and set.”
“What’s that, doctor?”
“They’ll try to set up an adversarial relationship between the surgeon and the anesthesiologist. There is not and can never be such a relationship. Don’t let them get away with that crap. If you do you’ll poison the mind of the jury and hurt your case. You can never stress enough that the anesthesiologist and surgeon are in the operating room for one purpose, and that is to work as a team, together with the nursing staff, for the benefit of the patient.”
“I see your point, doctor and it’s a good one that I’ll keep in mind.”
“Stress that teamwork whenever you can.”
“Have you always followed the order of a surgeon, doctor?”
“It’s not just simply following orders. It’s up to us anesthesiologists to decide what to use for a patient under each circumstance that arises. We don’t ask the surgeon. We’re the experts in all areas of sedation, and we use what we have to use based upon the constant monitoring of the patient’s physiological parameters and our review of his or her medical and therapeutic history. We take orders from the surgeon and carry them out under two circumstances.”
“What are they, doctor?”
Dr. Torgerson stood up and raised himself to his full five feet six inches, and walked toward attorney Stuart’s desk. He said, “This is important so take notes or make sure you don’t forget what I’m about to tell you. The plaintiff’s attorney will try and chew up the anesthesiologist on these points. First of all, if the surgeon’s order makes sense to us and we understand it and it doesn’t interfere or may cross-react adversely with what we’ve already given, we’ll do what the surgeon says without hesitation. Secondly if the surgeon gives us an order, as in this very unusual case, where we are dealing with a condition that most anesthesiologists have not experienced, then the order should be carried out. And Dr. Madhava did what any good anesthesiologist would do.”
“Are you saying, doctor that an anesthesiologist would have no experience with DIC?”
“I’m saying that the average anesthesiologist who limits his practice to the operating room may spend an entire career without ever seeing an acute case of DIC. I would agree with the surgeon’s quick diagnostic judgment in this case. He tried to reverse a fatal process. He should be given a medal for trying, not a lawsuit. Having said all that, there are anesthesiologists who may know a great deal about DIC.”
“Who are they, doctor?”
“It wouldn’t be relevant in this case, but there are anesthesiologists who specialize in intensive care. Some of them become intensive care directors and spend their working hours in the intensive care unit. There they see many patients who have the pre-conditions for developing DIC. Conditions such as sepsis, septic shock, malignant disease, gangrene, major surgical and obstetrical emergencies etcetera. Dr. Madhava, like most anesthesiologists, is not in this category, and don’t let the plaintiff’s attorneys suggest that all anesthesiologists are experts in DIC. The bottom line is that your client did exactly as he should have done and like a good crewman he followed orders.”
“Just out of curiosity, doctor, did you ever not follow a surgeon’s order?”
“Many times, but when I gave them my rationale, the great majority of surgeons saw the light and didn’t push me.”
“Great majority? You mean there were some that insisted on their order even after your explanation?”
“Yes.”
“What did you do?”
“I gave the surgeon a few words which translated as hell no. I used different terminology you understand; language I wouldn’t want a court reporter to have to take down. Then I invited him to take me before the quality committee where we could thrash it out.”
“Did they ever?”
“Never. And the patient didn’t get what the surgeon wanted either.”
“Very interesting. I think you’ll be a tough advocate for my client.”
“You can bet your ass I will. He deserves it.”
CHAPTER 9
The defense teams for the two doctors were pleased with the confidence of their expert witnesses. But this did not mean that the plaintiff’s attorneys were worried. Barbutti recognized the fact that he might have difficulty finding an expert in hematology to testify against Dr. Harris, so prior to his even trying he lined up a witness who dogmatically stated that Dr. Harris did not meet the standard of care. “No one in his right mind would use heparin under those circumstances,” he said. “He contributed to the patient’s death. Yes the patient was in extremis when he had the heparin injected, but that gave him the little extra push needed to send him to his maker.” This expert was Dr. Albert Burns, a thirty-year-old family practitioner, whose uncle was a prominent personal injury attorney. Dr. Burns was the exception to the rule in these times, electing a solo primary care practice in the days when solo practitioners were becoming a dying breed. The income from testifying in a number of trials was substantial and could sustain one while attempting to build up a practice. Dr. Burns was available to testify about a variety of medical situations and plaintiff’s attorneys were learning that he was reliable and cooperative.
Dr. Drossman was correct in his assumption. The two surgeons recruited by Barbutti to evaluate whether Dr. Harris met the standard of care, wrote back that they found no fault with his diagnosis or treatment, and that he did indeed meet the test of the accepted standard of care.
Not discouraged, Barbutti recruited a general surgeon, retired, from southern Illinois. Dr. Steve Dwyer was willing to testify that in his opinion, “Giving heparin under those circumstances was reckless, and playing God. Yes, when the patient’s blood pressure began to drop and there was no urine output it probably meant that death was imminent. At that point you’d have to be crazy to do what Dr. Harris did. There was little hope for the patient but what Harris did was seal his doom.”
Barbutti’s anesthesiologist expert witness, Dr. Adrian Tennant said, “This was a classic case when the anesthesiologist had every right to tell the surgeon to go to hell.”
“Isn’t the anesthesiologist required to follow the surgeon’s orders?”
“Once in a great while you have to stand up and be counted and go on the record for all to hear. I disagree and will not be part of this idea that an anesthesiologist has to do whatever the surgeon says, no matter how idiotic the demand. Dr. Madhava didn’t have the balls to refuse, so now he’s paying the price.”
The lines of battle had been drawn and were clear and distinct.
**********
Dr. Harris continued his busy surgical schedule. In the operating room his intense concentration allowed him to forget his pending lawsuit. The advice of the attorneys to keep quiet was observed by all concerned, but this, in and of itself, was insufficient to keep the filing of the suit secret. One needed only to read the Cook County Jury Verdict Recorder to learn about every malpractice suit filed each month in the county. The lawyers, after giving the advice to keep quiet, always added, “Everyone will find out soon enough, no matter how quiet you are, so just do your best to ignore the talk and concentrate on your work.”
