Negligence, not Pre-Existing Conditions, Blamed in a $4.9M Award to Amputee

Case Overview

Case Name: Samuel C. Gray and Belva Jean Gray, Husband and Wife v. Panagiotis Iakovidis, M.D., Bond & Steele Clinic, P.A. d/b/a Bond Clinic, P.A. and Bond Clinic, Husam K. Habboub, M.D., Radiology and Imaging Specialists of Lakeland, P.A., and Winter Haven Hospital Inc. d/b/a Winter Haven Hospital

Case Type: Medical Malpractice – Delayed Treatment

Injury:

Amputation – leg (below the knee)
Epidermis – gangrene; cellulitis
Other – fatigue; ischemia; infection; physical therapy

Plaintiff Attorneys:

Edward V. Ricci; Searcy Denney Scarola Barnhart & Shipley, P.A.
Matthew K. Schwencke; Searcy Denney Scarola Barnhart & Shipley, P.A.

Defense Attorneys:

Thomas E. Dukes III; McEwan, Martinez, Dukes & Hall, P.A. for Bond & Steele Clinic P.A. and Panagiotis Iakovidis
Mary Jaye Hall; McEwan, Martinez, Dukes & Hall, P.A. for Bond & Steele Clinic P.A. and Panagiotis Iakovidis

Case Outcome: Verdict – Plaintiff

Award Amount: $4,914,512.59

What Happened?

Emergency medical services took Samuel Gray, 61, to Winter Haven Hospital emergency room due to acute pain behind his left knee on Jan. 21, 2013. After his 3 pm arrival, the doctors determined that there was no blood flow in Gray’s lower left leg. The emergency room doctor contacted the on-call vascular surgeon, Dr. Panagiotis Iakovidis, around 7 pm that night. A few hours later, an angiogram revealed that Gray had a blood clot in his left leg. Arterial and venous clots often form in the legs but can also appear elsewhere in the body.

Doctors use angiograms, an X-ray diagnostic procedure, to identify any blood circulation issues in the heart, legs, arteries, kidneys, or other areas. Thrombosis is the medical term for a clot forming in an artery or vein or in the heart. When a clot shuts down blood flow in an artery a patient can experience ischemia. With this condition, cells deprived of blood flow start dying. Dying or dead tissue can turn black (necrosis) and spread outward. Clots can also break off and move to the lungs or brain, creating a life-threatening emergency.

The Decision for Thrombolysis Procedure

Surprisingly, although contacted on the evening of Jan. 21, Dr. Iakovidis didn’t arrive at the hospital to see Gray until about 10 am the next day. Eight hours later, Iakovidis decided Samuel needed thrombolysis to break up the clot. In this minimally-invasive procedure, a doctor maneuvers a catheter to the area of the clot to evaluate it. If the clot is treatable with medication, the catheter is connected to a pump for precise delivery of medications for several hours or several days. After the clot is broken up, the machine suctions out the pieces of the clot. Sometimes, thrombolysis needs to be repeated.

An hour after he placed the order for the procedure, Dr. Iakovidis learned that the hospital’s thrombolysis machine was broken. Due to the equipment problem, radiologist Dr. Husam Habboub didn’t perform the procedure on Gray until the morning of Jan. 23. Habboub did a second thrombolysis on Samuel later that evening.

Blood Flow Blockage Results in Amputation

A January 24th angiogram determined that Samuel Gray’s left leg still had no blood flow. The leg had become gangrenous—his lower leg tissue was dead due to blood flow deprivation. The next day, surgeons amputated his leg below the knee.

Afterward, during a stay at a rehab facility for physical therapy, Samuel developed a cellulitis infection and was re-admitted to the hospital. This type of bacterial skin infection leaves the skin swollen and inflamed, and usually painful when touched. Often occurring in the legs, untreated cellulitis can migrate to the lymph nodes and bloodstream and quickly threaten a person’s life.

Doctors gave Samuel medications to combat the infection at the hospital. Gray continued to receive antibiotics from health home medical aides at home for a period of time after he left the hospital. Once the infection was gone, Gray returned to his physical therapy.

Finding the right prosthetic was not a “snap” for Samuel. His first pin-lock prosthetic caused friction and irritation in an area on his remaining leg. He later switched to a more comfortable vacuum-socket prosthetic.

The Lawsuit’s Allegations and Testimony

Gray and his wife sued Dr. Iakovidis and his medical practice employer, Bond Clinic, along with Dr. Habboub, his employer, Radiology and Imaging Specialists of Lakeland, and Winter Haven Hospital for their negligence during Samuel’s treatment. The Grays claimed that the doctors committed malpractice and that their employers were vicariously liable for their actions. In addition, the Grays sued the hospital for non-delegable duty and negligent hiring, supervision, training, and retention.

The plaintiffs settled for an undisclosed amount with Winter Hospital, Habboub, and Habboub’s practice before the start of the trial.

