Opinion ID: 1835113
Heading Depth: 2
Heading Rank: 2

Heading: The medical malpractice lawsuit.

Text: On July 8, 1983, Ellen was involved in an automobile accident. She was taken from the scene of the accident to the emergency room at Fort Madison Community Hospital. At the hospital Ellen complained of pain in her right ankle as well as general body aches. Dr. James Kannenburg examined and treated Ellen in the emergency room. The emergency room medical records note that Ellen had been in an automobile accident and that she had possibly hit her head and lost consciousness. X-rays taken of Ellen's ankle showed no evidence of a fracture, dislocation, or any pathology involving the bones of the ankle. Ellen was released from the hospital shortly after her arrival with no significant medical instructions. Even though the hospital x-rays showed no sign of significant injury, Ellen still experienced pain and discomfort in her right ankle from July 8 to July 12. Because of this pain, Ellen tried to make an appointment with Michael on July 12. A staff member at Michael's office, however, told Ellen that she needed a referral from another doctor. Namen called Kathleen's office for a referral. Kathleen's nurse suggested that Namen take Ellen to the Burlington Medical Center emergency room for treatment. On July 13 Namen took Ellen to the Burlington Medical Center. Emergency records at the medical center list K. Wilson as Ellen's family physician. These records also note that Ellen had been in a 2-car-accident 7-8-83 and was experiencing a headache together with pain in her right leg, both arms, neck, and right hand. At the hospital Ellen was examined and treated by the emergency room physician, Dr. Gundrum. Dr. Gundrum ordered x-rays and diagnosed a contusion of the right ankle, elbow, and base of the cervical spine. Apparently no special treatment was ordered, and Ellen was released. On the same day of this hospital visit, Ellen and Namen went to Kathleen's office. Neither Ellen nor Namen had a scheduled appointment with Kathleen that day. Because Namen was Kathleen's patient, she agreed to see them. They went to Kathleen's office where Namen and Ellen explained Ellen's injuries. Namen and Ellen also relayed the information that both emergency room physicians had told them. The couple explained that Ellen had tried to get an appointment with Michael, but she needed a referral. Kathleen did not have Ellen's hospital x-rays, but she could see that Ellen's ankle was swollen. Kathleen agreed to call Michael's office. Michael's office then made an appointment for Ellen that afternoon. As Namen and Ellen were leaving Kathleen's office, Namen wanted to pay for the visit. He was told there was no charge, but he insisted on paying $17. This amount was less than the charge for a normal office visit. Michael saw Ellen the same day. He reviewed Ellen's hospital x-rays. He also took a medical history. Michael's records note that Ellen's chief complaint involved pain and swelling in her right ankle. Michael told Ellen this pain would probably subside in two to three days and suggested an ace wrap on the ankle to control the swelling. No other treatment or medications were suggested. Because Kathleen was the referring physician, Michael's office sent her a copy of his report. On July 27 Ellen suffered a ruptured congenital cerebral aneurysm. Emergency surgery was performed at University Hospitals in Iowa City to repair the rupture. Ellen died on August 5 due to complications following surgery. Two months after Ellen's death, Namen began discussing a possible medical malpractice lawsuit. He contacted a few local attorneys, but due to conflicts Namen was referred to Hayes. Namen and his daughter, Carol, met with Hayes on December 20 to discuss a possible lawsuit. Hayes' notes of this first meeting indicate that since Ellen's automobile accident in July she complained of headaches and that she was getting worse. According to the notes, Ellen complained of these headaches to both Kathleen and Michael. Hayes had Namen sign patient waiver forms. Hayes subsequently requested Ellen's medical records from Michael, Kathleen, Fort Madison Community Hospital, Burlington Medical Center, University of Iowa Hospitals and Clinics, and Dr. Kannenburg. On June 1984 Hayes met with Namen and Namen's son, Terry. At this meeting, father and son told Hayes that Ellen's head was hurting on the day of the car accident. They told Hayes that Namen had called Kathleen's office on July 12 because Ellen was experiencing terrible headaches. They said Kathleen's nurse had referred them to the hospital for x-rays. They also told Hayes that Ellen had specifically told Michael about the headaches but that Michael said there was nothing wrong with her. In his summary of the meeting, Hayes noted that the emergency room records of July 13 showed that Ellen complained of a