Verdicts

On Sept. 17, 2010, Bettie visited Dr. Wang in his office, where she complained of redness on her right breast and pain in that same location. After examination, Dr. Wang determined that the problem was merely a bug bite. However, by Sept. 20, 2010, the breast wound had worsened and Bettie had developed a fever. Dr. Wang advised Bettie to go to the emergency room. There, he saw her again, though another physician treated Bettie, prescribed oral antibiotics, and released her to return to her home.

Three days later, Bettie's home health care nurse became concerned when she noticed that Bettie was weak and that her breast wound had grown. She, Dr. Wang and the poison control representative advised Bettie to seek emergency care, but she did not do so. However, the following day she was admitted to the hospital. The next day after that, Sept. 25, 2010, Dr. Wang discontinued his patient's Coumadin because of a blood chemistry abnormality. By Sept. 28, the breast wound and the blood work results showed improvement, so Dr. Wang ordered the Coumadin restarted. The following day, Bettie developed a lesion on her thigh, prompting Dr. Wang to suspect Coumadin-induced skin necrosis (CISN).

Bettie eventually required a mastectomy to deal with the breast wound, and skin debridement for the thigh wound. She died on Aug. 1, 2011, almost exactly one year after she was taken off of Coumadin because of the CISN. Her husband, James A. Webster, filed a medical malpractice and wrongful death action against Dr. Wang and Windsong Medical Associates, P.L.C. in Superior Court, Yavapai County, AZ.

At trial, the plaintiff presented the testimony of his standard-of-care expert, James Wilson, M.D., who testified that Dr. Wang breached the standard by continuing the Coumadin administration on Sept. 20 and 24, 2010, and that restarting the medication on Sept. 28, 2010, also breached the standard of care.

The jury also heard the testimony of David Talan, M.D., the plaintiff's causation expert. Talan testified that CISN is capable of being stopped or slowed if caught in its early stages, but that the damage already caused may be irreversible. He also testified that the breast wound Bettie developed had probably gotten to the stage of requiring a mastectomy by Sept. 20, 2010. Nevertheless, he opined that the CISN of the thigh probably would not have developed had the Coumadin been discontinued on Sept. 20, 2010, and he further stated his belief that the cause of Bettie's death was complications from that thigh wound.

At the close of the plaintiff's case, the trial court granted the defendants' motion for partial summary judgment, pursuant to Rule 50 of the Arizona Rules of Civil Procedure. The court's reason for this determination was that plaintiff's expert, Dr. Talan, “indicat[ed] that as of September 20, 2010, there would have been damage no matter what.” Therefore, according to the trial court, “the jury should not be allowed to speculate as to treatment offered after September 20th, 2010.” The trial court therefore granted the motion for judgment as a matter of law “with regard to the claims of negligence after 9/20/2010.” The jury was informed that “the Court has made a legal ruling that the only conduct by defendants you are to consider is conduct occurring on or before September 20, 2010.”

In the final instructions to the jury, the court repeated that the “only conduct by Ying Wang, M.D., now at issue is that which occurred on September 20, 2010. In your deliberations you must not consider any conduct by Ying Wang, M.D., after September 20, 2010.” This instruction precluded the jury from considering that Dr. Wang continued Bettie on Coumadin for several days despite her breast wound, and then restarted it on Sept. 29, 2010, even after its discontinuance resulted in improvements to the patient. The jury returned a defense verdict.

Plaintiff Webster appealed. The appellate court considered the testimony of Webster's standard-of-care expert, James Wilson, M.D., and his causation expert, David Talan, M.D., in light of Rule 50, which provides that summary judgment in favor of a moving party may be granted if during a trial by jury a party has been fully heard on an issue and there is no legally sufficient evidentiary basis for a reasonable jury to find for that party on that issue. Such judgment as a matter of law is appropriate “only when the facts presented in support of a[n issue] have so little probative value that reasonable people could not find for the claimant.' Monaco v. HealthPartners of S. Ariz., 196 Ariz. 299, at 302, ¶ 6. Finding that the plaintiff's two medical experts offered sufficient testimony to allow a reasonable jury to infer that the decedent could have survived had her physician not taken certain actions after Sept. 20, 2010 — particularly Dr. Talan's testimony that he did not believe the thigh wound would have developed if the Coumadin had been discontinued on September 20 “[a]nd it wasn't reintroduced” — the appeals court held that the trial court's decision to grant partial summary judgment to the defendants was error.

Court Should Have Let Jury Consider All Evidence

The Court of Appeals of Arizona, Division One, has reversed a trial court grant of a defense motion to prohibit a jury's consideration of alleged negligent acts occurring after a date when a plaintiff expert opined that much of the damage that led to the decedent's death had already been done. Webster v. Windsong Medical Assocs., 2016 Ariz. App. Unpub. LEXIS 1655 (App. 2016).

