Victories

Dental Implants

In this case, the plaintiff entered into a $60,000 contract for dental implants. The plaintiff sued our client, alleging inadequate informed consent, improper pain management, excessive billing, and an unsuccessful treatment that left her without final dentures. She claimed that she was not sufficiently informed about the treatment options or associated costs and further claimed that the defendant failed adequately to address severe pain. She further alleged that the defendant charged excessive fees beyond the agreed bundle price and that the flawed treatment plan led to an unsuccessful and incomplete outcome.

At trial, we demonstrated that the plaintiff actively participated in the treatment plan and that the high cost of the procedure, and the written documentation, indicated her full and complete understanding of the treatment. We also proved multiple attempts, on the part of our client, to manage the plaintiff’s pain, including employing an anesthesiologist and offering specialized sedation, which the plaintiff refused. We also showed the additional charges were incurred due to complications stemming from the plaintiff’s undisclosed history with anesthesia and extremely low pain tolerance. We further proved that the incomplete treatment resulted from the plaintiff’s refusal to proceed with recommended follow-up procedures, in spite of our client’s efforts to please the plaintiff. During the trial, we established to the jury that the plaintiff's own decision to terminate treatment, and refusal to return, not any negligence on the part of the dentist, led to the unfinished procedure.

After less than an hour of deliberation, the jury returned a unanimous verdict in favor of the defense (12-0), finding our client not negligent and not liable for the plaintiff’s claim.

Result: Victory for the defense.

Intensive Care – Pulmonology

The plaintiff/decedent was a 60-year-old woman with multiple morbidities, including a history of hypertension and end-stage renal disease. Following a procedure for the elective placement of a left-sided AV fistula, she experienced hypoxemia and required ICU care under the care of a team of doctors, which included our client, an intensivist/pulmonologist. Several defendants were sued in the case.

The plaintiff’s attacks on our client centered on an alleged negligent failure to address and evaluate the patient’s hypoxemia, which was the basis for her ICU admission. Ultimately, the patient underwent a thoracentesis, suffered complications from that procedure including severe hemorrhage and ventricular tachycardia, and died.

The plaintiff’s allegations were many. This “scattershot” technique is not unusual in medical malpractice trials. In addition, the plaintiff’s lawyer alleged that our client failed to order timely arterial blood gas tests, did not intubate the patient when necessary, and neglected proper neurological evaluations and other diagnostic protocols.

When the case went to trial, all of the other co-defendants settled out of court. We were the only party to fight the case through to the jury verdict.

We and our client, and our expert witness, argued that intubation is a last resort, and the patient’s condition did not warrant it prior to the thoracentesis. Additionally, we presented strong evidence that the thoracentesis, which our client neither ordered nor performed, was the primary cause of death. Ultimately, the jury returned a unanimous defense verdict (12-0), finding our client not negligent or liable for the plaintiff’s claim.

Result: Victory for the defense

Cardiology

This was a case that, sadly, involved the death of a 59-year-old male patient with a history of severe coronary artery disease, COPD, and prior cardiac interventions. The plaintiffs’ attorney sued a total of eight defendants. Our client was the only one who went to trial. Every other defendant, except one, settled out.

In this jury trial, we defended a board-certified, very experienced, interventional cardiologist, who had performed a PCI (Percutaneous Coronary Intervention) procedure on the patient. This minimally invasive procedure, also called a Coronary Angioplasty, is aimed at opening narrowed or blocked coronary arteries without requiring major open-heart surgery.

The procedure was successful but resulted in complications, including a pseudoaneurysm and a large retroperitoneal hematoma. Our client repeatedly requested surgical intervention to address the bleeding issues. In spite of this, the surgical consult and surgery was delayed and, once it was finally done, did not resolve the problems. In fact, the operative documentation did not even refer to the primary problem locations. Three days after the surgery, the patient was discharged. A few hours later, he experienced severe shortness of breath and chest pain. He collapsed and died in spite of resuscitative efforts. Autopsy findings revealed pulmonary embolus as the cause of death.

