STATE OF LOUISIANA
COURT OF APPEAL
FIRST CIRCUIT
NUMBER 2006 CA 0599 R
GENE L THIBODAUX PATRICIA T
AND FELICIA T BADER
EVANS R THIBODAUX JR
NAQUIN
VERSUS
LEONARD 1 CHABERT MEDICAL CENTER FORMERLY SOUTH LA
MEDICAL CENTER JEFFERY J JOSEPH M D JOHN A DEAN M D
JOHN DAMPEER M D
THOMAS W DOWNES M D
JOSE MENA M D
AND CHRIS P PATRONELLA M D
Judgment Rendered September 14 2007
Appealed from
the
Thirty Second Judicial District Court
In and for the Parish of Terrebonne
State of Louisiana
Suit Number 106 961
Honorable David W Arceneaux
Presiding
Thomas A Gennusa
Counsel for Plaintiff Appellee
Metairie LA
Evans P Thibodaux Jr
Gregory C Weiss
Counsel for Defendant
Mandeville LA
Leonard J Chabert Medical Center
BEFORE WHIPPLE GUIDRY AND HUGHES JJ
Appellant
GUIDRY J
In this
Chabert
medical
appeals
malpractice action
the trial
court
of Flavia Marcel Thibodaux
s
Leonard J
it liable for the wrongful death
judgment finding
For the
reasons
Chabert Medical Center
that follow
affirm
we
FACTS AND PROCEDURAL HISTORY
Flavia Marcel Thibodaux
abdominal
pain
On
April
13
admitted
was
1988 staff
fifth year resident Dr Chris Patronella
Mrs Thibodaux which revealed
large pseudoaneurysm of her
Patronella
performed
the colon
however
they did
Chabert1
performed
3
resection with
primary end
remove
on
In the
at
a
following
several times with
time Mrs Thibodaux
conducted
months Mrs
complaints
was
the
Chabert emergency
room
transfusion
Thibodaux
I
Dampeer and
laparotomy2
Drs
to
s
care
on
a
Dampeer and
end anastomsis of
Rather
pseudoaneurysm
the circumstances
Thibodaux
including
Mrs Thibodaux
s
co
Drs
the risk of
morbidity
to resect
admitted
bleeding
with
to
and after
At the time of Mrs Thibodaux
1988
significant bleeding
Dean
numerous
s
was
a
tests
admission
unable
During this
rectum
Chabert three times and
On June 18
John
Dr
to Chabert emergency
reported
of passing blood from her
However the staff at Chabert
s
blood
for
later date
of Mrs Thibodaux
a
1988
let Mrs Thibodaux recuperate from the abdominal surgery and
to
the pseudoaneurysm
were
exploratory
the surgery
not
11
April
sigmoid volvulus twisted colon and
potential contamination of the operative field and
room
an
During
Dampeer and Patronella decided based
factors
on
surgeon Dr John
general
necrotic
aorta
sigmoid
a
a
to
to
diagnose the
Thibodaux
Mrs
from her
rectum
fifth year resident
tests
numerous
cause
reported
necessitating
oversaw
determined that Mrs Thibodaux
Chabert
was
known
to
Mrs
must
South Louisiana Medical
as
Center
2
3
Dr Thomas Downes and Dr Jose Mena assisted
There is
no
dispute
that the
that had been
placement
April 1988 surgery
during
pseudo aneurysm
performed at Terrebonne
2
was
the surgery
the result of
General
Hospital
an
aortobifemoral
several years
prior
graft
to the
have
aortaenteric
an
operatively
revealed
Drs
fistula
of
some
kind
Dampeer and Dean performed
large pseudoaneurysm of the
a
which needed
surgery
and
aorta
on
a
be
to
June 23
addressed
1988 which
communication
or
an
aortaenteric fistula between the pseudo aneurysm and the suture line from the April
Mrs Thibodaux
surgery
recovery but died
on
was
in surgery for
approximately eleven hours
Thibodaux
claims
s
to
pursuant
care
well
as
as
the
At the
a
bench trial
beginning of trial the parties agreed
surgeons from the suit
thereby leaving Chabert
as
the
judgment dated August 8 2005 the trial
a
Thibodaux and
against Chabert and awarded
only
court
to
held
was
plus
costs
Thibodaux filed
accrual
a
and
judicial interest from May
motion for
of interest from
court
judgment
December 29
1989 however
this
court
July
24
a
motion
ex
Chabert did
propio
2006
motu
and
accordance with La
2005
not
to
appeal
to
a
reflect
art
the
rule
to
203
44
595
1993
judgment
from
s
new
3
Mr
provide for the
May
21
1993
trial and amended the
interest due from June 23
cause
appeal
However
2088
in funeral
Thereafter
to
in
44
595
August 8 2005 judgment The
judicial
show
March 28