The case arose when plaintiff's decedent Bettie Webster was hospitalized for a pulmonary embolism on Aug. 22, 2010, where she was prescribed the anti-coagulation medicine Coumadin. Bettie was in the hospital for several days and was eventually discharged by Dr. Ying Wang, who had assumed responsibility for her care mid-stay. Upon discharge, Dr. Wang advised Bettie to continue taking the Coumadin and to receive outpatient monitoring.

On Sept. 17, 2010, Bettie visited Dr. Wang in his office, where she complained of redness on her right breast and pain in that same location. After examination, Dr. Wang determined that the problem was merely a bug bite. However, by Sept. 20, 2010, the breast wound had worsened and Bettie had developed a fever. Dr. Wang advised Bettie to go to the emergency room. There, he saw her again, though another physician treated Bettie, prescribed oral antibiotics, and released her to return to her home.

Three days later, Bettie's home health care nurse became concerned when she noticed that Bettie was weak and that her breast wound had grown. She, Dr. Wang and the poison control representative advised Bettie to seek emergency care, but she did not do so. However, the following day she was admitted to the hospital. The next day after that, Sept. 25, 2010, Dr. Wang discontinued his patient's Coumadin because of a blood chemistry abnormality. By Sept. 28, the breast wound and the blood work results showed improvement, so Dr. Wang ordered the Coumadin restarted. The following day, Bettie developed a lesion on her thigh, prompting Dr. Wang to suspect Coumadin-induced skin necrosis (CISN).

Bettie eventually required a mastectomy to deal with the breast wound, and skin debridement for the thigh wound. She died on Aug. 1, 2011, almost exactly one year after she was taken off of Coumadin because of the CISN. Her husband, James A. Webster, filed a medical malpractice and wrongful death action against Dr. Wang and Windsong Medical Associates, P.L.C. in Superior Court, Yavapai County, AZ.

At trial, the plaintiff presented the testimony of his standard-of-care expert, James Wilson, M.D., who testified that Dr. Wang breached the standard by continuing the Coumadin administration on Sept. 20 and 24, 2010, and that restarting the medication on Sept. 28, 2010, also breached the standard of care.

The jury also heard the testimony of David Talan, M.D., the plaintiff's causation expert. Talan testified that CISN is capable of being stopped or slowed if caught in its early stages, but that the damage already caused may be irreversible. He also testified that the breast wound Bettie developed had probably gotten to the stage of requiring a mastectomy by Sept. 20, 2010. Nevertheless, he opined that the CISN of the thigh probably would not have developed had the Coumadin been discontinued on Sept. 20, 2010, and he further stated his belief that the cause of Bettie's death was complications from that thigh wound.

At the close of the plaintiff's case, the trial court granted the defendants' motion for partial summary judgment, pursuant to Rule 50 of the Arizona Rules of Civil Procedure. The court's reason for this determination was that plaintiff's expert, Dr. Talan, “indicat[ed] that as of September 20, 2010, there would have been damage no matter what.” Therefore, according to the trial court, “the jury should not be allowed to speculate as to treatment offered after September 20th, 2010.” The trial court therefore granted the motion for judgment as a matter of law “with regard to the claims of negligence after 9/20/2010.” The jury was informed that “the Court has made a legal ruling that the only conduct by defendants you are to consider is conduct occurring on or before September 20, 2010.”

In the final instructions to the jury, the court repeated that the “only conduct by Ying Wang, M.D., now at issue is that which occurred on September 20, 2010. In your deliberations you must not consider any conduct by Ying Wang, M.D., after September 20, 2010.” This instruction precluded the jury from considering that Dr. Wang continued Bettie on Coumadin for several days despite her breast wound, and then restarted it on Sept. 29, 2010, even after its discontinuance resulted in improvements to the patient. The jury returned a defense verdict.

Plaintiff Webster appealed. The appellate court considered the testimony of Webster's standard-of-care expert, James Wilson, M.D., and his causation expert, David Talan, M.D., in light of Rule 50, which provides that summary judgment in favor of a moving party may be granted if during a trial by jury a party has been fully heard on an issue and there is no legally sufficient evidentiary basis for a reasonable jury to find for that party on that issue. Such judgment as a matter of law is appropriate “only when the facts presented in support of a[n issue] have so little probative value that reasonable people could not find for the claimant.' Monaco v. HealthPartners of S. Ariz. , 196 Ariz. 299, at 302, ¶ 6. Finding that the plaintiff's two medical experts offered sufficient testimony to allow a reasonable jury to infer that the decedent could have survived had her physician not taken certain actions after Sept. 20, 2010 — particularly Dr. Talan's testimony that he did not believe the thigh wound would have developed if the Coumadin had been discontinued on September 20 “[a]nd it wasn't reintroduced” — the appeals court held that the trial court's decision to grant partial summary judgment to the defendants was error.