Case Name: Techler Paul, as Personal Representative of the Estate of Marie Paul, deceased v. FL-Broward Nursing, LLC, a Florida limited liability company d/b/a Deerfield Beach Health and Rehabilitation Center, LTC Hospitalists, Inc., a Florida corporation, Hemangini J. Mehta, M.D
- Nursing Homes
- Wrongful Death
- Medical Malpractice – Nurse; Failure to Treat; Negligent Treatment; Lost Chance of Recovery
- Cardiac – Myocardial Infarction
Plaintiff Attorney: Gary A. Friedman; Friedman & Friedman, P.A.
- Marc P. Ganz; Nosich & Ganz, Attorneys At Law for LTC Hospitalists, Inc., Hemangini J. Mehta
- George M. Vinci Jr.; Spector Gadon & Rosen for FL-Broward Nursing, LLC
- Karen M. Rich; Spector Gadon & Rosen for FL-Broward Nursing, LLC
Case Outcome: Arbitration
Award Amount: $3,015,000.00
Actual Award: $1,055,250.00
On June 6, 2014, Marie Paul, a 65-year-old woman suffering from end-stage kidney disease, went to Deerfield Beach Health and Rehabilitation Center. At the time she moved into the center for care, her kidney condition required her to have regular dialysis treatments, which were a medical necessity. Three days after moving in, Paul’s medical lab report showed that she had elevated potassium levels, above what is normal. Her attending doctor, Hemangini Mehta, knew about the lab results.
An overabundance of potassium in a person’s blood is called hyperkalemia. Hyperkalemia is associated with poorly-working kidneys. Potassium is an important nutrient that keeps nerves and muscles—including the ones in the heart—functioning properly. One of the kidneys’ jobs is to balance how much potassium is taken in with how much is lost by urination. Too much potassium in the blood creates a risk of serious heart problems.
An adult’s potassium level typically ranges from 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia exists when someone’s potassium levels exceed 5.5 mmol/L. Anything above 6.5 mmol/L can cause heart problems. Immediate treatment is required.
Plaintiff’s Hyperkalemia Leads to Death by Heart Attack
The day after the lab results showed that she had hyperkalemia, Marie had her regular dialysis treatment appointment at a facility across town. Because of her condition, Paul required special transport in an ambulance, which the center had arranged. However, on the morning of her appointment on June 10, a licensed practical nurse at the center canceled the transport service. This meant that Marie did not have dialysis that day.
About twelve o’clock the night of June 11, 2014, Paul started to exhibit restlessness and confusion. The center’s nursing staff administered oxygen to the patient to no avail. Marie went into cardiac arrest at approximately 1 a.m. She was sent to a nearby hospital. Laboratory tests at the hospital revealed that Paul’s potassium level had worsened, rising from 5.8 to 7.4. The hospital pronounced Marie Paul dead at 2 a.m. Physicians determined that a myocardial infarction, brought on by her underlying untreated hyperkalemia, caused her death.
Allegations and Testimony
Paul’s surviving husband, Techler Paul, sued the operator of Deerfield Beach Health and Rehabilitation Center, FL-Broward Nursing, LLC; Dr. Mehta; and Mehta’s employer, LTC Hospitalists Inc. for wrongful death. During the case, Dr. Mehta and LTC Hospitalists were dismissed as defendants. The legal action proceeded to arbitration solely against FL-Broward Nursing.
In his lawsuit, Mr. Paul sought compensatory damages for the loss of his wife’s companionship. He also sought damages for his emotional pain and suffering from her death. Additionally, he asked that the defendants pay him for the costs of Marie’s funeral.
Mr. Paul alleged that the defendants caused his wife’s wrongful death when they failed to properly treat her medical conditions. He also asserted that the defendants’ actions amounted to medical malpractice.
Failure to Treat
His lawyer contended that the medical standard of care for Marie’s worsening hyperkalemia required that she receive care and treatment and/or dialysis on the morning of June 10. Mr. Paul’s counsel also alleged that FL-Broward Nursing and Mehta were aware that Marie didn’t have the scheduled dialysis. The plaintiff maintained that when Dr. Mehta examined Marie on the afternoon of June 10, she knew about her abnormal potassium levels from the lab results and that the patient was terribly upset about the missed dialysis appointment.
The plaintiff claimed that Dr. Mehta’s failure to order emergency dialysis and medication to lower Marie’s potassium levels on June 10 departed from the standard of care. Further, Mehta’s issuance of an order for dialysis the next day, on June 11, was also a failure of care. Counsel contended that Mehta had standing orders for Marie’s dialysis at Deerfield Beach Health and Rehabilitation Center. These orders included the administration of oxygen if the patient’s oxygen saturation levels fell below 90%. In the early evening hours of June 10, Marie developed shortness of breath. She also had an oxygen saturation level of less than 90%
The plaintiff’s attorney also argued that the nurse’s cancellation of Marie’s transportation to her dialysis appointment was negligence on the part of FL-Broward Nursing and its nursing staff. Moreover, the transport cancellation delayed and severely compromised Marie’s chances to get the needed dialysis that day. Lastly, Paul’s counsel contented that FL-Broward Nursing’s staff was negligent when they failed to call Dr. Mehta when Marie’s condition and symptomology started to significantly change around midnight on June 11, 2014.
Defendant’s Response & Attempt to Apportion Liability to Dr. Mehta
The defendant, FL-Broward Nursing, denied any negligence or standard of care departure that occurred in Marie’s care and treatment. In Florida, a defendant may argue that liability should be apportioned to a third party not named as a defendant. These third parties are often called a Fabre defendant.
In the Paul case at hand, the defense counsel added Dr. Mehta (previously dismissed from the matter) as a non-party, Fabre defendant for liability apportionment in any award.
Who Won the Case?
The judge serving as the arbitrator awarded Mr. Paul compensatory damages in the amount of $3,015,000.
The award broke out as follows:
- Estate of Marie Paul – $15,000 wrongful death: funeral burial expense
- Techler Paul – $3,000,000 wrongful death: loss of companionship, and pain and suffering
The arbitrator determined that Dr. Hemangini Mehta—a non-party, Fabre defendant at arbitration—was 65% percent liable for Ms. Paul’s death. The arbitrator determined that FL-Broward Nursing was 35% liable. After offset for the comparative-liability, Mr. Paul likely recovered $1,055,250.
The plaintiffs retained expert witnesses in:
This case is a reminder that something as simple as a staff nurse canceling a transport for a patient’s treatment can lead to dire outcomes. Staff at medical facilities have duties to patients. They must execute care compatible with the relevant standard of care. Building a compelling case against nursing staff can be as important as convincing a judge or arbitrator of a doctor’s negligence.
Plaintiff counsel will also want to ferociously fight any motions to dismiss doctors in medical malpractice cases in Florida. Doctors are frequently found to shoulder the lion’s share of responsibility in medical malpractice cases because they oversee a patient’s care and staff execute doctors’ orders. The Fabre defendant strategy in this case drastically reduced the plaintiff’s award.