$61.6M Jury Award Holds Doctors Accountable for Preventable Amputation

Case Overview

Case Name: Peter Sfameni v. John Ryan, Eric Winer, Rhode Island Hospital and University Medicine Foundation, Inc., No. PC-2013-1368

Case Type: Medical Malpractice – Failure to Treat; Delayed Treatment

Injury:

• other – infection; prosthesis
• epidermis – gangrene
• amputation – leg (above the knee)
• arterial/vascular – deep vein thrombosis

Plaintiff Attorney(s): Michael P. Quinn Jr.; Decof, Decof & Barry, PC

Defense Attorney(s):

• Jennifer Boyd Herlihy; Adler Cohen Harvey Wakeman & Guekguezian L.L.P.
• Brian A. Fielding; Adler Cohen Harvey Wakeman & Guekguezian L.L.P.

Case Outcome: Verdict–Plaintiff

Award Amount: $40,000,000.00

Actual Award: $61,606,575.00

What Happened?

Emergency Room Visit

Peter Sfameni, a 55-year-old man, went to the Rhode Island Hospital emergency room on December 17, 2010. He told the doctors and staff that he had lower back pain and had been experiencing fatigue and weight loss. Sfameni took the anticoagulant medication for a blood-clotting disorder he had. Doctors at the hospital told him to stop taking the blood thinner so they could perform a colonoscopy to find out if he had lymphoma. The attending physicians, Dr. John Ryan, an internist, and Dr. Eric Winer, an oncologist, sent Sfameni home. They told him to return for the diagnostic procedure in two days.

Anticoagulants are drugs prescribed to prevent patients from getting a deep vein thrombosis (DVT) or a pulmonary embolism (PE). DVTs are blood clots that can form in the deep veins of a person’s legs or arms. The interference with blood circulation in these limbs can result in tissue death, called gangrene. Gangrene is a serious condition, which requires immediate medical attention. Sometimes, a clot can break off and travel to the lungs where the PE blocks the blood flow to this vital organ. PEs are life-threatening.

Hospital Doctors Say Stay off the Blood Thinner

Sfameni returned to the Rhode Island Hospital—as the doctors directed—to have the lymph-node biopsy. By then he had been off his anti-clotting medication for 10 days. At the time, the doctors determined that he was hyper-coagulated and admitted him to the hospital. Instead of the planned lymph-node biopsy, the medical team did a bone marrow biopsy that day.

After the biopsy, another doctor recommended that Sfameni start taking his blood thinners. However, that order was canceled. Doctor Ryan discharged him on December 22, 2010. Doctor Ryan also instructed him to stay off the blood thinners until after they could do a lymph-node biopsy scheduled for six days later. Doctors Ryan and Winer, who were residents at the time, advised him he could start back on the blood thinner medication a week after the upcoming lymph-node biopsy.

Blood Clots Lead to Amputation

On December 28, 2010, Sfameni become seriously ill, and doctors readmitted him to Rhode Island Hospital. He was experiencing life-threatening blood clots in his legs and lungs. Although the hospital gave Peter anticoagulants, his right leg became severely gangrenous. The gangrene was so extensive that on January 7, 2011, doctors had to amputate Sfameni’s right leg above the knee.

After the amputation, Sfameni spent five months in the hospital, followed by four months of rehabilitation. Sfameni endured discomfort from an ill-fitting prosthesis. Eventually, the providers gave him a prosthesis that fits properly and functioned appropriately.

Allegations and Testimony

Sfameni filed a medical malpractice lawsuit against Dr. Ryan, Dr. Winer, and their employer, University Medicine Foundation, Inc. The plaintiff also named Rhode Island Hospital, which employed the emergency room residents, as a defendant.

The Plaintiff’s Allegations

Sfameni alleged that he would not have suffered the life-threatening blood clots that resulted in the loss of his leg if Ryan and Winer had properly administered blood thinners at the time of his discharge.

In the complaint, Sfameni described his experiences with ever-present phantom pain. He also claimed he suffered from depression, anxiety, and isolation. On top of that, his immobility led to a loss of independence. In terms of his personal life, Sfameni suffered from a fear that he wouldn’t be able to find a romantic partner because of his disability. He added that his appearance as a disabled, amputee caused him embarrassment. This resulted in Sfameni becoming reclusive, rarely leaving his house.

In his complaint, Sfameni solely sought damages for past and future pain and suffering. His lawyer suggested to the jury that the award should be $20 million.

Rhode Island Superior Court Judge Kristin Rodgers oversaw the trial. At trial, Sfameni’s medical expert testified that when the doctors discharged the plaintiff without doing the planned lymph-node biopsy, the standard of care required the doctors to prescribe Lovenox—an anticoagulant—until they were able to perform the needed biopsy. The expert said that taking Lovenox would have been sufficient to anticoagulated Sfameni’s blood and prevent the blood clots that formed in his lungs and legs.

The Defense Response

Ryan and Winer contended that the treatment they provided to Sfameni did not depart from the standard in the care. The defense’s hematology expert opined that sending Sfameni home without anticoagulation was acceptable practice due to the risk of bleeding. The hematologist’s opinion was backed up by the defense’s internal medicine expert.

The defense did not actively dispute Sfameni’s injury and damages. The defense did, however, argue that Sfameni was getting along better in his daily life. Furthermore, the defense claimed that Sfameni and his quality of life had improved overall.

During the lawsuit proceedings, the parties had stipulated that if Ryan, Winer, or both were found liable, then University Medicine Foundation, Inc. would also be liable.

Who Won the Case?

After only two hours of deliberation, the unanimous jury found that Ryan, Winer, University Medicine Foundation, Inc., and Rhode Island Hospital had been negligent in treating Sfameni. The fact-finders determined that the defendants were jointly and severally liable. The jury awarded Sfameni damages totaling $40 million. The total award, including interest at a 12% rate as the law mandated, amounted to $61,606,575.

After the trial, the defendants sought a new trial and remittitur. The defendants asserted that the jury’s award amount for Sfameni indicated that the jury had been “inappropriately impassioned” against the defendants.

Expert Specialities

The plaintiff retained an expert witness in:

• Hematology

The defendants retained expert witnesses in:

• Hematology
• Internal Medicine

Key Takeaways

This case is a good reminder that medical residents can make mistakes that have dire consequences for patients. Medical malpractice lawyers can successfully litigate to hold residents and their employers accountable. No one needs to endure an amputation that could have been prevented with proper medication. Rational juries can discern what medical expert witnesses tell them. Juries can separate fact from fiction when presented with conflicting expert opinions on what is the required medical standard. In the end, this jury did the right thing for a plaintiff who truly suffered life-altering injuries at the hands of negligent doctors.