Brain damage results from bleeding during heart surgery, leaves patient in vegetative state. $68M. Fresno County.
Cardiothoracic surgeon said to leave surgery before it is completed. Patient begins to bleed profusely and there is no qualified surgeon available.
- Case Name: Cristobal Arteaga, individually; Maria A. Arteaga Alvarez, individually; and Cristobal Arteaga, as Guardian ad Litem of Silvino Perez v. Fresno Community Regional Medical Center; Pervaiz A. Chaudhry, M.D.; Valley Cardiac Surgery Medical Group; and Does On
- Court and Case Number: Fresno Superior Court / 13CECG03906
- Date of Verdict or Judgment: Tuesday, March 20, 2018
- Type of Action: Medical Malpractice
- Judge or Arbitrator(s): Hon. Jeffrey Y. Hamilton
- Plaintiffs: Silvino Perez, 71Cristobal ArteagaMaria A. Arteaga Alvarez
- Defendants: Fresno Community Regional Medical CenterPervaiz A. Chaudhry, M.D.Valley Cardiac Surgery Medical GroupAshwin BhattSanjay SrivastaChaudhry Medical Inc.Community Hospitals of Central CaliforniaCommunity Regional Anesthesia Medical Group Inc.
- Type of Result: Jury Verdict
- Gross Verdict or Award: $68,035,462
- Award as to each Defendant:
Following the liability phase of the trial, the jury found that Chaudhry was negligent in the care, diagnosis, and/or treatment of Perez. It also found that Chaudhry's negligence was a substantial factor in causing Perez harm.
After the trial on injuries and damages, the jury determined that the plaintiffs' compensatory damages totaled $55,645,060 (based on the $5,645,060 present value of Perez's future medical costs), or $56,127,573 (based on the $6,127,573 future value of Perez's future medical costs). Of that verdict award, Perez was awarded $30,645,060 (present value), or $31,127,573 (future value), and Arteaga Alvarez was awarded $25 million for the past and future loss of her husband's love, companionship, comfort, care, assistance, protection, affection, society, and moral support.
The jury also found that Chaudhry's conduct constituted malice, oppression or fraud.
Following the punitive damages phase of the trial, the jury awarded $12,390,402 in punitive damages against Chaudhry.
Thus, the plaintiffs' total award was $68,035,462 (present value) or $68,517,975 (future value).
Since the conclusion of the trial, the parties have agreed that Valley Cardiac Surgery will pay a confidential settlement sum for all matters covered by the trial, which will include a dismissal of Dr. Chaudhry. The settlement is currently being finalized by a written agreement.
- Economic Damages:
Future medical cost for Silvino: $5,645,060 (Eight years [reduced to present value].)
- Non-Economic Damages:
Past for Silvino: $10,000,000
Future for Silvino: $15,000,000
Past loss of society companionship: for Maria: $15,000,000
Future loss of society companionship for Maria:$10,000,000
- Punitive Damages:
- Trial or Arbitration Time: 3 months.
- Post Trial Motions & Post-Verdict Settlements: There is a hearing set to decide whether MICRA applies given the jury's findings.
- Attorney for the Plaintiff:
Shernoff Bidart Echeverria LLP by Ricardo Echeverria, Claremont.
Heimberg Barr, LLP by Steven A. Heimberg M.D. and Marsha E. Barr-Fernandez, Los Angeles.
Mitchell Law Group by Jeffrey S. Mitchell, San Francisco.
- Attorney for the Defendant:
Hassard Bonnington LLP by James M. Goodman and Rebecca L. Cachia-Riedl, San Francisco. (For Pervaiz Chaudhry, Chaudhry Medical Inc., Valley Cardiac Surgery Medical Group.)
- Plaintiff’s Medical Expert(s):
Robert Shuman, M.D., cardiothoracic surgery, Long Beach.
Barbara Greenfield, R.N., C.N.L.C.P., life care planning; South Pasadena.
Jeffrey Goodman ; M.D., cardiology, Los Angeles.
Leonard Adelson, M.D., pulmonology, Sherman Oaks.
Michael Rosove, M.D., hematology, Santa Monica.
- Defendant's Medical Expert(s):
Adam Brant, M.D., neurosurgery, Fresno.
Junaid Khan, M.D., cardiothoracic surgery, Oakland
- Plaintiff's Technical Expert(s):
David Fractor ; Ph.D., economics, Pasadena.
Karen Rayment, MSEE, PE, CFEI, MBA, PMP, electrical, Alameda.
