Case Name: Joseph GIAMMANCHERE, et al. v. John ERNST, III, M.D., Dr. Miljana Mandich, M.D. AND Touro Infirmary
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1999-05-19
Citations: 742 So. 2d 572
Docket Number: No. 96-CA-2458
Parties: Joseph GIAMMANCHERE, et al. v. John ERNST, III, M.D., Dr. Miljana Mandich, M.D. AND Touro Infirmary.
Judges: Court composed of Chief Judge ROBERT J. KLEES, Judge JOAN BERNARD ARMSTRONG, Judge STEVEN R. PLOTKIN, Judge CHARLES R. JONES, Judge DENNIS R. BAGNERIS, Sr.
Reporter: Southern Reporter, Second Series
Volume: 742
Pages: 572–582

Head Matter:
96-2458 (La.App. 4 Cir. 5/19/99)
Joseph GIAMMANCHERE, et al. v. John ERNST, III, M.D., Dr. Miljana Mandich, M.D. AND Touro Infirmary.
No. 96-CA-2458.
Court of Appeal of Louisiana, Fourth Circuit.
May 19, 1999.
Opinion Granting Rehearing Sept. 15, 1999.
Writs Denied Dec. 17, 1999.
Daniel W. Nodurft, Gretna, Louisiana, Counsel for Plaintiffs/Appellants.
George E. Cain, Jr., Grég A. Pellegrini, Frilot, Partiridge, Kohnke & Clements, L.C., New Orleans, Louisiana, Counsel for Defendant/Appellant The Louisiana Patients’ Compensation Fund.
Peter E. Sperling, Monique G. Morial, Frilot, Partridge, Kohnke & Clement, New Orleans, Louisiana, Counsel for Defen-danVAppellee John Ernst, III, M.D.
Court composed of Chief Judge ROBERT J. KLEES, Judge JOAN BERNARD ARMSTRONG, Judge STEVEN R. PLOTKIN, Judge CHARLES R. JONES, Judge DENNIS R. BAGNERIS, Sr.

Opinion:
I,PLOTKIN, Judge.
The Louisiana Patient's Compensation Fund ("LPCF") appeals a jury verdict awarding the plaintiffs, the surviving spouse and children of Ms. Louise Giam-manchere (hereinafter referred to collectively as "the Giammancheres"), $800,000 in survival and wrongful death damages, based on the negligence of defendants Touro Infirmary and Dr. Miljana Mandich. The Giammancheres appeal the jury's find ing that defendant, Dr. John Ernst III, was not at fault for the injuries sustained by Mrs. Giammanchere that lead to her death. We affirm in part, reverse in part, and amend the damage award.
Facts
On September 9, 1988, Mrs. Giam-manchere fell as she was leaving a physical therapy session at Touro Infirmary. She was immediately transported to Touro's emergency room with the help of her physical therapist, Melinda Rome. Dr. Mandich examined Mrs. Giammanchere and reviewed the x-rays taken as a result of the fall. Dr. Mandich concluded that Mrs. Gi-ammanchere suffered sprained muscles in the left hip and released her with an aftercare instruction sheet. The record evidence indicates that the hip fracture was discovered by a Touro |¡,radiologist later that same day, and that the x-rays were returned to the emergency room. However, Ms. Giammanchere was not informed of the hip fracture on that date.
On September 23, 1988, Mrs. Giam-manchere visited her regular physician, Dr. Ernst, complaining of lower back pain. At that time, she told Dr. Ernst about the fall that occurred at Touro. However, Dr. Ernst was not given the records from the emergency room nor was he informed that X-rays had been taken. Mrs. Giammanch-ere contacted Dr. Ernst again on October 19, 1988, to inform him that her hip was causing her extreme pain. Dr. Ernst ordered Mrs. Giammanchere to go immediately to the emergency room to be' examined by Dr. Charles Billings, an orthopedic surgeon.
Dr. Billings ordered additional x-rays and reviewed the original x-rays taken the day Mrs. Giammanchere fell at Touro. Dr. Billings diagnosed a hip fracture, which was evident on both sets of films. Mrs. Giammanchere was admitted to the hospital to undergo a week of physical therapy. She was released on October 26, 1988, with a prescription for home therapy. The home therapy was not effective, and Dr. Billings performed surgery to repair Mrs. Giammanchere's injured hip on December 31,1988. Mrs. Giammanchere suffered several system failures, including a stroke, following the surgery and died in the hospital on April 14, 1989. She remained in the hospital from the date of surgery until the day she died.
