Monday, December 10, 2018

Dr. Katharine Wenstrom Concludes a Mother's Post-Partum, Catastrophic Brain Damage Could Have Been Avoided in $46M Med Mal Case

The Trial: Trabue v. Atlanta Women’s Specialists, a medical malpractice trial over the catastrophic brain damage a woman suffered in a collapse days after she gave birth.

The Expert: Dr. Katharine Wenstrom, an obstetrician, testifies for the plaintiff and concludes that complications from unchecked preeclampsia and a pulmonary edema likely caused the new mother’s heart to stop.

The Verdict: $45.8 million.


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

Dr. Katharine Wenstrom’s testimony during this Atlanta medical malpractice trial was key to the plaintiff’s success, as she addressed the standard of care, causation, and damages in a case that led to a $45.8 million verdict.

Shannon Trabue suffered a heart attack while undergoing hospital X-rays on August 25, 2009, three days after giving birth via Caesarean section. Although hospital staff resuscitated her, she went without oxygen for more than 10 minutes and suffered lifelong brain damage that her attorneys say renders her unable to care for herself.

The Trabue family’s lawyers claim Trabue’s heart attack was caused by unchecked blood pressure problems stemming from her preclampsia, and a pulmonary edema, or fluid in her lungs, that Atlanta Women’s Specialists obstetricians Drs. Rebecca Simonsen and Stanley Angus failed to properly treat.

With a steady, calm demeanor, Wenstrom, a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, gives simple, straightforward explanations, drawing the jury members to her by answering questions with eyes toward them in an unforced manner.

Her responses are strong and consistent. Without hesitation and with unflinching confidence, she responds to the question, “Do you have an opinion about whether Dr. Angus’ care, that you have said falls below the standard of care … caused or contributed to making her heart stop beating?” Without equivocation, she responds, “Yes it did.” She goes on to establish a direct connection between that breach, the cardiac arrest, and the patient’s damaged brain. Then, with unwavering certitude she states that this whole catastrophe could have been avoided using basic bedside analysis of fluid intake and output, casting doubt about how closely the defendant was following the patient. With references to her teaching responsibilities, she brands her opinions with the  authority of one entrusted with educating other physicians about the standard of care, at the same time implying that this is a problem so commonly encountered, yet so devastating that even her residents would have handled this better.

Perhaps the most damaging of all of the doctor’s explanations is her simply stated reasoning concerning the administration of a common diuretic. “What we tell our residents is that if you think it could be pulmonary edema, that’s the first thing on your list, give Lasix right then. You don’t have to wait for an X-ray. Just give Lasix. It costs a couple of bucks. If they are not fluid overloaded, the Lasix won’t hurt them. If they are fluid overloaded, that could save their life. You don’t have to send the patient down for a chest X-ray before you give them Lasix and that simple treatment could have made all the difference.” Anyone can understand that logic.

Then, casting further aspersions upon the handling of Trabue’s medical case, she states, “When you give [blood pressure medication] hydralazine, you don’t just give the test dose and walk away…. You have to stay by that patient’s side until you have the blood pressure under control.” She practically makes it appear that the patient was abandoned in her time of need by those in charge of her treatment.

Wenstrom points out that this is not a complicated or an unusual problem. It was common, foreseeable, and should not have been missed. Finally, she carefully lays out the reasons why the defense argument—that Trabue’s collapse was caused by an unforeseeable pulmonary edema—is untenable. There had been precautions taken to prevent pulmonary embolism, the patient had no predisposing factors, a specific test had been done to rule out pulmonary embolism, and, most damning of all, she uses the defendants’ own actions to strengthen her argument.

“Had they thought that a clot had caused this problem, they would have put her on IV heparin. They did not.” Yet the doctor points out that the defendant did eventually treat the patient with three doses of Lasix, the treatment for pulmonary edema.

Dr. Wenstrom projects confidence, authority, and simply understood logic to establish what went wrong, how it would have been avoided if the standard of care had been followed, how that breach directly led to the damages, while at the same time undermining the defense position and making their care appear inappropriate. Her testimony carried the case for the plaintiff.

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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.