- Defendant's Technical Expert(s):
Karl Volk, economics, Walnut Creek.
Facts and Background
- Facts and Background:
Plaintiff Perez is a 71-year-old male with no prior history of heart issues, generally healthy. However, on March 31, 2012, he complained of shortness of breath and chest pains. As a result, he was taken to the emergency room at Community Regional Medical Center, in Fresno, where he was admitted for further testing and evaluation. In the days that followed, it was determined that Perez needed to undergo urgent open heart surgery, which was scheduled for April 2, 2012.
On April 2, 2012, plaintiff Silvino Perez underwent open heart surgery to have an aortic valve replacement and to repair an ascending aortic aneurysm. The surgery was performed by Dr. Pervaiz Chaudhry, a cardiothoracic surgeon. General surgeon Dr. Kalwant Dhillon, and a physician's assistant, Bella Albakova, assisted in the surgery. By all accounts, the surgery went well.
Toward the end of the surgery, Chaudhry allegedly left Albakova and Dhillon to close the chest. Not only did Chaudhry leave the operating room, he also left the hospital to go meet a new cardiologist across town in a restaurant called Campagnia. However, after Chaudhry left the operating room, at 12:17 p.m., Perez began to have bleeding complications. As a result, Perez went into hypovolemic shock and coded. As a result, calls were made to Chaudhry and chest compressions were performed on Perez's freshly closed chest. Albakova then re-opened Perez's chest and attempted to cannulate Perez's heart to get him back on the bypass machine. However, when she was unable to do so, Albakova began to manually massage Perez's heart.
Once Chaudhry arrived back at the hospital at 1:29 p.m., he was able to quickly cannulate Perez and get him back on the bypass machine so that his body and brain were again able to receive circulated oxygenated blood. Chaudhry then performed further surgery to repair the perforation of the heart. After several more hours of surgery, Perez was finally sent to the intensive care unit at about 8:50 p.m. As a result, Perez had been on the operating room table for over 13 hours.
Although Perez's life was saved, he suffered a brain injury.
Perez's stepson, Cristobal Arteaga, acting individually and as Perez's guardian ad litem, and Perez's wife, Maria Arteaga Alvarez, acting individually, sued the operator of Community Regional Medical Center and Community Medical Centers, Fresno Community Hospital and Medical Center (which was initially erroneously sued as "Fresno Community Regional Medical Center"); the corporate entity that operates Fresno Community Hospital and Medical Center, Community Hospitals of Central California; Chaudhry; Chaudhry's medical groups, Valley Cardiac Surgery Medical Group and Chaudhry Medical Inc.; the anesthesiologist present during the surgery, Dr. Ashwin Bhatt; Bhatt's medical group, Community Regional Anesthesia Medical Group Inc.; and a cardiologist, Dr. Sanjay Srivasta.
Before trial began, Arteaga and Arteaga Alvarez reached a confidential settlement with the hospital defendants. Bhatt, Community Regional Anesthesia Medical Group, and Srivasta were also dismissed from the case. Thus, the matter only continued against Chaudhry, Valley Cardiac Surgery Medical Group, Chaudhry Medical Inc.
- Plaintiff's Contentions:
Plaintiffs' counsel contended that phone records revealed that at 12:25 p.m., after Chaudhry left the operating room and hospital, a phone call was placed from Albakova's cell phone to Chaudhry. Albakova did not recall the phone call. Chaudhry allegedly said that it was customary for her to call once the case was completed. However, plaintiff's counsel noted that the medical records showed that at 12:28 p.m., Chaudhry telephonically ordered a DIC panel, which is a blood test that one would allegedly only order if one had a concern about abnormal bleeding.
Counsel contended that another call was placed from the cell phone of the circulating nurse, Geri Breaux, to Chaudhry at 12:39 p.m. to let him know that there were 200ccs of blood in the Pleur-evac Chest Drainage System. It was undisputed that the nurses had a standing order to call Chaudhry whenever the bleeding reached 200ccs. Chaudhry subsequently ordered blood products over the phone and they were placed, according to the records, four minutes later, at 12:43 p.m. Plaintiffs' counsel also noted that Bhatt testified that he ordered Factor VII, which is another blood product that would only be ordered in response to excessive bleeding, and ordered the nurses to call Chaudhry because he was concerned about excessive bleeding.
