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Elisa Sales v. Summerlin Hospital & Medical Center

Dr. Jeffrey Goodman, cardiac electrophysiologist, testifies for defense on charting of patient during treatment. Leading to settlement during jury deliberations.

The Expert: Dr. Jeffrey Goodman, a cardiac electrophysiologist in Los Angeles, California, testifies for the defense as to the charting of the patient during her treatment, and concludes the staff acted appropriately.

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

Testifying for the defense in a 2019 medical malpractice trial out of Nevada, Dr. Jeffrey Goodman, a Los Angeles cardiologist subspecializing in electrophysiology, counters the plaintiff’s claim that a hospital staff’s failure to begin emergency resuscitation quickly led to the patient’s brain damage.

This video clip begins with a chart review of the observations of other physicians that have taken care of Salas since the incident. Two doctors’ charts are specifically cited which seem to demonstrate that the patient had no significant neurologic deficits. The first, the Review of Systems portion of the History and Physical, contains a Neurologic section which fails to spotlight any neurologic deficits. She seems to be “verbal” and does not have poor muscle control leading to difficulty with walking or balance. In the second, she seems to be able to communicate on her own, and detail her visual problems to an optometrist. The optometrist cautions her at that time about her diabetes and the detrimental effects that the disease could have on her vision and overall health in the future if she does not properly deal with it.

Goodman says that these records indicate to him that, despite plaintiff claims of major delays and inappropriate performance of CPR, there could not have been any significant delays or inadequate CPR for the patient to be able to perform neurologically at the level that she did when attended to and documented by these two doctors.

The documentation during the code was very poor and inconsistent with the outcome that occurred. The patient was actually saved and spared of significant neurologic damage. The expert states that if the documentation as written was true, Salas should have been dead or in a vegetative state due to lack of oxygen to her brain and other organs.

The doctor then discusses his feeling that since 2010, this patient has been persistently non-compliant with her diabetic regimen. This, he opines, will result in advancement of cardiovascular disease resulting in early heart attack and stroke. “She’s got them all,” he says, “and it is due in major part to her uncontrolled diabetes.” He points out that her records for nine years show high blood sugars indicating “non-controlled diabetes.” This would “absolutely” give her a decreased life expectancy due to preexisting “heart muscle function that was half normal, previous strokes and blockages in the arteries, and kidney problems” occurring at the same time as her persistent non-compliance in dealing with her diabetes. Diet is critical to this management in addition to exercise and medication. Her diet had consistently been poor despite pleas from her treating physicians as documented in these charts. These preexisting conditions in combination with her non-compliant behavior regarding diabetes will lead to a significantly lower life expectancy.

The testifying expert concludes that the nursing staff performing the CPR was in compliance with ACLS standards of care, that they saved her life, and they prevented profound, permanent neurologic damage. The case settled after it was sent to the jury.

About the Author Dr. Gary F. Gansar, MD, FACS

Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.

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