of Dr. Fernandez and the hospital, dismissing claims against them. In a subsequent six-day jury trial against Dr. Dauterive, the jury found him not negligent, concluded that he did not fail to inform Mrs. Fusilier of surgical risks, and determined that his training was adequate and not a cause of her injuries. Additionally, Mrs. Fusilier's husband and grandson claimed loss of consortium due to her condition.
Plaintiffs appealed a trial court judgment regarding Dr. Dauterive and Iberia General Hospital, which was upheld by the court of appeal despite dissent from Judge Peters. He argued that the injuries to Mary Fusilier's aorta, mesentery, and duodenum resulted from negligence, and he contested the majority's claim that more evidence was needed to apply res ipsa loquitur. Subsequently, the plaintiffs sought certiorari, which was granted.
The document emphasizes that appellate courts cannot overturn trial court findings unless there is manifest error. The reviewing court must assess if the trial court's conclusions were reasonable based on the entire record, not merely if some evidence supports them. Plaintiffs asserted that the jury incorrectly determined the standard of care, arguing that the jury accepted the testimony of the defendant's expert, which suggested that as long as a physician corrects discovered injuries, they meet the standard of care. This viewpoint, plaintiffs argue, allows physicians to evade liability for negligence if they rectify their mistakes.
The jury's response to whether Dr. Dauterive was negligent left ambiguity, as it was unclear if they found no negligence or if they acknowledged negligence but deemed it not causative of the injuries. The document concludes that there are insufficient facts to support a finding that a physician, who punctured multiple organs during a procedure and attempted to correct these errors, was not negligent.
LSA-R.S. 9:2794 outlines the plaintiff's burden in medical malpractice cases against physicians in Louisiana. The plaintiff must demonstrate:
1. The standard of care and skill typically exercised by physicians in similar locales and circumstances, particularly within the relevant medical specialty.
2. The defendant's failure to meet this standard of care or to apply reasonable diligence and judgment in their practice.
3. A direct causal link between the defendant's negligence and the plaintiff's injuries.
The jury must be instructed that proving negligence requires a preponderance of evidence, and that injury alone does not imply negligence unless the doctrine of res ipsa loquitur applies. Physicians are not expected to provide the highest degree of care but must meet the standard typical of their peers in similar situations.
In the case of Dr. Dauterive, expert testimony from Dr. William Rout concluded that the doctor’s performance during a laparoscopic cholecystectomy was below the accepted standard of care, leading to significant injuries. Dr. Rout indicated that the defendant improperly inserted surgical instruments, causing complications, and criticized Dr. Dauterive's inadequate training prior to the surgery, asserting that a brief course and practice on animals were insufficient for performing the procedure on humans.
Defendant Dr. Dauterive was criticized by Dr. Rout for inadequately assisting in laparoscopic procedures before performing surgery on the plaintiff, Mary Fusilier. Dr. Rout asserted that a properly trained surgeon could have prevented an aorta injury during the procedure and claimed that Fusilier was not an appropriate candidate due to her obesity and prior abdominal surgeries. In contrast, Dr. Fernandez, who assisted during the surgery, testified that Dr. Dauterive's technique was appropriate, and there were no issues with the placement of instruments or the use of laparoscopic tools. Dr. Fernandez also challenged Dr. Rout's assertion about contraindications related to prior surgeries, noting that Fusilier's medical records showed no significant scarring.
Dr. Edward Chaisson, a defense expert, supported Dr. Dauterive's actions, stating he met the standard of care and that complications like perforations are inherent risks of laparoscopic procedures. Dr. Chaisson emphasized that recognizing and addressing complications indicates adequate care. Dr. Barry McKernan, a pioneer in laparoscopic surgery, corroborated that Dr. Dauterive’s training exceeded typical standards of the time and stated that obesity and prior surgeries are not contraindications unless they are in the same surgical area. He noted that Fusilier’s previous surgeries were not relevant to the cholecystectomy site, further supporting Dr. Dauterive’s adherence to the standard of care.
Dr. McKernan testified that injuries from trocars and various needles can occur even with experience and safety measures. During cross-examination, he was questioned about a 1990 article he co-authored, which recommended a year of basic coursework in diagnostic laparoscopy and performing 25 to 50 diagnostic laparoscopies under supervision before a surgeon could perform a laparoscopic cholecystectomy. Dr. McKernan clarified that the article's relevance was lost due to delays in publication, as by then, the content was outdated. It was confirmed that in 1990, no national standards existed for performing laparoscopic cholecystectomies. The court rejected Dr. Chaisson's argument that meeting the standard of care was sufficient if a physician recognized and addressed complications. Dr. Dauterive was found to have caused the plaintiff's complications, specifically a perforated aorta, mesentery, and duodenum, and it was established that during attempts to repair these perforations, he also punctured the plaintiff's intestine and splenic capsule. The court criticized the jury's verdict, stating it was manifestly erroneous, as expert testimonies failed to provide a credible explanation for the injuries, which were dismissed as mere complications. The only defense offered was an unfounded claim that the plaintiff's aorta was displaced, unsupported by medical records. The court concluded that Dr. Dauterive's negligent insertion of needles led to the injuries. As a result, it reversed the appellate court's affirmation of the jury's verdict and remanded the case to assess damages.
The court reversed and remanded the case, with Judge Lemmon concurring, while Judge Marcus was not part of the panel. The excerpt details the procedural differences between laparoscopic and open cholecystectomy. In open cholecystectomy, a large abdominal incision is made to remove the gallbladder, whereas laparoscopic cholecystectomy involves a small incision above the umbilicus, where a varies needle is inserted to inflate the peritoneal cavity with carbon dioxide. Following this, a trocar is inserted, allowing a laparoscope equipped with a camera and high-intensity lighting to visualize the abdominal organs. Additional small incisions are made to facilitate the dissection and removal of the gallbladder, which is ultimately extracted through the umbilical incision.
Furthermore, the court of appeal affirmed the trial court's decision to grant summary judgment in favor of Iberia General Hospital, noting that the plaintiffs did not contest this issue in their briefs or during oral arguments, making the ruling final. The trial court's dismissal of claims against Dr. Fernandez is also final, as the plaintiffs did not appeal that judgment.