Plaintiffs’ counsel, a very experienced and skilled medical malpractice trial lawyer, argued that the patient exhibited signs of deep vein thrombosis (DVT) and pulmonary embolism (PE) as early as three days before the surgery, and that anticoagulants should have been administered immediately following the surgery itself. He contended that this delay led to the plaintiff’s death. At his Closing Argument, he asked the jury to award $4–$5 million in non-economic damages, plus $859,000 in economic damages, and pre-judgment interest.

We responded to plaintiffs’ arguments by bringing in expert testimony to educate the jury to the fact that an earlier start of anticoagulants would have carried its own set of dangerous risks. We demonstrated that anticoagulants could not safely be administered due to the patient’s active bleeding and that the surgical team failed to address the hematoma and pseudoaneurysm, thereby prolonging and exacerbating the bleeding risk. Additionally, we emphasized that only a single embolus was found at autopsy, and our scientific evidence indicated it formed 6–48 hours before the plaintiff’s collapse, making it unlikely to be tied to any alleged negligence on the part of our client.

Though one defendant was dropped out early on, our client was, ultimately, the only defendant who did not settle out of the case. The trial was a longer one, taking parts of three weeks before completion. It was a hard-fought trial against a very good plaintiffs’ lawyer in a county known to be a very favorable venue for plaintiffs.

The jury returned a verdict in favor of the defense, finding our client neither negligent nor liable for the plaintiff’s death.

Result: Victory for the defense

Psychiatry/Toxicology/Pharmacology

In this death case, the plaintiff/decedent had a complex medical and personal history that influenced her treatment with our client, a very experienced psychiatrist whom she had seen intermittently for over a decade. Her attendance at therapy sessions often depended on her ability to find transportation and on her financial situation, leading to periods of consistent care interspersed with gaps. The patient struggled with methamphetamine use, was HIV positive, and had hepatitis C. Our client treated her for severe bipolar disorder, noting the characteristic fluctuations in her condition. He prescribed Seroquel in doses ranging from 1200 mg to 1500 mg per day, tailored to her financial limitations and ability to afford medications. Despite her other medical challenges, our client’s interactions with the patient were primarily focused on managing her bipolar disorder rather than addressing her other health issues, which were being addressed by other providers.

The patient was found deceased in her apartment. Ultimately, it was determined that she had died approximately two and a half weeks before she was found. The plaintiffs in the subsequent wrongful death lawsuit alleged that her death resulted from the combination of Seroquel, prescribed by our client, and other medications she was taking. They further claimed that the dosage of Seroquel, prescribed by our client, exceeded FDA recommendations and was a direct cause of her death.

We fought against the plaintiff’s allegations, emphasizing that our client’s prescription decisions were guided by his professional judgment, the severity of the patient’s condition, and the constraints of the patient’s financial circumstances. We argued that her death could not be conclusively linked to his treatment or the dosage of Seroquel she received. Our client’s care was framed within the patient’s broader health challenges and the difficulties inherent in treating a patient with her medical and social complexities.

Ultimately, the jury rendered a defense verdict, finding no negligence or causation attributable to our doctor’s decisions and actions. The decision underscored the lack of evidence directly connecting his treatment decisions to the patient’s death and highlighted the broader challenges in managing her very complex health issues.

Result: Victory for the defense

Obstetrics/Gynecology/Surgery

This case centered on allegations that the plaintiff suffered a ureteral injury due to negligent medical care during and after her hysterectomy performed by our client, the defendant. The patient underwent a laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy performed by our Ob/Gyn client. During this surgery, the patient sustained a thermal injury to her ureter. Post-operatively, she experienced abdominal pain, nausea, and pelvic discomfort. Our client promptly responded to these complaints, examined her, and performed an ultrasound, which was unremarkable. Consultation with an internal medicine physician revealed a diagnosis of deep venous thrombosis and postoperative ileus. Over the following days, the patient’s condition improved, and her elevated creatinine levels decreased from 1.7 to 1.1, approaching normal. After multiple examinations and days of hospitalization, she was discharged.

