124 So. 3d 461
La. Ct. App.2013Background
- Plaintiff Elizabeth Ekendahl sued Dr. Kevin Murphy after her husband Carl developed streptococcal sepsis and died following a January 25, 2005 clinic visit; she alleged malpractice for not performing a confirmatory throat culture after a negative Quidel Quick Vue InLine Strep A rapid test (QST) and for giving an intramuscular Celestone (steroid) injection.
- At the visit Carl had sore throat, mild headache/chills, mild tonsillar/posterior pharyngeal erythema without exudate, normal temperature, posterior pharyngeal ulcerations, and tender anterior cervical nodes; his children had recent strep diagnoses.
- Dr. Murphy performed a QST that was negative, did not follow the manufacturer’s instruction to culture negative results, diagnosed viral pharyngitis, and administered 2 cc Celestone for symptom relief; Carl worsened, was hospitalized January 30, and died February 21, 2005.
- A Medical Review Panel (MRP) found Dr. Murphy met the standard of care. At trial the court found no expert established that failing to culture or giving the Celestone shot fell below the applicable standard.
- Multiple experts testified with divided views: some endorsed use of QST without culture in adults and allowed single-dose steroids; one expert said the steroid injection breached the standard and risked worsening infection. The trial court dismissed the suit; the appellate court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether failure to perform throat culture after negative QST violated standard of care | Manufacturer’s QST insert required culture after negative; following insert was standard and omission was negligent | National guidelines and expert testimony support QST alone in adults; manufacturer insert is evidence but not dispositive | Affirmed: no manifest error — using QST without culture was within standard of care in these facts |
| Whether administering Celestone injection breached standard of care and caused strep sepsis | Single IM steroid masked/worsened infection, impaired immune response, and was below standard of care | Single-dose Celestone is commonly used, transient immunosuppression unlikely to cause sepsis, and within standard of care | Affirmed: court found insufficient evidence that injection breached standard or caused sepsis |
Key Cases Cited
- Terrebonne v. Floyd, 767 So.2d 758 (La. App. 1st Cir. 2000) (manufacturer warnings can sometimes establish prima facie negligence)
- Christiana v. Sudderth, 841 So.2d 911 (La. App. 5th Cir. 2003) (deviation from manufacturer warning may be negligence without expert testimony in some circumstances)
- Roberts v. Marx, 109 So.3d 462 (La. App. 2d Cir. 2013) (expert testimony generally required to establish medical standard of care)
- Raymond v. Government Employees Ins. Co., 40 So.3d 1179 (La. App. 3d Cir. 2010) (discusses damages exceeding malpractice cap in analogous contexts)