Friday, February 21, 2020

Dr. Amol Bapat Outlines Conclusions on Cause of Patient’s Fall, Clearing Doctor in Medical Malpractice Trial

The Trial:  Berryhill v. Daly, a medical malpractice case in which plaintiff contends he suffered a back-breaking fall from a deer stand because of medicine defendant physician prescribed after a heart procedure. Plaintiff contends the physician did not adequately warn him.

The Expert: Dr. Amol Bapat, an Atlanta-area cardiologist, details his belief that the medicine did not cause plaintiff to fall.

The Verdict: For the defense.


By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

 

In a Georgia medical malpractice case, Dr. Amol Bapat, an Atlanta-based interventional cardiologist testifies for the defense. The plaintiff contended that he suffered a back-breaking fall from a deer stand because of medicine the defendant physician prescribed after a heart procedure, and that the physician did not adequately warn him of the side effects. However, Bapat convincingly detailed his belief that the medicine was not the culprit.

The expert begins by explaining that the defendant had a stent placed and was therefore observed overnight in the hospital to be sure that no immediate complications occurred. Since the patient was to be discharged the following morning, and there was a good chance that the doctor would not see him again before discharge, he discussed discharge instructions and medications with the patient’s family after the procedure.  Bapat sees this as an appropriate procedure, as patients are frequently discharged by mid-level healthcare workers as long as the patient remains stable. In this case, the patient was kept on the same medications at discharge as he was taking on admission. This, the expert explains, was appropriate because a stent did not cure any of the disease processes or conditions that these medicines addressed. These medications had not caused any side effects previously, so it was a fair assumption that they would be tolerated afterward. Indeed, one medication under question, Bystolic, should not be stopped suddenly due to the chance of causing heart arrhythmia. 

Bapat then addressed questions regarding the discussion that occurs between a doctor and his patient prior to discharge since this discussion was not specifically documented in the patient’s chart. The expert testifies that anything more than minimal - if any - documentation of this discussion would be unusual because “it is virtually impossible to document every conversation and every word we have ever said to a patient.” Most doctors have a standard routine speech that they give to a patient on discharge, hitting the high points.

The expert goes on to address the patient’s fall, testifying that it was most likely due to a vasovagal response. When challenged by the plaintiff’s attorney that this theory was not previously proposed and therefore could not be stated here and now, the doctor insisted that he had proposed exactly this theory during his deposition.  When the plaintiff’s counsel suggested that the expert had stated during the deposition that the fall was related to three medications, the testifying expert calmly replies, “I did not say that.”

Examining the symptoms reported by the patient when the fall occurred, Bapat stated that the patient “had just exerted himself, became nauseated, clammy, spinning with a vertigo feeling” prior to his fall and this is classic for a vasovagal event in which one overexerts oneself and has a paradoxical reaction that results in one passing out or fainting. This occurs suddenly as it did in this case. This theory is supported by the fact that the plaintiff had no symptoms of hypotension or low blood pressure prior to this event. In addition, it would be highly unusual for the medicines involved here to have been taken for as long as they were, then to suddenly exhibit severe side effects that had never been manifested before.

Bapat gave clear and confident testimony, remaining unperturbed by challenge from the plaintiff’s counsel, and he totally backed the care given in this case. The jury agreed, finding for the defense.

 

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.