found in favor of Evans
from the amended judgment
dismissed Chabert
C CP
the
rather than
1989
appeal
issued
to correct
the motion for
subsequently granted
on
trial
June 23
Additionally Chabert filed
trial
new
21
on
named defendant
Thibodaux
Mr
survival
dismiss the individual
damages which included 200 000 00 in general damages and 3
expenses
However
Gene Thibodaux
wrongful death claims of
Naquin and Felicia Bader Thereafter
In
for Mrs
responsible
seeking wrongful death and survival damages
dismissed
and 29 2005
surgeons
Naquin and Felicia
exception of prescription filed by Chabert plaintiffs
an
were
Patricia
petition against Chabert and the
a
into
24 1988
April
Thereafter Evans Thibodaux Gene Thibodaux Patricia
Bader filed
went
which
was
for lack of
on
Accordingly
maintained
jurisdiction
January 12
2007
on
in
the
Louisiana
Supreme
Court
dismissing
Chabert
appeal
s
writs in this
granted
matter
and remanded the
reversed this
court
this
for
matter to
court
ruling
s
briefing
argument and opinion
DISCUSSION
In order to
the
prevail
establish
1
ordinarily
exercised
in
a
medical
degree of knowledge
or
similar
a
medical
or
practices in
plaintiff has
the
state
locale
or
degree of
to
care
of Louisiana and
and
under
similar
particular specialty and the
a
negligence raise issues peculiar
involved then the
specialty
possessed
community
circumstances and where the defendant
acts of
skill
plaintiff is required
a
by physicians licensed to practice in the
actively practicing in
alleged
action
malpractice
the burden of
to
the
proving
particular medical
the
degree of
care
ordinarily practiced by physicians within the involved medical specialty
2 that
the defendant either lacked this
to
reasonable
care
that skill and
failure
and
3
that
as
La
10 11
La
15
6
07
applicable
the substandard
suffered
physician
s
physician
benefit of
676 So
will
not
hindsight
2d 218
at p
application
or
skill
the
doctor
a
plaintiff
must
breach of that standard of
v
care
injury the plaintiff would otherwise
11
951 So 2d at 314
to
always evaluated in
a
terms
standard of
perfection
Venable 95 2345 p 4 La
In medical
or
not
establish the
an
be held
of
Mitchell 06 0382
malpractice
4
actions
nor
and that
not
have
of reasonableness
existing when his professional judgment
Lefort
220
v
use
951 So 2d 307 314 writ denied 07 0905
In other words
conduct is
under the circumstances
The
to the
caused
care
Lieux 06 0382
The
See La R S 9 2794A Lieux
958 So 2d 1199
standard of care
in the
degree of care the plaintiff suffered injuries that would
1st Cir 12 28 06
App
failed
or
proximate result of this lack of knowledge
a
otherwise have been incurred
pp
skill
or
diligence along with his best judgment
exercise this
to
degree of knowledge
was
exercised
evaluated with the
App 1st Cir 6 28 96
opinions
from medical
experts
necessary to determine both the
are
whether that standard
was
breached
When medical experts
witnesses
are
Lefort 95 2345
called
are
persuasive although
not
as
well
State
05 2126 p
1678 p 8 La
the
assess
the expert
as
14
determinations
Foundation 96 1136 p
writ denied 97 1651
are
in conflict
reviewing
will
11
April
an
Hoot
701 So
2d 209
with the
to
s
1988
discovered
a
Salvant
v
experience
Bradbury v Thomas 98
The trier of fact
Woman
v
must
Hospital
s
691 So 2d 786 789 790
When the
experts
applicable standard of
opinions
care
the
that the trial
graft
court
erred in
finding the
At trial Dr Shamblin
June 24
1988
s
a
board certified
sigmoid volvulus and
on
a
general
medical records from Chabeli
According
an
to these
records
Mrs
abdominal aortic aneurysm
The records further indicate that Mrs
exploratory laparotomy
to
surgeons and that the surgeons at Chabert
general
4
care
asserts
past surgical history included repair of
an
is
expert Dr James Shamblin legally sufficient
s
of
through
aortobifemoral
underwent
and
opinion
the conclusions of the trier of fact
stated that he reviewed Mrs Thibodaux
Thibodaux
with