headache. Following this meeting Hayes wrote to Dr. Jon Brillman, a board certified neurologist in Pennsylvania. Hayes had worked with Brillman on previous medical malpractice cases. In his letter Hayes summarized the facts as related to him by Namen and his children. Hayes also sent copies of Ellen's medical records. Hayes asked Brillman to determine whether the orthopedist failed to deliver to Ellen Rashid the expected standard of care under the circumstances. In making this determination, Brillman was asked to assume the facts as stated by the Rashids as true. Brillman called Hayes with his opinion on August 1, 1984. Brillman based his opinion on the following assumptions: an automobile accident, a `black-out,' amnesia, and a primary complaint of severe headaches on the following days. It was Brillman's opinion that an orthopedist could not be faulted for not diagnosing or suspecting the aneurysm right after the accident, but if Ellen continued to complain of headaches a physician and an orthopedist presented with such history and complaints should have referred her to a neurologist or ordered a CAT scan, and a failure to do so would constitute a failure to meet the expected standard of care. Brillman theorized that Ellen had suffered a small rupture of the aneurysm that had caused her to black out and have the accident. Because of this rupture, Brillman thought there was early bleeding that had healed somewhat but had caused the headaches. According to Brillman there probably was a rerupture of the aneurysm on July 27 that ultimately led to Ellen's death. Brillman believed that an investigation of the headaches on July 13 could very well have prevented the rerupture of the aneurysm on July 27. Brillman agreed to work with Hayes as an expert witness on the case. After this call, Hayes wrote to Namen and told him what Brillman had said. Hayes then met with Namen and his children on August 15, 1984. At this meeting they decided to sue Michael and Kathleen for malpractice. On October 31 Hayes sent Namen a copy of the proposed petition. In his letter to Namen, Hayes asked Namen to review the petition and to call him with questions, suggestions or changes. The petition was filed on January 24, 1985. The Wilsons were served on January 25, a Friday. Over the weekend they discussed the lawsuit at length and its implications for their medical practices and their future. By Monday they had decided to end their private practices and enter the military. They made this decision believing that in the military they could practice medicine without fear of personal suits for malpractice. Eventually both did enter the military. Kathleen filed an answer to the petition on February 7. In it she specifically denied a doctor-patient relationship between Ellen and her. Kathleen's answer also alleged that she never examined, treated, or consulted with Ellen. The answer asserted that Kathleen's only connection with Ellen was to set up an appointment with Michael. After Kathleen learned that Dr. Brillman was scheduled to be an expert witness, she telephoned him on February 25. Brillman described Kathleen as being very upset. He in turn was upset by her call. Kathleen described Namen to Brillman as a litigious person who had suffered from emotional problems. She also gave Brillman the details about Ellen's visits to her office and to Michael's office. Kathleen emphasized that Ellen had only complained about her sprained ankle and had never made any complaints about headaches. Brillman responded that if the facts were as she said, no malpractice had been committed and he would not testify. Brillman's opinion relied heavily on Ellen's alleged complaints of severe and unremitting headaches. Because of Kathleen's call, Brillman reviewed the materials he had received from Hayes. As a result of this review Brillman felt that the records tended to support Kathleen's claim that there had been no significant complaints of headaches. So he decided not to testify. Still incensed about the lawsuit, Kathleen wrote a letter to Representative Del Stromer, the minority whip of the Iowa Legislature. Her letter detailed the facts about the lawsuit and also disclosed certain medical facts about Namen's mental illness. Kathleen asked Stromer to change Iowa law and make it easier for doctors to sue attorneys for malicious prosecution and abuse of process. The letter triggered a call to Hayes from William J. Wimmer, the lobbyist for the Association of Iowa Trial Lawyers. Wimmer also sent Hayes a copy of Kathleen's letter to Stromer. After visiting with Wimmer, Hayes realized he was a potential defendant in a suit by the Wilsons. On March 13 Brillman telephoned Hayes with the news: he would not testify. Brillman told Hayes that after reviewing the records, he concluded there was no evidence of malpractice by the Wilsons. Apparently, Brillman had not reviewed