Opinion ID: 1862642
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Atkins

Text: The second crucial factual issue before the jury was whether Dr. Atkins had effected a new placement of the catheter. Throughout the trial, Dr. Atkins insisted that he had merely changed the catheter over a wire, that is, that he had inserted a guidewire through the existing, properly positioned catheter, which he then withdrew, and, after withdrawing the former catheter, had inserted another catheter into the same vein using the guidewire and the length of the former catheter, in conjunction with the location of the sutures that had secured it, as reference points. According to this account, Dr. Atkins merely used the incision made earlier by Dr. Hendron in the child's right side to change the catheter. Within an hour after the procedure, Dr. Atkins met Dr. Baldwin while Dr. Baldwin was making his evening rounds. At that time, Dr. Atkins told Dr. Baldwin that the catheter had been changed over a wire, and that the procedure had been accomplished without problems or complications. Dr. Atkins testified that the procedure was accomplished without difficulty in approximately 20 minutes. In contrast to Dr. Atkins's version, nurse Cheryl Castner testified that Dr. Atkins did not merely change the catheter over a wire, but, rather, that he effected a new placementa more hazardous procedure according to all the witnesseswhich required the doctor to introduce a guidewire through a needle into a subclavian vein, probing the vein without the benefit of the former catheter as a reference point, and, ultimately, stopping the tip of the catheter just short of the heart's upper receiving chamber. She described the procedure as a very difficult, traumatic placement. She recalled that Dr. Atkins had a very difficult time inserting the catheter. Nurse Castner estimated that the procedure took approximately one hour, [7] during which Dr. Atkins, whose hands, according to nurse Castner, were shaking so hard that he was having a hard time feeding [the] catheter and the wire and all of [the] parts together, was successful in inserting the catheter only after he had made numerous attempts to push it into place. Nurse Castner's account of events was corroborated by Dr. Kelly's autopsy report, which indicted that Charles was catheterized on the left side of the body at the time of the autopsy. These contradictions are significant because of the degree of difficulty of the respective procedures in relation to Dr. Atkins's level of experience and because of the accuracy of the information relayed to Dr. Baldwin. Dr. Atkins testified that before the incident giving rise to this suit, he had never, in a pediatric patient, made an unsupervised catheter placement or changed a catheter over a wire. Dr. Baldwin testified that although a change over a wire was a very simple procedure, one that a resident could be expected to perform without prior notification of the attending physician, he would expect Dr. Atkins or any resident to notify him before undertaking a new placement. (Emphasis added.) Elsewhere, Dr. Baldwin stated: [I]t would have been my policy that I would want to have been informed about a new placement. He also testified that Dr. Atkins was obligated to inform him regarding difficulties encountered during the procedure. The evidence thus suggested that if the catheterization had not been over a guide-wire, Dr. Atkins not only violated the policy of Charles's attending physician, but also lied to that physician about his conduct. Dr. Atkins contends that, because Dr. Baldwin by casual observation so easily could have determined which catheterization procedure had been performed, the jury could not reasonably have concluded that he had lied to Dr. Baldwin. We disagree. [8] Under the evidence presented, the jury reasonably could have interpreted Dr. Atkins's conduct as follows: (1) notwithstanding Dr. Baldwin's policiesof which he was, or should have been, awareDr. Atkins, for personal reasons, decided to undertake an unsupervised new placement for which he perceived himself to be competent; (2) Dr. Atkins made a new incision on the right side near the pre-existing incision; (3) Dr. Atkins expressly rejected nurse Castner's suggestion that he use a heart monitor [9] and nurse Taylor's suggestions of a post-procedure X-ray [10] because the recordation of such devices on the chart would have indicated to Dr. Baldwin that he had made a new placement; (4) notwithstanding the difficulties that developed, he told Dr. Baldwin that the procedure had gone well in order to prevent further inquiry into the matter; [11] and (5) following the fatal cardiac arrest, he attempted to perpetuate the deception. [12] This interpretation so charges Dr. Atkins with awareness of the impropriety of his conduct and with attempts at concealment as to weigh heavily in favor of sustaining the judgment of the trial court. Haslip, ___ U.S. at ___, 111 S.Ct. at 1045.