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Copsey v. Park

Court of Appeals of Maryland

May 24, 2017

JENNY J. COPSEY, Individually and as Personal Representative of the Estate of LANCE D. COPSEY, Deceased, et al.
v.
JOHN S. PARK, et al.

          Argued: December 5, 2016

         Circuit Court for Anne Arundel County Case No. 02-C-13-178530.

          Barbra, C.J., Greene, McDonald, Watts, Hotten, Getty, Rodowsky, Lawrence F., (Senior Judge, Specially Assigned), JJ.

          OPINION

          Greene, J.

         In this case, Jenny J. Copsey, the widow of Lance D. Copsey, individually and as the personal representative of the Estate of Lance D. Copsey, deceased, along with the minor children and mother of the decedent are the petitioners. They allege that the respondents, John S. Park, M.D. ("Dr. Park") and his employer, Brown, Croft and Frazier, P.A. ("Annapolis Radiology"), were negligent when Dr. Park interpreted radiological images on June 4, 2010, leading to Lance D. Copsey's ("Mr. Copsey") fatal stroke on June 10, 2010. Initially, the petitioners sued Dr. Park and three subsequent treating physicians, along with their employers. Prior to trial, however, the petitioners partially settled their claims and dismissed two of the doctors and their employer. A day after trial had begun, the petitioners also dismissed the remaining subsequent treating physician. The trial judge denied the petitioners' motions in limine which opposed the admission of evidence regarding the non-parties' statuses as former defendants and Dr. Park's raising the defense that the negligence of subsequent treating physicians was an intervening and superseding cause of Mr. Copsey's death.

         We shall hold that evidence of non-party negligence was relevant and necessary in providing Dr. Park a fair trial as it tended to show he was not negligent; thus, the alleged prejudice did not outweigh its probative value. Further, causation was an issue for the jury to determine and Dr. Park presented sufficient evidence for a reasonable jury to conclude that he was not negligent; and if found to be negligent, his negligence was superseded by the independent and extraordinary negligence of others. Accordingly, we shall affirm the judgment of the Court of Special Appeals which held that both of the motions in limine were properly denied because the Martinez case permits the introduction into evidence of non-party negligence and causation. Martinez ex rel. Fielding v. Johns Hopkins Hosp., 212 Md.App. 634, 70 A.3d 397 (2013).

         FACTUAL AND PROCEDURAL BACKGROUND

         Mr. Copsey had several risk factors for stroke including moderate obesity, hypercholesterolemia, [1] hypertension, and a smoking habit. On February 4, 2010, Mr. Copsey was presented to the Anne Arundel Medical Center ("AAMC") emergency room after slipping, falling, and hitting the back of his head while playing racquetball. He complained of nausea and a headache. The hospital released him after treatment and a reportedly normal cranial CT scan.

         Three months later, on May 26, 2010, Mr. Copsey returned to the AAMC emergency room. He complained of recurring episodes of dizziness since the morning of May 26. Another CT scan revealed normal results. He was referred to his internal medicine physician, Aditya Chopra, M.D. ("Dr. Chopra"), for a follow-up appointment.

         On June 1, 2010, Mr. Copsey saw Dr. Chopra. Mr. Copsey complained of difficulty walking, nausea, headaches, and persistent vertigo. Dr. Chopra prescribed a generic brand of Dramamine and antibiotics and suggested Mr. Copsey consult an ophthalmologist and, if the symptoms did not improve, also advised him to see an ear, nose, and throat doctor. Mr. Copsey did meet with an ophthalmologist, on June 2, 2010, who determined there was no ophthalmological etiology for his diplopia[2] and recommended a neurologic consultation and a neuroradiologic evaluation.

         On June 4, 2010, Mr. Copsey returned to see Dr. Chopra who performed both of the recommended neurological assessments and found signs of neurological problems and thus advised Mr. Copsey to return to the emergency room for immediate attention. On that afternoon, Mr. Copsey returned to the AAMC emergency room. He told Charles Iliff, M.D. ("Dr. Iliff"), that he had vertigo occurring for about a week, numbness in the right side of his face, right arm, and right leg, headaches, mild shortness of breath, mild diplopia, and trouble walking. Dr. Iliff's examination of Mr. Copsey was normal, but after consulting with a neurologist, Larry Blum, M.D. ("Dr. Blum"), a CT scan and a brain MRI/MRA[3]were conducted.