the medical records before giving Hayes his initial opinion by telephone on August 1, 1984. Brillman's decision not to testify was based on a lack of documentation that headaches were a prominent part of Ellen's initial complaints. Without the complaint of headaches, Brillman felt there was no basis for his opinion of an aneurysmal rupture at the time of the accident. The next day Brillman wrote Hayes, documenting what he had told Hayes the day before. On March 21 Kathleen moved for summary judgment. Kathleen's motion was based solely on a claim that no doctor-patient relationship existed between Ellen and her. Hayes forwarded a copy of the motion to Namen. After reviewing the motion, Namen wrote Hayes and again recounted the events. Namen swore that his version of the facts was true and volunteered to take a lie detector test. On March 25 Kathleen's attorney wrote to Hayes. The attorney suggested an early deposition of Brillman because the Wilsons felt Brillman would not support a claim of malpractice against either of them. On March 28 Hayes replied to this letter. Hayes told the attorney the parties should be deposed before the expert so the expert could have the defendants' versions of the facts. On the same day Hayes wrote Brillman asking for his opinion based on two different sets of facts. Under one set of facts Brillman was asked to assume Ellen had complained to Kathleen and Michael about a violent, unremitting headache. Under the other set of facts Brillman was asked to assume no such complaint had been made. On March 29 Brillman called Hayes. Brillman told Hayes that Kathleen had called him two days before, virtually begging him not to hurt her. Brillman told Hayes he would not testify but he would help Hayes find another expert. Brillman suggested Dr. Arthur Taub of Yale University. Several days later Brillman wrote to Hayes. Brillman related that the medical records showed no sign of an initial aneurysmal rupture and revealed no initial chief complaint of a headache. Based on these records Brillman concluded the Wilsons had committed no negligence. Responding to Hayes' request to assume Ellen's chief complaint to the Wilsons was one of a violent, unremitting headache, Brillman reached a different conclusion. Under this set of facts, Brillman believed the Wilsons should have undertaken further investigation as to the cause of the headache. On April 5 Hayes filed a resistance to Kathleen's motion for summary judgment. He supported the resistance with affidavits from Rashid and his daughter, Carol. The gist of the two affidavits was that Ellen had suffered severe headaches which she complained of to the Wilsons. Hayes also attached the July 13, 1983, emergency room records listing Kathleen as Ellen's physician. Kathleen filed additional affidavits in support of her motion for summary judgment. These included one from her office staff and several from personnel at the Burlington Medical Center. In substance these affidavits denied any doctor-patient relationship between Kathleen and Ellen. They also denied that Kathleen had done anything for Ellen except to make an appointment with Michael. Finally, the affidavits denied that Ellen had ever complained of headaches either to the medical center or to Kathleen and her staff. In her own affidavit Kathleen admitted that Namen had paid $17 for the July 13, 1983, office call. However, she asserted that Namen paid this amount despite the fact that he had been told there was no charge for the call. The motion for summary judgment was heard on April 22. Several weeks later Namen, Kathleen, and Michael were deposed. Except as to two points, Namen's deposition virtually corroborated Kathleen's account of the July 13, 1983, office visit: Kathleen's only involvement was to make an appointment for Ellen to see Michael at Namen's request. Namen conceded that Kathleen had not examined Ellen, had not questioned Ellen about her symptoms, had not seen Ellen's x-rays, and had not treated Ellen. In contrast to Kathleen's account, Namen did testify that Ellen had complained to Kathleen that she was still having terrible headaches. In addition, Namen's version of the $17 payment also differed. According to Namen he asked the receptionist how much the bill was and she presented him with a bill for $17 which he paid. Kathleen attached portions of Namen's deposition covering these matters to her motion for summary judgment. Hayes requested additional time to respond to Kathleen's motion and this request was granted. Hayes thereafter supplemented the resistance with several affidavits. Kathleen's motion for summary judgment was sustained on June 17. The essence of the ruling was that no doctor-patient relationship had existed between Kathleen and Ellen. So, according to the ruling, Kathleen had no relevant duty to Ellen and accordingly could not be liable to her (or to her personal