Delays and Lack of Action

At the trial with the remaining defendants, Gray’s lawyer contended that Iakovidis should have come to the hospital immediately after being contacted by the emergency room team on the evening of Jan 21. Had Iakovidis seen Gray without delay that night, Gray’s leg would have been saved. This was a main point in the plaintiff’s case.

Counsel for the Grays maintained that Samuel required treatment within eight to 12 hours after his first signs of motor dysfunction that transpired at approximately 11 p.m. on Jan. 21. An expert vascular surgeon for the plaintiffs asserted that Iakovidis should have arrived at the hospital within one hour after the call from the emergency room physician.

The vascular expert also stated that Gray would have had a 90% chance of a successful outcome if a thrombectomy had been done on the evening of Jan. 21 or the morning of Jan. 22.

No Timely Move to Another Facility

If Dr. Iakovidis couldn’t see Gray on Jan. 21, then he should have transferred the patient to another medical facility for timely treatment. The plaintiffs also argued that after it was clear Dr. Iakovidis was not going to evaluate Samuel on Jan. 21, the emergency room doctor should have gotten another doctor to treat Gray that night. When it became apparent the thrombolysis procedure would be delayed due to the non-functioning machine, the hospital should have moved Gray to a facility with a working thrombolysis machine.

Problematic Clot Strategy

The plaintiff’s counsel claimed that Dr. Habboub’s strategy for treating the clot was sub-par. They asserted that as an interventional radiologist, Habboub should have known that doing thrombolysis several days after Gray’s symptoms first surfaced would not be effective. In addition, Habboub should have known that the second thrombolysis on Gray would also likely fail.

Given the delays, the appropriate action would have been for Dr. Habboub to perform a quicker procedure called a thrombectomy. With this approach, Habboub would have immediately pulled the clot out of Gray’s body.

The Defense’s Arguments

The defense counsel maintained that there was no delay in treatment. First, Gray received a blood thinner after his arrival at the hospital. Second, they argued that Iakovidis’s treatment of Gray’s acute lower limb ischemia fell within the time range for the general standard of treatment—48 to 72 hours.

The next defense argument was that Dr. Iakovidis did not delay treatment. Rather, because Gray had underlying medical conditions—diabetes, chronic atrial fibrillation, atherosclerotic disease, small vessel disease, and more blood clots in both legs—Iakovidis needed time to consider various treatment options.

Pre-existing Conditions Led to Amputation

In the defense’s view, the first thrombolysis took care of the blood clot at issue. A vascular surgery expert for the defense testified that Gray’s pre-existing medical conditions resulted in the amputation—not the clot. The Grays’ counsel did not agree. They asserted that because blood flow was not restored to the leg, the thrombolysis was a failure.

The defense called an expert interventional radiologist to the stand. This expert’s view was that by the time Gray arrived at the hospital, his leg was already beyond saving.

The plaintiffs’ counsel conceded that Samuel suffered from high blood sugar, had plaque built up in his arterial walls (atherosclerosis), and had an irregular heart rhythm (atrial fibrillation). However, they argued that these conditions were unrelated to the avoidable amputation of his leg. According to the plaintiffs’ interventional radiologist expert, Samuel’s arteries were in good condition other than the clot. In this expert’s view, immediate treatment of Gray’s clots would have had a high probability of success.

Difficult Life as an Amputee

Mr. Gray described difficulties in his daily life following the amputation. He still works as a hospice bereavement counselor, but it takes him longer to get ready for work every morning. He requires help from his wife to bathe and dress. Samuel also has a hard time with daily living tasks such as getting out of chairs, going up and down stairs, and getting in and out of cars.

Samuel Gray’s life-care plan prepared by an expert life-care planner and physiatrist detailed his medical needs for the future. Elements of the plan included physical therapy, aquatic therapy, psychological treatment, and X-rays. For his mobility, Samuel will require a wheelchair, power scooter, and walker. The plan also discussed ongoing medication, attendant care, follow-up appointments, and independent aides.

The defense counsel countered that with his pre-existing conditions, much of the treatment outlined in the plan would have been necessary even without the amputation.

Who Won the Case?

After a six-day trial and four hours of deliberations, the jury found that Dr. Iakovidis had been negligent and that his negligence caused the injury to Samuel Gray.

Samuel Gray’s award totaled $4,614,512.59. The personal injury damages were:

$147,630 for past medical costs
$466,883 for future medical costs
$1,000,000 for past pain and suffering
$3,000,000 for future pain and suffering

The award for his wife Belva Gray’s loss of consortium totaled $300,000

$50,000 for past loss of consortium
$250,000 for future loss of consortium

Expert Specialities

The plaintiffs retained expert witnesses in:

The defendants retained expert witnesses in:

Key Takeaways

This case is a good reminder that effective expert witnesses can help juries sort through misguided claims that pre-existing conditions were the cause of a patient’s injuries. Here, the jurors discerned that the negligent treatment of Gray’s clot over several days was the reason for his amputation. Clearly, the plaintiffs’ experts did a good job helping the jury distinguish between the other medical conditions the defense tried to blame and the real cause of this terrible injury—sub-par treatment of a medical emergency.