         On the same date, a radiologist, Dr. Park, interpreted the CT scan at 4:02 p.m. and the MRI/MRA at 6:45 p.m. Dr. Park reported an allegedly normal CT scan and MRI/MRA. Specifically, he found:

There is no evidence of acute intracranial hemorrhage, infarction, mass effect, or midline shift. No abnormal extraaxial fluid collections are identified. The ventricles, sulci, and cisterns are normal. There is no acute injury to the skull base or calvarium.
There is normal anatomy of the circle of Willis with no evidence of aneurysm, anteriovenous malformation, or abnormal vessel cut-off. No hemodynamically significant stenosis is identified. Incidental note is made of fenestration of the left vertebral artery.
There is no evidence of acute intracranial hemorrhage, infarction, mass effect, or midline shift. No abnormal extraaxial fluid collections are identified. The ventricles, sulci, and cisterns are normal. The flow voids at the skull base are normal. There is no acute injury to the skull base or calvarium.

         On June 5, 2010, Dr. Blum independently reviewed the MRI and MRA images after Dr. Park and also confirmed there were no abnormalities. Dr. Blum believed Mr. Copsey's symptoms were merely evidence of migraines. Mr. Copsey was discharged on June 6, 2010, and diagnosed with migraines, cluster migraines, vertigo, hypercholesterolemia, mildly elevated blood pressure, and hypertension; his discharge summary indicated he was "otherwise doing fine."

         On June 7, 2010, Mr. Copsey was seen by Dr. Chopra for outpatient evaluation. Mr. Copsey indicated he had no chest pain, dizziness, shortness of breath, cough, nausea, vomiting, diarrhea, constipation, aches or pains, headache, or burning urination. Dr. Chopra noted that Mr. Copsey had no neurological issues and told him to go back to the emergency room or follow-up with Dr. Blum if his symptoms returned. His symptoms did return towards the end of the day, but he did not return to see Dr. Blum at AAMC for a follow-up evaluation until June 9, 2010.

         At the follow-up, Mr. Copsey stated that his symptoms, including diplopia and headaches, had returned and that he had begun experiencing hiccups and trouble swallowing. Mr. Copsey's neurological exam was normal, but the new symptoms concerned Dr. Blum. Thus, he ordered an urgent interpretation of a new brain MRI, writing "*STAT*" on the order form and telling Mr. Copsey to return to him with the results. Dr. Blum's requisition to the radiologist specified an urgent call back from the radiologist. Vijay Viswanathan, M.D. ("Dr. Viswanathan"), in the radiology department, interpreted the MRI at 4:02 p.m. and noted:

1. Ill-defined new band-like signal abnormality within the right lateral medulla which is nonspecific but is concerning for acute infarction. This is a new finding since the prior study dated June 4, 2010.
2. This could be suggestive of lateral medullary syndrome/Wallenberg syndrome.
3. Left vertebral artery abnormal flow void which is nonspecific. It is difficult to appreciate the connection between right medullary abnormality and left vertebral artery abnormality. Clinical correlation advised.
4. No evidence of intraorbital pathology.
I discussed these findings with Dr. Alkaitis, covering physician for Dr. Blum at 1030 p.m., 6-9-10.

         An "infarction" is brain-cell death caused by insufficient flow of blood. Dr. Viswanathan dictated the report at 4:42 p.m., but it was not until 10:30 p.m. that Dr. Viswanathan notified the on-call neurologist, Damanhuri Alkaitis, M.D., ("Dr. Alkaitis") of the findings. Dr. Viswanathan did not report these results to Dr. Blum, as he was asked to do, or anyone else at AAMC or to Mr. Copsey.

         Mr. Copsey returned to see Dr. Blum around 6 p.m. with the images. In his report, Dr. Blum reflected that the radiology department never called him despite his request for an urgent call back. However, Dr. Blum could have accessed Dr. Viswanathan's findings earlier by checking the Medical Center's computer database or by contacting the radiology department. He reviewed the images himself and found no abnormalities. Thus, Dr. Blum released Mr. Copsey from the hospital. Mr. Copsey had already been released by the time Dr. Viswanathan notified Dr. Alkaitis of the MRI results at 10:30 p.m. Mr. Copsey was not informed that a lateral medullary infarct had been discovered nor did Dr. Viswanathan or Dr. Alkaitis take any action in contacting Mr. Copsey, his family, or arranging for an ambulance to transport Mr. Copsey back to the hospital emergency room for treatment that night.