Chabert
care
breached that standard of
from
which the
on
their
to
676 So 2d at 221
case
prove the standard of
surgeon
10 3 97
Mr Thibodaux
testimony of
evaluations
give great deference
at p 4
In the instant
upon the facts
App 1st Cir 3 27 97
La
La
220
at
weight assigned
any
757 So 2d 666 673
concerning compliance
court
Lefort 95 1472
6
and
credibility of all the witnesses and make factual
these
regarding
care
the views of such expert
testify
935 So 2d 646 656
9 24 99
App 1st Cir
and
p 4 676 So 2d
professional qualifications
s
La 7 6 06
testimony
at
controlling and
testimony by the trier of fact is dependent
based
to
standard of
applicable
Thibodaux
April 13 1988 whereupon the
surgeons
pseudo aneurysm of the left limb of the
assign error to the trial court s finding of causation Accordingly our
discussion is limited to determining whether the trial court erred in finding that Mr Thibodaux
established the applicable standard of care of general surgeons and that the surgeons in the
4
Chabert does not
instant
case
breached that standard of care
5
aOliobifemoral
of the colon which
anastomosis
the
as
an
two
enlargement
that while
according
surgical notes
cuts out
the twisted
of
blood vessel much like
a
a
according
pseudoaneurysm which
to ten
the
was
to
was
corrected
portion
blister
Shamblin
or
by an end
of the colon and
when
end
resects
pseudoaneurysm
a
Additionally
he stated
a
Dr
the surgeons allowed the
an
orange
to
remain
placed against
a
cause
suture
the
blood vessel
as a
adjacent
to
line
on
pseudoaneurysm pulsates
a
the fixed colon
development of
tube
a
stated that
enteric
nature
the
refers
to
the antheral intestines
that it communicates with
means
sigmoid portion of the colon
aortacolonic fistula which is
allows blood
the rectum
to
as
a
Shamblin the
contaminated with bacteria from
psuedoaneurysm
at
performed
a
Chabert
Hartman
some
According
s
an
Shamlin
Dr
part of the gastrointestinal
involved in this
case
making it
Such
a
an
fistula
case
placement of the
the anastomosis
to Dr
Shamblin
suture
adjacent
deviation from the standard of
was a
called
pseudoaneurysm into the intestines and through
ultimately occurred in this
to Dr
pulsating
and that any fistula that is
subcategory of aortaenteric fistulas
transfer from the
According
was
the
tract
or
aortaenteric fistula between the pseudoaneurysm and the intestines
surgeons
to
perimeter of the intestines and about eight
about the size of
explained that
pseudoaneurysm would
tract
twisting
from the anastomosis
Dr
enteric in
a
walls of the vessel
two
the medical records
within the
centimeters in diameter
suture
and
sigmoid volvulus is
is fusiform and involves all three walls of the vessel
pseudoaneurysm is saccular and only involves
Shamblin stated that
a
Dr Shamblin defined
ends of the intestines
true aneurysm
a
explained that
the
to
procedure that
a
remaining
Dr Shamblin
graft
care
out
6
to
of Mrs Thibodaux
the
was
pulsating
required of general
the surgeons
pouch procedure and colostomy
directed the open end of the intestines
line which
should have
which would have
s
body through
the
abdominal wall and closed off the
line
suture
any
placed
the pseudoaneurysm
near
omentum
a
so as
Dr Thomas Boos
a
to end
never
no
exact surgery
and
colostomy
on
or an
heard of
a
to
to
on
a
performing
In his
opinion either
was
at
acceptable
applicable standard of
Hartman
a
care
placement of
have made any difference and has
never
heard of
having
pseudoaneurysm
Boos
However
recommended in aneurysm
over
time
pulsate the
Dr
repairs
of the suture line from
a
same
was no
need
duodenal fistula
and that the
to
line in the absence of
place
a
credit the
to
at p
that
acknowledge
pulsation
However
omentum
suture
a
is
prevent
line
the
and
aneurysms
pulsated all around
case
Dr Boos
to
against
acknowledged that all
pseudoaneurysm in this
for
omentum
of the arteries
break down the
Dr Boos
would
was
of the
opinion that
between the pseudoaneurysm and the
