Court: United States District Court for the District of Kansas
Case Name: Wheeler v. United States
Citation: 2018 U.S. Dist. LEXIS 199136
A pregnant woman was admitted to an army community hospital where hospital staff found she had protein in her urine, high blood pressure, elevated liver enzymes, and low platelets. These findings led to a diagnosis of severe preeclampsia, which indicated a high risk of postpartum hemorrhage and hypovolemia. Nurses recommended her transfer to another hospital, partly because of concerns that there were too few nurses. One of the prenatal doctors also advocated a move based on the risk of infection, and because the unit had limited staff at the time. However, the medical staff ultimately decided against the move and induced labor.
The woman delivered a child via C-section and afterward experienced declining blood pressure and urine output, increasing heart rate, and she became excessively tired. She was later found unresponsive, was resuscitated, and underwent emergency exploratory surgery. The medical staff then moved her to another hospital where she died later that day. This led her husband to bring a neglect case against the U.S. government under the Federal Tort Claims Act, arguing, among other issues, that the community hospital should have moved his wife to another facility. The plaintiff retained two maternal fetal medicine expert witnesses to support his case.
The Maternal Fetal Medicine Expert Witnesses
The plaintiff’s maternal fetal medicine expert witnesses were both physicians specializing in maternal fetal medicine. The maternal fetal medicine experts opined that upon observing the deceased’s low platelet levels, the army hospital staff should have run a blood coagulation test. The experts asserted that a competent fetal medicine specialist would have identified the symptoms of postpartum hemorrhage through a coagulation test and ordered a more intensive assessment of her condition. They further asserted negligence by the army hospital staff for failing to move the deceased to another hospital. The experts suggested that if the deceased’s physicians had conducted the appropriate tests and treatment, she would not have suffered hypovolemia, anoxic brain injury, and death.
The defendant responded that the plaintiff’s experts had not adequately shown that the failure-to-transfer was the proximate cause of death. The defendant argued neither expert had personal knowledge of how the patient would have been treated at the proposed transfer facilities.
One of the maternal fetal medicine experts testified that his opinion was based on his experience with a medical transport service and with a high-risk pregnancy unit. He cited his experience as a maternal fetal medicine specialist and his knowledge of the type of facility with a level III maternity unit as further qualifications.
The second maternal fetal expert witness testified that he could not say how the treatment would have differed at the transfer hospital, however, he based his opinion on his expectations of those types of facilities. He further testified that tertiary care facilities differ from community hospitals, such as the army hospital, because they have experts, sub-specialists, and specifically ICUs with experience in critical care and bleeding disorders.
The court noted that rather than focusing on claims of specific knowledge of the transfer facilities, the experts were qualified to testify on the types of resources available to these types of level III hospitals. The court further noted that the defendant’s arguments should only go to the weight to give the experts’ opinions. The court found no reason to dismiss the experts’ conclusions, permitting their evidence as to causation.
The motion to exclude the plaintiff’s two maternal fetal medicine experts was denied.