Opinion ID: 1126760
Heading Depth: 1
Heading Rank: 4

Heading: dr agrawal's testimony

Text: On direct examination by Byrd's counsel, Dr. Agrawal testified on the one hand that Dr. Engelhardt violated the applicable standard of care by giving Byrd steroids without first ruling out a viral cause of his inflammation, such as herpes, by taking tissue samples from Byrd's colon and performing specific diagnostic tests on the biopsy tissue, including either or both viral cultures and a fluorescent antibody screen. Dr. Agrawal was not asked on direct examination whether such substandard conduct reduced Byrd's chances of having his condition treated successfully with appropriate medication, thus obviating the need for surgical removal of his colon. On the other hand on cross-examination, Dr. Agrawal explained that it would have taken one or two weeks to obtain the results of such diagnostic tests and said that if he were treating Byrd, he would have given him steroids immediately, just as Dr. Engelhardt did, even if the viral tests had been performed, irrespective of the risk ... [o]f possibly making a viral colitis worse. Dr. Agrawal said that even if Dr. Engelhardt had performed the diagnostic tests, it would have been reasonable for him to have commenced steroid treatment immediately, before he received the test results, because Byrd was gravely ill when Dr. Engelhardt first saw him and required immediate treatment at that time. According to Dr. Agrawal, ulcerative colitis is far more common than herpetic colitis and the risk benefit ratio was much more in favor of the patient getting better with steroids than waiting for the tests or making his condition worse [by not giving him steroids while awaiting the test results]. Our brackets. Dr. Agrawal said that if the tests had come back positive for herpes, he would have stopped the steroid treatment at that point and started treating Byrd with Zovirax. Because the viral studies were not performed on Byrd in January 1987, Dr. Agrawal obviously did not and could not say definitively whether Byrd had herpetic colitis at that time. He initially said it was possible that Byrd had herpetic colitis, but later testified that he had no reason to dispute Dr. Engelhardt's diagnosis of ulcerative colitis based on the description of Byrd's condition in the January 1987 medical records. Dr. Agrawal testified that ulcerative colitis may develop overnight, and may affect the entire colon within a week. He said Byrd's entire colon could have become inflamed due to ulcerative colitis between his discharge from the Baton Rouge hospital on December 28, 1986, and his visit to the Pineville hospital on January 13, 1987. In contrast, according to Dr. Agrawal, it would be very unlikely that a patient such Byrd, whose immune system was not compromised, would suddenly develop inflammation of his entire colon due to herpetic colitis. Dr. Agrawal opined that if Byrd had herpetic rather than ulcerative colitis when the steroid treatment began on January 19, 1987, steroids would likely have caused Byrd's condition to worsen within 24-48 hours. Dr. Agrawal agreed that Byrd's medical records showed no deterioration, but rather some slight improvement, in Byrd's overall condition during his ten-day course of steroid treatment (less blood loss, fever subsided, patient reported he was feeling better, etc.), and no change, for better or worse, in the appearance of his colon before and after he received steroids. Dr. Agrawal opined that it was possible, though unlikely, that Byrd had both ulcerative colitis and herpetic colitis in January 1987. He said that had viral studies been performed, they would have helped to diagnose the presence of both conditions. When asked whether Zovirax would have battled Byrd's condition into remission if he had herpetic colitis in January 1987, Dr. Agrawal said simply, we don't know. From his examination of Byrd's medical records, Dr. Agrawal squarely opined that Dr. Engelhardt's administration of steroids for ten days without performing diagnostic studies to rule out a viral cause of Byrd's inflammation  did not make his condition worse.  Our emphasis. Dr. Agrawal testified generally that there was no reason why Dr. Engelhardt could not have performed viral studies on Byrd. Neither Dr. Agrawal nor any other expert witness was specifically asked about or contradicted Dr. Engelhardt's statement that the condition of Byrd's colon prevented the obtaining of an adequate tissue sample to be tested. The testimony of Drs. Agrawal, Harrington, DeVille and Hegmann was the only expert evidence Byrd relied on to show Dr. Engelhardt's alleged malpractice.