suture
graft
testimony of
Lefort 95 1472
omentum
to use omentum
Clearly the testimony of the experts conflicts and the
to
by choosing
buffer the anastomosis of the graft
to
including against the anastomosis
there
did
which will infect the anastomosis
cause
pouch
s
end anastomosis
feel that
duodenum
end
that time and the
not
rubbing
Dr Boos
primary
a
care
pseudoaneurysm and that he has performed
end anastomosis
Further Dr Boos stated he did
constant
standard of
applicable
behalf of Chabert
contraindication of
surgeons did not deviate from any
perform the end
testified
several occasions
end
suture
surgeon and member of the
general
deviation from any
anastomosis in the presence of
this
the surgeons should have
Alternatively
board certified
the individual surgeons
stated that he had
eliminating
prevent erosion and formation of a fistula
to
medical review panel that found
or
of her intestines
tissue buffer between the pseusoaneurysm and the
fatty
line of the anastomosis
by Chabert
remaining portion
4
one
676 So
expert
2d
at
over
221
7
trial court
s
decision
the other demands great deference
Chabert
asserts
however that the
of
development
an
aortacolonic fistula is
established standard of
Shamblin
s
evidence
with
end
opinion regarding
the standard of
or
that there
rare
an
not
supported by
Shamblin
to Dr
journal article
no
medical
inexperience
s
in
inexperience
was
and that Dr
occurrence
care was
aortacolonic fistulas and
performing
an
upon which Dr Shamblin
prevention of aortaduedenal fistulas and
occurred in the instant
as
such
preventing
end anastomosis the 1981 medical
relies deals with the
fistulas
for
Chabert asserts in addition
Particulary
pseudoaneurysms
to
care
extremely
aortacolonic
not
case
However Dr Shamblin stated that he studied with Dr Marden Black who
specialized
Clinic
in colon surgery and
Dr
Shamblin also
thyroid
stated that he researched
aortaenteric fistulas and stated that the
the
same
for
a
during his residency
surgery
duodenal fistula and
aortaenteric fistula is between the
aorta
material is
less
placed between the aneurysm
likely
to
occur
Dr
After
court
s
a
or
graft
covers
to
formation of this
particular
from
a
that
principle
a
a
we
While all the
pulsating
fistula
as a
Dr
fifth year
are
aneurysm
serves as a
Patronella
general
aortaduodenal
duodenal fistulas
and the duodenum
kind of fistula is very
suture line and omentum
causing
testimony
namely from
an
the fistula is
so
is the
same
even
find
for
an
as more
in the trial
credible than the
testimony indicates that the
rare
the medical evidence and
known
or
no error
to
develop
under certain
pseudoaneurysm compressed
buffer
to
keep this pulsating
mass
acknowledged in his deposition
surgery resident he knew that
8
an
the colon rather than the duodenum
testimony also indicates that fistulas in general
against
preventing
accept the testimony of Dr Shamblin
expert testimony offered by Chabert
fistula would be
Dr Shamblin stated that
thorough review of the entire record
decision
circumstances
In
Shamblin stated that the
aortaenteric fistula but the material
a
and the intestine whereas
fistula is between the aorta and the duodenum
the Mayo
pseudoaneurysms and
principle of preventing
enteric fistula
an
at
a
pulsating
pseudoaneurysm which is compressing the intestines and surrounding
could erode and
present in the instant
find
no error
applicable
fistulas
cause a
case
of
Therefore
and the surgeons
in the trial court
standard
tract
s
care
were
finding that the
in
failing
structures
because these factors
admittedly
aware
were
of them
we
surgeons at Chabert breached the
to
place
omentum
between
the
pseudoaneurysm and the suture line from the anastomosis
CONCLUSION
For the
foregoing
reasons
we
affirm the trial
favor of Mr Thibodaux
All
be borne
Chabert Medical Center
by the appellant
costs
of this
AFFIRMED
9
court
appeal in the
s
judgment finding
amount
of
5 982 51
are
in
to