The Giammancheres filed suit against Touro, Dr. Mandich, and Dr. Ernst. Prior to trial, the Giammancheres settled their suit against Dr. Mandich for $31,500. Following the trial, the jury found that Dr. Mandich and Touro fell below the standard of care by failing to inform Mrs. Giam-manchere of the fracture and that the misdiagnosis of the hip fracture caused Mrs. Giammanchere's ultimate 1,Meath. The jury awarded $400,000 in survival damages, $325,000 in wrongful death damages to Mr. Giammanchere, and $25,000 each in wrongful death damages to each of the three Giammanchere children, for a total award of $800,000.
On May 23, 1996, the trial court entered judgment in conformity with the jury verdict against Touro and Dr. Mandich. However, because the defendants were all qualified health care providers under the Louisiana Medical Malpractice Act, the trial court reduced the award to the $500,000 maximum for medical malpractice damages. LSA-R.S. 40:1229.01 et seq. Fault was apportioned as follows:
Dr. Ernest— 0%
Touro Infirmary— 10%
Dr. Mandich— 60%
Ms. Giammanchere— 30%
After the judgment, on June 28, 1996, the LPCF, which is responsible by law for any damages in excess of $100,000, intervened in the action, then filed the instant appeal. The Giammancheres also appealed, contesting the jury's finding that Dr. Ernst was free from fault.
Exception of Res Judicata
The LPCF filed an exception of res judi-cata in this court, citing a October 13, 1997 trial court judgment dismissing a petition filed by the Giammancheres against the LPCF after the entry of judgment in the instant case on exceptions of lis pendens and no cause of action. The LPCF claims that the October 13, 1997 judgment should be considered res judicata to the issues raised by this appeal. The ^alleged basis of the no cause of action was the Giam-mancheres' failure to meet the requirements of the Medical Malpractice Act to retain the suit against the LPCF after settlement with Dr. Mandich. We can only assume that the basis of the exception of lis pendens was the appeal of the judgment in the instant case. However, the record before this court contains no evidence of the actions of the trial court following the entry of the judgment on appeal in the instant case. Because the record contains no evidence to support the LPCF's exception of res judicata, the exception is hereby denied.
Medical malpractice
In order to recover damages in a medical malpractice case, the plaintiff must establish the following elements through expert medical testimony: (1) the standard of care applicable to the defendant health-care provider (2) breach of the standard of care by the defendant healthcare provider (3) cause-in-fact between the breach and the damages suffered, and (4) actual damages. LSA-R.S. 40:1299.39; Bailey v. State Through Dept. of Health and Human Resources, 96-2797, p. 4 (La.App. 4 Cir. 5/21/97), 695 So.2d 557, 559. A trial court's decision on these inquiries is considered a factual conclusion, reversible on appeal only if the appellate court finds manifest error. Martin v. East Jefferson General Hospital, 582 So.2d 1272, 1276 (La.1991); Bailey, at 4, 695 So.2d at 559. Accordingly, this court may reverse the trial court's findings that Dr. Mandich and Touro committed medical malpractice only if it makes the following findings: (1) the record reflects no reasonable factual basis for the trial court's finding, and (2) the record establishes that the finding is clearly wrong. |5Baumeister v. Plunkett, 95-2270, p. 7 (La.5/21/96), 673 So.2d 994, 998; Bailey at 4-5, 695 So.2d at 559.
We find no manifest error in the jury's finding on the medical malpractice issue in the instant case. At trial, testimony from several medical experts indicated that Touro and Dr. Mandich breached the standard of care when they failed to diagnosis Ms. Giammanchere's fractured hip, which was evident from the x-rays taken on the day of the fall. Moreover, the testimony indicated that the standard of care was also breached when Touro and Dr. Mandich failed to inform Mrs. Giam-manchere of the fracture even after it was discovered by the Touro radiologist later on the day of the fall.