representative) for medical malpractice. In reaching that conclusion the court relied heavily on Namen's admissions in his deposition. Hayes forwarded the ruling to Namen and suggested that they should get together to discuss a possible appeal. When Hayes and Namen left the depositions, the two talked about the possibility of settlement. They also talked about releases for everyone, including Hayes, as part of the settlement. Namen was agreeable to the release idea. Shortly after the depositions and before the summary judgment ruling, Hayes had begun settlement negotiations with the Wilsons' attorneys. The Wilsons were amenable to releasing Namen but not Hayes. The Wilsons' attorney gave Hayes this counterproposal. In turn, Hayes discussed the counterproposal with the Rashids. By this time Namen had become incensed about Kathleen's letter to Del Stromer. Namen wanted to sue her for disclosing confidential medical information about him to Stromer. After that, Namen was never amenable to settlement. Hayes met with the Rashids on June 25 to talk about appealing the summary judgment ruling. Namen wanted to appeal. Hayes then appealed and told Namen that he had done so. After Brillman refused to testify, Hayes set out to find a new expert witness. Hayes contacted at least five doctors. In general, these doctors evaluated the case the same. They all noted the discrepancy between Namen's version and the Wilsons' version. The doctors' opinions generally coincided with Brillman's: if the Wilsons' version was true there was no malpractice; if Namen's version was true, there was. Because of the problems he was encountering with the experts, Hayes began to realize that a trial would probably be unsuccessful. Hayes tried to convince Namen of this and tried to convince him to settle. Namen refused to budge. In an August 29 letter to Namen and Namen's children, Hayes told them that the Wilsons' attorneys had made several inquiries about a release and dismissal of the case. Hayes urged settlement because of the difficulty he was having with the experts. He told the Rashids that they should consider this option as the best alternative at the present time. In this letter Hayes did not refer to his own release. In response Namen wrote Hayes and suggested that a certain doctor be contacted as an expert. Namen also told Hayes he would not dismiss the suit. The Wilsons' attorneys made several more attempts to settle the suit to no avail. Finally, in February 1986, Hayes wrote to Namen suggesting two alternatives: Hayes would assist him in either dismissing the case or in finding him another attorney. In a return letter, Namen said he would never dismiss the case and that he expected Hayes to represent him at trial or to find him another attorney. In response, Hayes wrote Namen in April requesting payment of $1878 for expenses. Hayes also indicated that pursuing the case to trial would cost Namen $10,000 to $15,000 and that his firm would require Namen to advance $12,500 for future expenses. Finally, Hayes told Namen that if this arrangement was not satisfactory, he intended to withdraw because of the substantial difference between the two concerning the merits of the case. Namen responded, insisting that Hayes continue with the case. Namen also made some vague threats as to what would happen if Hayes withdrew. In May Hayes filed a motion to withdraw in Michael's case. Hayes cited the differences between Namen and himself. Hayes also asserted that he had asked Namen to hire other counsel but Namen had failed to do so. Following a hearing, the court granted Hayes' motion to withdraw, which was formally approved by a written order on June 12, 1986. Namen apparently never could hire new counsel to take over the case against Michael. Michael then filed a motion for summary judgment in July. Namen did not attend the hearing on the motion which was scheduled for July 23. Namen did, however, inform the court by letter that he wanted the case dismissed. The district court continued the summary judgment hearing until August 4 at which time Namen appeared in person. At the hearing Namen told the court he wanted to dismiss not only the district court action but the appeal as well. The district court dismissed the action against Michael. The court, however, had no jurisdiction to dismiss the appeal. Hayes was not aware that Namen wanted to dismiss the appeal. When he found out, Hayes sent Namen an authorization to do so. In the accompanying letter Hayes explained he understood Namen wanted to dismiss the appeal. Namen never responded to Hayes' letter, which was sent September 16. On September 16 Kathleen filed a motion to dismiss the appeal. She supported the motion with a transcript of the August 4 hearing at which Namen had stated he wanted the appeal dismissed. There was no resistance to this motion. On October 27 this court dismissed the appeal.