July 1, 2021

Nonsuit in Medical Malpractice Wrongful Death Case

AJ was a 23 year old, 316 pound young man admitted on November 20, 2012 to our client, a drug and alcohol rehabilitation facility, for Oxycodone and Xanax addictions.  The facility’s Medical Director placed AJ onto Valium and methadone taper detoxification protocols.  Numerous nurses monitored and treated AJ for withdrawal symptoms.  AJ had difficulty following instructions and claimed to be experiencing various medical problems.

On November 25, AJ claimed that he could not see or move and the facility called 9-1-1 and sent AJ to the Emergency Room at the local hospital.  A hospital nurse performed and EKG, which revealed a prolonged QT interval.  AJ had a urine screen done that showed low potassium.  The ER doctor diagnosed AJ with vasovagal syncope and drug abuse.  AJ returned to the facility at approximately 12:10 am on November 26.  The ER did not provide the facility with the EKG results, either verbally or in writing.  At 11:30 am that morning, AJ was unresponsive to stimuli and sent back to the hospital.  A different ER doctor examined AJ and returned him again to the facility with a diagnosis of drug abuse.

On November 27, AJ met with the Medical Director of the facility and agreed to start following instructions.  On November 28, AJ met with a psychiatrist at the facility, who examined AJ and prescribed Neurontin.  On the evening of November 28, AJ again claimed to be experiencing medical problems, which the nurses believed were typical symptoms of withdrawal.  Nurses at the facility suggested to the Medical Director that AJ be transferred to a higher level of care facility that could provide medical managed care with a lower nurse to patient ratio.  The staff at the facility did not believe that AJ needed to go back to the hospital a third time.  Believing that AJ’s condition was behavioral, and not medical, based on his treatment history and after he returned twice from the hospital without a new diagnosis or treatment instructions, the Medical Director advised that the facility would continue to care for AJ and that he did not need to be transferred to another drug treatment facility, which could not have been accomplished overnight.  AJ was monitored and observed multiple times throughout the early morning of November 29 and was sleeping comfortably and not in any distress.  At approximately 7:50 am that morning, nurses found AJ unconscious on the floor of his room.  They started CPR and AJ was transported by ambulance to the hospital, where he was pronounced dead.

Plaintiffs asserted causes of action against the facility for negligence, vicarious liability for the negligence of its Medical Director and psychiatrist, Wrongful Death, and Survival.  They asserted claims of professional negligence against the Medical Director and psychiatrist.  Plaintiffs claimed that the methadone provided for the oxycodone addiction combined with hypokalemia (low potassium) caused the prolonged QT, resulting in Torsades de Pointes, a specific type of abnormal heart rhythm that can lead to sudden cardiac death.  They also claimed that AJ was not properly and continuously monitored as a detoxification patient and his medical condition was not recognized on November 28, resulting in the facility failing to send him back to the hospital a third time.

Plaintiffs also asserted professional negligence claims against the hospital and its two ER doctors for vicarious liability, Wrongful Death, and Survival.  Plaintiffs claimed that AJ had a prolonged QT on his EKG and low potassium on his first visit to the ER.  Combined with the syncope he allegedly experienced that day, the hospital should have evaluated AJ using a cardiac monitor and admitted him to the hospital for further testing and monitoring.  Plaintiffs alleged that on the second visit, the next day, the hospital should have performed a repeat EKG and once again admitted AJ for further testing and monitoring.

The facility, its Medical Director, and its psychiatrist all denied liability and claimed that they properly treated AJ.  They appropriately monitored AJ throughout his stay.  The methadone was properly administered and at the small dosages used would not have caused the prolonged QT interval.  The facility also made sure that AJ was drinking orange juice upon his return from the ER, which would have increased his potassium level.  Moreover, the facility acted appropriately on November 28 because it sent AJ to the hospital twice and he was medically cleared and returned to the facility, so there was no reason to believe that AJ’s alleged issues that evening was anything other than behavioral.  The hospital and its ER doctors claimed that the EKG was not abnormal, that the prolonged QT found on the EKG was well below the level that causes Torsades de Pointes, AJ’s potassium was only minimally low, and AJ did not actually have a syncopal event on either day he went to the ER.  As a result, there was no reason to admit him for monitoring.

The hospital settled with plaintiffs a week before trial commenced the first time on October 31, 2016 before the Honorable Mark L. Tunnell in the Court of Common Pleas of Chester County, Pennsylvania.  Rawle & Henderson partner Daniel J. Rucket represented the facility at trial.  At the close of Plaintiffs’ case at the first trial, Judge Tunnell entered a nonsuit for all of the defendants based on the qualified immunity under Pennsylvania’s Mental Health Procedures Act.  The Plaintiffs appealed.  The Superior Court remanded the case as to the ER doctors.  The Supreme Court remanded the case as to the facility and its doctors.

The second trial commenced on May 25, 2021 in the Historic Courthouse in West Chester.  Mr. Rucket and Rawle & Henderson associate David J. Samlin represented the facility at the second trial.  Plaintiffs presented several expert witnesses, including an addiction specialist, nurse, cardiologist, and emergency room physician.  AJ’s mother, father, and grandmother also testified.  The defendants presented several fact witnesses and experts and collectively argued that AJ did not die from Torsades de Pointes.   On the tenth day of trial, the 12-person jury took under two hours to return a defense verdict for all defendants.

Mr. Rucket has represented the facility for 15 years.  He has obtained defense verdicts in all jury trials in which he has defended the facility, including two wrongful death cases. He represents the facility’s parent company on claims made against psychiatric hospitals, methadone clinics, and drug rehabilitation facilities.  Mr. Rucket’s practice also consists of a broad range of general casualty defense litigation cases, to include construction site accidents, premises liability, motor vehicle accidents, catastrophic injury, products liability, defamation, construction defects, and water infiltration claims.

Mr. Samlin concentrates his law practice on general litigation, environmental torts, product liability, premises liability, and construction.  He has represented clients in the defense of environmental matters including underground storage tank (UST) cases, groundwater contamination cases, and claim eligibility determinations, and has represented a variety of clients at both arbitrations and trials, obtaining defense verdicts in both forums.  He has also authored and/or contributed to dispositive motions in several premises liability cases involving waiver of liability clauses in fitness club memberships, which have been enforced and upheld by the Pennsylvania Courts of Common Pleas and Pennsylvania Superior Court.

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