The failure to inform Mrs. Giammanch-ere was a breach of Touro's own policies and procedures, according to Debra Kri-ner, Touro's risk manager. The responsibility for contacting Mrs. Giammanchere fell to Dr. Mandich, Ms. Kriner stated. Ms. Kriner's testimony on this issue was corroborated by the testimony of Peter Geilich, who the court accepted as an expert in hospital policies and procedures. Mr. Geilich testified that Touro and Dr. Mandich also breached the standard of care by failing to send Mrs. Giammanch-ere's records to Dr. Ernst, her regular physician.
Survival Damages
La. C.C. art, 2315.1(A) provides for survival actions as follows:
If a person who has been injured by an offense or quasi offense dies, the right to recover all damages for injury to that person, his property or otherwise, caused by the offense or quasi offense, shall survive for a period of one year from the death of the deceased.
|6Generally, survival damages are warranted if plaintiff presents any evidence ("a scintilla") of pain or suffering on the part of the decedent. Declouet v. Orleans Parish School Board, 96-2805 (La.App. 4 Cir. 6/3/98), 715 So.2d 69, 78, writs denied, 98-2051, 98-2054, 98-2058, 98-2079 (La.11/13/98), 730 So.2d 450, 451, 935, 936. Fright, fear and mental anguish during the ordeal are compensable. Id.
In the instant case, the plaintiffs presented ample evidence that Mrs. Giam-manchere experienced pain and suffering as a result of the misdiagnosis of her hip fracture. The evidence presented at trial indicates that the delay in diagnosing Mrs. Giammanchere's hip fracture resulted in a six-week delay in treatment during which Mrs. Giammanchere suffered pain. Moreover, Dr. Billings testified that the delay in diagnosis probably contributed to Mrs. Gi-ammanchere's stress and a loss of muscle tone, and that providing stability for the fracture as soon as it happened would have allowed earlier rehabilitation. Based on the above evidence, we find no manifest error in the jury decision awarding Mrs. Giammanchere $400,000 in survival damages.
Moreover, our review of the record convinces us that the Giammancheres suffered damages for loss of consortium during the six-week period between the fall and the diagnosis of the hip fracture. The record indicates that the relationships in the Giammanchere family were close and loving; Mr. Giammanchere testified that his wife was the center of the family. After Mrs. Giammanchere's fall, the record indicates, many regular family activities, including barbecues, bingo, and dinners, were discontinued. In her husband's words, "everything just fell apart." Accordingly, we amend the trial court judgment to award Mr. Giammanchere $100,-000 in loss of consortium damages, |7and to award each of the three Giammanchere children $25,000 in loss of consortium damages. All awards are subject to the jury's apportionment of 30 percent of the fault to Mrs. Giammanchere.
Wrongful Death Damages
Wrongful death damages are governed by La. C.C. art. 2315.2(A), which provides, in pertinent part, as follows:
If a person dies due to the fault of another, suit may be brought by the following persons to recover damages which they sustained as a result of the death:
(1) The surviving spouse and child or children of the deceased, or either the spouse or the child or children.
We find that the trial court judgment awarding the Giammancheres damages for Mrs. Giammanchere's wrongful death is manifestly erroneous and must be reversed. The testimony of the witnesses at trial, as summarized below, clearly showed that the delay in diagnosis did not cause the death of Mrs. Giammanchere.
Several physicians were called by both parties to establish the facts of the case. All of the physicians concluded that, although the delay in diagnosis caused Mrs. Giammanchere additional pain, it did not cause her death. Dr. Billings, the orthopedic surgeon who performed the hip surgery on Mrs. Giammanchere, testified that the delay in diagnosis merely changed the timing of the surgery and not the outcome. He testified as follows:
Q. It's also true that you do not believe that the delay in taking this lady to surgery, the delay in treatment of this hip fracture in any way increased her risk or likelihood for post-operative complications, isn't that true?
A. I think she would have had the same risks of surgery whether the surgery would have been done initially at the time of the fracture or at some point later.
|8This conclusion was supported by the testimony of Dr. Mathieu, a member of the medical review panel that initially reviewed the case. In medical malpractice cases, the medical review panel is "a body of experts assembled to evaluate the plaintiffs claim and to provide the courts and the parties with an expert opinion." Derouen v. Kolb, 397 So.2d 791, 794-795 (La.1981). Dr. Mathieu testified:
Q. It's true that the expert opinion this medical review panel was that Mrs. Giammanchere's death and ultimate demise was in no way related to this delay in treatment for the hip fracture; isn't that correct?
