Monday, June 17, 2019

Dr. John Schaefer’s Testimony on Patient’s Potential Infection Leads to $3.5M Verdict

The Trial: Banks v. Rezaiamiri,  a 2015 Georgia negligence trial in which a physician’s office was accused of negligence for not following up on calls from a patient who had successfully undergone a cervical laminectomy but called complaining of a severe cough and sweating. The patient subsequently died, and his wife sued, claiming the practice failed to return a call regarding his health.  

The Expert: Dr. John Schaefer, an infectious disease specialist from Virginia, testifies he believes the patient died from pneumonia caused by Alpha strep bacteria that could have been easily treated if caught in time.

The Verdict: $3.5 million.


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

In a 2015 Georgia medical malpractice case, Dr. John Schaefer, a board-certified infectious disease specialist from Virginia, testifies as to the negligence of a physician whose office failed to respond to calls from a patient who had successfully undergone a cervical laminectomy, but called complaining of a severe cough and sweating. The patient’s subsequent demise from pneumonia possibly caused by a bacteria that Schaefer says could have been easily treated, resulted in a verdict for the plaintiff of $3.5 million.

The expert begins by explaining that the patient was extremely susceptible to infection due to his low white blood count. Usually, an alpha hemolytic streptococcal infection is quickly cured in a patient with a normal white blood count with the use of antibiotics. But in this case, the autopsy revealed infections with this organism in both lungs.

Using a visual prop, Schaefer describes for the jury the pathophysiology behind pneumonia. This infection occurs when the bacteria is inhaled into the lung. The lungs should be sterile, so the presence of bacteria in the air sacs of the lungs is pathologic. Bacteria in these sacs result, therefore, in the body’s white blood cells migrating to this area to defend against the toxins produced by those bacteria. The combination of these bacteria and white blood cells, with the products of their destruction in the air sacs is pus. The accumulation of pus and fluid within the air sacs will prevent the free exchange of oxygen that the body craves and carbon dioxide, which it must expel.

Infections like this will cause fever, the expert explains. The accumulation of fluid in the lungs as the body attempts to defend itself leads to the stimulation of the cough reflex and production of sputum which will be variously colored according to the type of bacteria it is contaminated with. Sometimes this may be tinged with blood as well. If too many air sacs fill with fluid, not enough oxygen is passed into the bloodstream to support normal bodily functions. A patient may become confused and weak.

Pneumonia can be caused by fungi, bacteria, viruses, or parasites contaminating the lungs. Treatment includes IV fluids, oxygen, and antibiotics. If the situation becomes bad enough, the patient may be placed on a ventilator or even have his blood oxygenated artificially.

The diagnosis is made by noting signs of cough, fever, and chills. Listening with the stethoscope, the doctor can hear particular sounds that are typical of pneumonia. Usually a chest X-ray will demonstrate the accumulation of air sacs filled with fluid in a particular area. Occasionally, in a dehydrated patient, this accumulation is not apparent until IV fluids are given. The X-ray may then reveal the area of pneumonia.

The doctor explains that bacteria are omnipresent in our external environment as well as living on our skin, in our mouth, and in our intestines where they survive without harming us. It is only when they are in the “wrong location” that they become a problem. This particular organism, alpha strep, survives without causing a problem as long as it remains in our mouths or throat where over 400 different types of bacteria live. He considers it to be a “weak” organism because it is so susceptible to antibiotics and the body’s defenses. In this case, with the low white blood count the patient’s defenses were down, leaving him at risk.

 

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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.