         On June 10, 2010 at approximately 4:00 a.m., Mr. Copsey suffered a stroke when he woke up to use the bathroom. His wife took him to the AAMC emergency room after she found him on the floor of their home unable to get up. A CT scan conducted at approximately 6:07 a.m. revealed a right medullary hypodensity, reflective of an acute stroke.

         Mr. Copsey's condition worsened by approximately 11:00 a.m. He was then transferred to Johns Hopkins Hospital ("JHH"). JHH diagnosed Mr. Copsey with bilateral vertebral dissections; multiple acute brainstem and cerebellar strokes; hyperlipidemia; and head trauma from the racquetball fall in February.

         On June 12, 2010, Mr. Copsey underwent angioplasty and received a stent in his right vertebral artery. However, the following day he became unresponsive. After treatments failed, Mr. Copsey's condition continued to deteriorate. He died on June 13, 2010.

         The petitioners filed survival and wrongful death actions on September 27, 2011, in the Circuit Court for Anne Arundel County against Dr. Park and Annapolis Radiology, Dr. Viswanathan and his employer, Anne Arundel Diagnostic Imaging, Inc., and Dr. Blum and Dr. Alkaitis, and their employer, Bay Area Neurology, LLC ("Bay Area"). According to the petitioners, between June 4 and June 10, each doctor involved in the treatment negligently failed to timely diagnose Mr. Copsey's evolving stroke. They sought to hold all of the doctors involved jointly and severally liable for the death of Mr. Copsey. The petitioners reached pre-trial settlements with the defendants, Dr. Blum, Dr. Alkaitis, and Bay Area Neurology. Those defendants were dismissed from the action. On September 17, 2014, a day after the trial had begun, the petitioners voluntarily dismissed Dr. Viswanathan and his employer, Anne Arundel Diagnostic Imaging, Inc. Thus, Dr. Park and his employer, Annapolis Radiology, were ultimately the only defendants left in the case to stand trial.

         On August 26, 2014, the petitioners moved in limine, to prevent introduction of certain evidence, prior to trial. The first motion was to exclude all evidence relating to Dr. Blum's and Dr. Alkaitis' prior statuses as defendants and the pre-trial settlements. The second was to preclude Dr. Park from raising as a defense that the negligence of subsequent treating physicians was an intervening and superseding cause of Mr. Copsey's alleged injuries. After hearing arguments from both parties on the first day of trial, the Honorable Paul G. Goetzke, presiding, denied both of the motions.[4]

         Trial

         Prior to trial, the petitioners' attorney wrote a letter to their expert witness, Dr. Caren Jahre ("Dr. Jahre"), a radiologist/neuroradiologist, discussing all of Mr. Copsey's history, the studies performed, his symptoms, and the cause of death. The respondents suggested that Dr. Adam Hecht ("Dr. Hecht"), a neurologist and Dr. Jahre's partner, may have read this letter, but Dr. Hecht testified at trial that he could not recall whether or not he had read the letter. Moreover, Dr. Jahre indicated in her de bene esse deposition testimony that she could not recall if she looked at the letter before her review, but also stated that she only does blind reviews when an attorney directs it, which was not done here, and that she did know in advance of conducting her review to look for vertebral artery occlusions. Dr. Hecht and Dr. Jahre testified that the June 4 MRA showed abnormalities in the left vertebral artery ("LVA") and the right vertebral artery ("RVA"), which should have been detected by Dr. Park.

         A defense witness, Dr. Susan O'Sullivan ("Dr. O'Sullivan"), a radiologist, pointed out that an objective blind review is meant to prevent bias from a hindsight review where a radiologist knows exactly what to look for when reviewing a study.[5] Two of the defense experts, Dr. Alan Hyman ("Dr. Hyman") and Dr. O'Sullivan, conducted blind reviews and did not notice any problems or abnormalities that went unnoticed by Dr. Park. Dr. Hyman, an assistant clinical professor of neuroradiology at Mt. Sinai Medical School, found the MRI/MRA, including the LVA ...


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