A. The irony here is that there was a delay in the diagnosis and we had to consider that being fair to the patient and the patient's family, and what we found was that the patient in walking on the hip as evidenced by the record had some discomfort and that was a couple of days before the diagnosis was made, so there was a delay in the treatment and the eventual treatment was surgery. The outcome of the surgery was that in all surgeries and anesthesia there's always a risk that there's complications and this lady had a very peculiar type of blood problem where she had a lupus like clotting mechanism where she was predisposed to have strokes. She was a stroke waiting to happen. Her blood was thick. It had a tendency to clot, and after the operation she had a stroke in a very important part of the brain and the brain stem and eventually died from it. In actuality the delay in diagnosis just really prolonged the lady's life...
Dr. Mautner, another member of the medical review panel, agreed with Dr. Mathieu' testimony when he took the stand to testify as follows:
Q. Isn't it also true that the panel after reviewing these records collectively and you individually do not believe that Mrs. Giammanchere's death and demise was in any way related to the delay in treatment of the hip fracture, isn't that true?
A. That's correct.
Dr. Aaron Friedman, an expert in the field of neurology and one of Mrs. Giam-manchere's former physicians, also testified regarding the causation issue.
. .In your opinion as a neurologist, did that delay in surgery in any way contribute or add towards her potential to develop these complications that did develop postoperatively? IflQ-
A. No. The delay in surgery — I can't see how a delay in surgery would have contributed to her having a stroke.
Q. She had the same likelihood to get these complications had the surgery been done a month or two sooner?
A. Or a month or two later.
Dr. Maureen Stein, an expert witness in the field of cardiology, testified after reviewing the medical records that she also agreed with the other physicians.
Q. In your expert opinion, was the patient's death and downhill course in any way related to this delay in treatment of the hip fracture?
A. No.
Q. Could you explain to the jury why that is?
A. The hip fracture itself did not actually precipitate her ultimate death which was due probably to a stroke. A stroke appears to have occurred at the time or shortly after the time of her surgery for the hip fracture which we see not uncommonly in patients that have severe disease in their blood vessels and have to undergo a surgical procedure that seems to precipitate problems with blood flow to varying parts of the body, and in patients that have severe disease particularly to the blood vessels to the brain, it can cause strokes.
Q. And she had this severe vascular disease long before she fell?
A. Predating the fall.
Q. And she also had a history of prior accidents, of cerebral accidents?
A. Yes.
In short, all of the experts at trial agreed that the delay in diagnosis was not a cause of the death of Mrs. Giammanch-ere. Accordingly, the trial court judgment awarding Mr. Giammanchere and the Gi-ammanchere children damages for Mrs. Giammanchere's wrongful death is reversed.
|10Dr. Ernst's Liability
The jury concluded that Dr. Ernst was not liable for failing to obtain Mrs. Giammanchere's emergency room records. The plaintiffs have appealed this decision and request that Dr. Ernst be held liable for damages. The jury was presented with conflicting testimony regarding Dr. Ernst's actual knowledge of the hip injury and whether he was aware of the existence of the x-rays. Where the factfinder is presented with two permissible views of the evidence, the choice between them cannot be manifestly erroneous or clearly wrong. Housley v. Cerise, 579 So.2d 973 (La.1991); Resell v. ESCO, 549 So.2d 840 (La.1989). Accordingly, the jury's finding that Dr. Ernst was not liable is affirmed.
Conclusion
For the reasons described above, the exception of res judicata filed by the LPCF is denied. The jury's finding that Touro and Dr. Mandich committed medical malpractice is affirmed, as is the award to Ms. Giammanchere of $400,000 in survival damages. The judgment is amended to award Mr. Giammanchere $100,000 in loss of consortium damages, and to award each of the Giammanchere children $25,000 in loss of consortium damages. The jury's finding that Dr. Mandich's negligence caused Ms. Giammanchere's death and awarding wrongful death damages to the Giammancheres is reversed. The total award is $575,000, reduced by Mrs. Giam-manchere's 30 percent fault to $402,500 plus legal interest from the date of judicial demand. The jury finding that Dr. Ernst was free from fault is affirmed. All costs are assessed to the LPCF.
AFFIRMED IN PART-, REVERSED IN PART; AMENDED.
JONES, J., dissents with reasons.