206 So. 3d 1070
La. Ct. App.2016Background
- Cynthia Reynolds, with uncontrolled hypertension, diabetes, obesity, smoking history, and other comorbidities, underwent an in‑office hysteroscopy by Dr. Washington Bryan on May 8, 2008; she had eaten that day and had no primary‑care clearance.
- During the procedure she stopped breathing and had no pulse; Dr. Bryan performed CPR, gave epinephrine, but lacked intubation equipment; Parish Anesthesia resuscitation team arrived and intubated her minutes later; she suffered anoxic brain injury, prolonged hospitalization, transfer to long‑term care, and died May 31, 2008.
- A medical review panel unanimously found Dr. Bryan breached the standard of care for performing an office hysteroscopy on a high‑risk patient but could not determine whether the procedure was directly related to death; panel could not confirm consent because no written record existed.
- Plaintiffs (Reynolds’ children) sued under Louisiana’s Medical Malpractice Act seeking survival and wrongful death damages; trial judge found breach of standard of care, causation, and awarded damages; judgment totaled awards against Dr. Bryan and the state compensation fund.
- On appeal Dr. Bryan argued (1) plaintiffs failed to prove a national/bright‑line standard forbidding an in‑office procedure; (2) the breach was not a cause‑in‑fact of cardiac arrest/death and the alleged nine‑minute intubation delay finding was erroneous; and (3) trial court erred on informed consent; appellate court reviewed under manifest error/clearly wrong standard.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Applicable standard of care for performing in‑office hysteroscopy on high‑risk patient | Bryan breached the national standard requiring physician to ensure patient medically capable and have life‑saving equipment when sedatives/para‑cervical block used | No bright‑line national rule forbids in‑office hysteroscopy; expert (Winfield) says in‑office is acceptable for such patients | Court credited panel experts Guette/Hogan over Winfield; standard requiring assessment of medical fitness and availability of life‑saving equipment applies; decision not manifestly erroneous |
| Causation — whether breach caused death (cause‑in‑fact) | Breach (performing on high‑risk, after eating, without intubation equipment) led to aspiration, delayed intubation, anoxic brain injury and death | Plaintiff did not prove the procedure caused cardiac arrest and death; event causation uncertain | Court found sufficient evidence (expert testimony) that breaches increased aspiration risk and delay in definitive airway care was a but‑for cause of brain injury and eventual death; finding not manifestly erroneous |
| Alleged nine‑minute delay in intubation (timing of Parish Anesthesia response) | Nine‑minute gap between call and intubation resulted in oxygen deprivation contributing to brain injury | Interprets record to show earlier arrival (no nine‑minute gap); disputes timing | Court credited trial judge’s reading and expert testimony supporting delay; not clearly wrong |
| Informed consent | Plaintiffs alternatively argued no adequate informed consent (no written record) | Dr. Bryan argued consent was obtained and trial erred finding otherwise | Appellate court pretermitted full review because even if consent finding reversed, malpractice finding under Medical Malpractice Act would still sustain liability; judgment affirmed on malpractice grounds |
Key Cases Cited
- McCarter v. Lawton, 44 So.3d 342 (La. App. 4 Cir. 2010) (standard of review: manifest error/clearly wrong in medical malpractice findings)
- Barre v. Nadell, 657 So.2d 514 (La. App. 4 Cir. 1995) (discusses appellate review of factual findings)
- Pfiffner v. Correa, 643 So.2d 1228 (La. 1994) (elements required to prove medical malpractice under Louisiana law)
- Montz v. Williams, 188 So.3d 1050 (La. 2016) (burden of proof and review standard in malpractice cases)
- Mitter v. Touro Infirmary, 874 So.2d 265 (La. App. 4 Cir. 2004) (deference to trier of fact on credibility in medical cases)
- Wooley v. Lucksinger, 61 So.3d 507 (La. 2011) (trial court’s advantage in evaluating live testimony)
- Stobart v. State through Dept. of Transp. and Development, 617 So.2d 880 (La. 1993) (allocation of trial and appellate functions; standard of review)
- Hubbard v. State, 852 So.2d 1097 (La. App. 4 Cir. 2003) (cause‑in‑fact analysis in medical malpractice)
- Serigne v. Ivker, 808 So.2d 783 (La. App. 4 Cir. 2002) (necessity of expert testimony to establish standard of care)
- Rousset v. Smith, 176 So.3d 632 (La. App. 4 Cir. 2015) (deference to trial court’s factual findings where two permissible views exist)