It was undisputed by those who remained in the operating room following the 12:39 p.m. call to Chaudhry that Perez was bleeding profusely. The witnesses included the anesthesiologist, Bhatt; the perfusionist, Aaron Schreur; the scrub nurse, Marni Allen; and the two circulating nurses, Geri Breaux and Nichole Kroes. Almost all of the witnesses testified that Perez bled out 1500ccs in the 20 minutes after the 12:39 p.m. call to Chaudhry, at which point Perez went into hypovolemic shock and coded. Thus, plaintiffs' counsel argued that when Chaudhry left, he did not ensure that there was a backup cardiothoracic surgeon in the hospital.
Plaintiffs' counsel contended that Chaudhry was called again at 12:59 p.m. to let him know that Perez had coded. He was a half hour away from the hospital, at Campagnia, and there was no backup cardiothoracic surgeon at the hospital. Counsel contended that as a result, Chaudhry immediately called Albakova and his partner, Dr. Robert Stewart, who was also a cardiothoracic surgeon, and allegedly told them both to get to the operating room as soon as possible. However, Stewart was also a half hour away and, according to the medical records, he arrived in the operating room at the same time as Chaudhry, at 1:29 p.m.
Albakova was still in the hospital when she got the call from Chaudhry and she rushed to the operating room within minutes. Plaintiffs' counsel contended that when Albakova arrived, others were performing chest compressions on Perez's freshly closed chest, which never should have been done. As a result, Albakova immediately intervened, re-opened Perez's chest, and tried to cannulate Perez's heart to get him back on the bypass machine so that his brain would continue to receive oxygenated blood.
However, plaintiffs' counsel contended that Albakova had never cannulated a patient since she was not a cardiothoracic surgeon. Albakova then began to manually massage Perez's heart, at which time she allegedly felt her thumb go through the right ventricle. Plaintiffs' counsel argued that the perforation of the heart happened either when the chest compressions were being done or when Albakova began doing the manual heart massage. Regardless, counsel contended that there was so much blood in the chest cavity by that point that Albakova testified that she could not even see the heart and, more importantly, no one could get Perez back on the bypass machine so that his oxygenated blood could be circulated.
Thus, plaintiffs' counsel argued that Chaudhry breached the standard of care and hospital rules by leaving the operating room early and having his physician assistant complete the surgery by closing the chest. Counsel also argued that Chaudhry breached the standard of care and hospital rules by leaving the hospital with no backup cardiothoracic surgeon available when the patient was not yet stable in the intensive care unit. Counsel argued that as a result, when Perez coded, there was no qualified physician able to timely get him back on the cardiopulmonary bypass machine and that the delay resulted in a massive brain injury due to the lack of circulated oxygenated blood.
- Defendant's Contentions:
Defense counsel contended that Chaudhry did not leave the surgery early and that he remained in the operating room, supervising his physician assistant through the closure of the chest. Chaudhry also asserted that he did not violate the standard of care by leaving the hospital because, when he left, Perez was stable in the operating room, which acts as a recovery room for open heart surgery patients following surgery.
Chaudhry claimed that even though his name was on the order for the DIC panel, someone else ordered it and just used his name as the lead surgeon for the order. Chaudhry was also adamant that all he was told was about was when Perez's bleeding reached 200ccs, which he claimed was not concerning enough for him to return to the operating room, so he kept driving to his business meeting.
Injuries and Other Damages
- Physical Injuries claimed by Plaintiff:
Perez suffered bleeding complications, went into hypovolemic shock and coded. As a result, chest compressions were performed on his freshly closed chest. His chest was then re-opened and his heart was manually massaged until Chaudhry arrived back at the hospital and was able to quickly cannulate Perez on the bypass machine so that Perez's body and brain were again able to receive circulated oxygenated blood. Further surgery was then performed to repair the perforation of the heart. In total, Perez had been on the operating room table for over 13 hours.
Although Perez has a healthy, beating heart today, he suffered a massive traumatic brain injury (TBI) as a result of the delay in getting him back on the bypass machine following the code. To this day, Perez remains in a near vegetative state in a nursing home in Fresno.
Plaintiffs' counsel contended that Perez, 76 at the time of trial, can still feel pain even though he remains in a near-vegetative state, which is estimated to continue for the rest of his life.
Prior to the subject incident, Perez was the primary caretaker for his wife of 46 years, Maria Arteaga Alvarez, who suffers from symptoms of dementia. Thus, Arteaga Alvarez presented a claim for her loss of consortium.
Perez's family also sought recovery of punitive damages as a result of Chaudhry's alleged conduct.