No Proximate Cause for Hospital in Medical Malpractice Case

Obtained a defense verdict on behalf of a hospital in a New York medical malpractice case involving an 82-year-old female admitted for aortic valve replacement.  She was discharged to a sub-acute rehab (SAR) facility but was readmitted seven days later for dehiscence of the sternal incision and anemia.  During this admission, she developed incontinence associated dermatitis (IAD) of the buttocks and later wounds in the gluteal cleft, described by the nursing staff as Stage 2 pressure ulcers. She adamantly refused to be discharged to another SAR, opting to return home with a visiting nurse service and physical therapy every other day. One of the wounds resolved; the other deteriorated to Stage 4, requiring two flap graft procedures and 40 sessions of hyperbaric therapy, and finally closed after nine months. The plaintiff's experts claimed various deviations in charting skin breakdown prevention that proximately resulted in the wounds developing and deteriorating. The defense's expert wound care nurse testified that the wounds were caused by IAD, not pressure, and that the nursing staff mistakenly characterized them. Likewise, the defense's geriatric expert testified that the wounds would have healed sooner and not required flap grafts or hyperbaric therapy had the plaintiff accepted transfer to SAR, where she would have received a higher level of care. The jury was asked to award $1.5 million for past and $500,000 for future pain and suffering for this now 87-year-old. The jury found the hospital had deviated from accepted standards but no proximate cause. The hospital offered a high-low arrangement of $100,000/$750,000 during trial, but the plaintiff would not accept less that $250,000/$950,000 in light of a $106,000 Medicare lien. The settlement demand prior to trial was $300,000 and, after jury selection, was increased to $650,000.  When the jury indicated it had a verdict after 90 minutes, the plaintiff's attorneys "agreed" to accept the hospital's high/low offer, which the hospital chose to honor (even though it previously refused), but only if the plaintiff agreed to be responsible for the Medicare lien.