During her first post-operative visit, the patient reported significant improvement. Although she still experienced mild intermittent abdominal pain, she had no difficulty voiding, was ambulatory, and had normal bowel function. Her abdominal examination was normal, with no signs of complications. A few days later, however, she presented to the emergency room with a chief complaint of severe pain. Further evaluation revealed a left ureteral injury with urine extravasation into the peritoneal cavity, necessitating surgery to repair the injury.

The plaintiff claimed that the ureteral injury, her pain and suffering, additional hospitalizations, and the corrective procedure were the result of our client’s negligence. She alleged that he failed to perform the surgery properly, did not adequately assess her intraoperative and postoperative conditions, and did not fully disclose the risks associated with the procedure.

At trial, the jury found in favor of the defense, determining that the doctor was not negligent and that no negligence on his part caused the patient’s injuries.

Result: Victory for the defense

Dental Extractions and Dentures

The plaintiff, a 60-year-old man with very poor oral hygiene, sought treatment from our client for tooth pain. After discussion of the various options available, and after the passage of some weeks, the plaintiff elected to undergo a full-mouth extraction, as his wife had done previously. The plaintiff elected to have his teeth removed and replaced with dentures. Subsequently, the defendant performed the full-mouth extraction, after again obtaining written consent from the plaintiff to do so. The plaintiff later claimed he only consented to the removal of two teeth, had no idea whatsoever that the defendant was removing anything more than two teeth, that the risks and alternatives were never explained, that he never understood and never consented to the full mouth extraction, and that the procedure left him with exposed root tips and no immediate dentures. Due to an allegedly severe gag reflex, the plaintiff claimed he was unable to be fitted for dentures and remained toothless for over seven months. He sought damages for pain, suffering, disfigurement, and future dental costs.

For the defense, we argued that the plaintiff’s many years of extremely poor oral hygiene made a full-mouth extraction and fitting for dentures a reasonable option, consistent with the plaintiff’s desire to minimize costs and time spent in dental appointments. We further demonstrated that the procedure, treatment plan, and risks, were clearly communicated, both orally and in writing, to the plaintiff, on more than one occasion by more than one person, long before the extractions were done. We also presented evidence that the plaintiff was fully informed of the procedure beforehand. After careful investigation, the defense was able to identify and obtain the testimony from three witnesses who testified that the plaintiff understood his options, including the option to do nothing or to just have two teeth removed, and that he elected to have a full-mouth extraction and dentures.

Further, testimony from the defendant and two members of his staff established that the plaintiff was aware of the full-mouth extraction plan and signed consent forms to that effect. We also highlighted, for the jury, the plaintiff’s contributory actions, including removing his own sutures and continuing to use oral tobacco despite pre- and post-operative instructions not to do so. The defense emphasized inconsistencies in the plaintiff’s claims, such as enduring a lengthy procedure without questioning the removal of all teeth. We were able to present evidence that the plaintiff himself had taken pictures with his cell phone during the extraction and that these photos showed several teeth, not just two, on a tray at the dental chair.

The jury returned a unanimous verdict for the defense, finding our client had not been negligent and was not liable for the plaintiff’s claim.

Result: Victory for the defense

Spine Surgery

This case involved allegations against our client, a spine surgeon, for negligent medical care leading to the plaintiff’s claimed leg complications and nerve issues after a minimally invasive disk decompression surgery. The patient, a 57-year-old female, had a history of back and neck pain and sought treatment from our client, who performed a procedure aimed at relieving the patient’s pain.

Despite being advised against extended travel post-surgery, she traveled home for two hours and later experienced difficulty moving her legs. An MRI was promptly ordered, and both our client, and a consulting neurologist diagnosed her leg issues as caused by a viral flare, likely triggered by stress. Although her left leg improved within days, she ultimately saw neurosurgeons about the problem. The first neurosurgeon recommended conservative treatment. The second performed a nerve graft surgery, which we argued was unnecessary and caused further damage.

The plaintiff admitted to significant leg recovery, but electromyography tests showed the operated nerve did not recover. The operating neurosurgeon noted that nerves could take up to two years to heal, suggesting his surgery was premature. The defense maintained that our client’s care was indicated and appropriate, and that the viral flare caused complications, not his actions. The plaintiff's expert initially criticized our client but later, under cross-examination, conceded that the viral flare might have contributed to the symptoms.

Our client was the only defendant at the trial. The jury found that our client was not negligent.

Result: Victory for the defense

Cardiology – Pacemaker - Cardiac Tamponade – Intensive Care

The plaintiff in this case was the decedent's husband. The decedent was 68 years old at the time of her death. This case revolves around the allegations that her treating physicians, including our client, failed to timely diagnose a cardiac perforation and pericardial blood accumulation, leading to cardiac tamponade, following her permanent pacemaker placement. According to the plaintiff’s counsel, the decedent was discharged after the procedure without the proper diagnosis, which was only established the following day through an echocardiogram and CT scan. This delay, the plaintiff claimed, caused the decedent to suffer from prolonged hypotension, which required high-dose vasopressor support, ultimately leading to multi-organ failure and death.

The plaintiff alleged that our client, one of the treating physicians, fell below the standard of care by not ensuring that a STAT chest CT scan was performed, not ordering a STAT cardiothoracic consultation to address the cardiac perforation and pericardial tamponade, and not ensuring that such consultation occurred in a timely manner. The plaintiff argued that these failures significantly contributed to the delay in diagnosis, which resulted in the patient’s death.

In response to the plaintiff’s allegations, we contended that our doctor had provided appropriate care by promptly ordering a chest CT scan, and by ensuring that an echocardiogram was also promptly conducted. We emphasized that echocardiograms are the most reliable method for diagnosing pericardial tamponade, asserting that a CT scan alone would not have sufficed. Based on the impressions from the echocardiogram and CT scan, the defense argued that no tamponade was present at the pertinent time, which meant there was no basis for ordering a cardiothoracic consultation. The defense maintained that criticisms of our client for not obtaining a STAT CT scan or consultation were unfounded, as there was no clinical indication at the time suggesting a need for immediate intervention.

All of the co-defendants, except one, settled out of the case prior to trial. The one remaining co-defendant settled out of the case before verdict.

Result: Victory for the defense

Pancreatitis – Ketoacidosis – Cardiology

This multi-defendant case centered on allegations that the patient suffered a cardiac arrest and subsequent brain injury due to negligent medical care following his hospital admission and care under his team of doctors, which included our client, one of several defendants. The patient, a 32-year-old male with diabetes, chronic pancreatitis, and hypertriglyceridemia, presented to the hospital with acute pancreatitis and diabetic ketoacidosis. He was admitted to the ICU under the care of one of the co-defendant physicians, who coordinated treatment with a consulting gastroenterologist, another defendant. Despite significant abnormalities in the patient’s lab values, including critically low calcium levels, no supplemental calcium was administered. His condition deteriorated, culminating in a cardiac arrest, anoxic brain injury, and a permanent vegetative state.

During the litigation, the plaintiffs alleged that failures by the various healthcare providers to address hypocalcemia led to cardiac arrest and resulting injuries. They further argued that medications such as Metoprolol, administered by our client, a cardiologist, weakened the patient’s heart and contributed to his cardiac arrest. In contrast, we contended that the patient’s condition was caused by systemic inflammatory responses to pancreatitis and diabetic ketoacidosis, not by any negligence on the part of any defendant, much less our client. We emphasized that cardiologists do not typically manage hypocalcemia or its related complications and that the patient’s tachycardia was a natural consequence of his underlying conditions.

Before the lengthy trial, one co-defendant was dropped from the case while all of the remaining co-defendants settled with the plaintiffs, leaving only us and our client to proceed to trial.

At trial, the plaintiffs’ attorney, one of the best medical malpractice plaintiffs’ lawyers in the country, asked the jury to award $110 million in past damages, attributing 90% of the responsibility to our client alone. However, the jury found that he was not negligent and instead found liability only on the part of three of the defendants who had already settled out of the case. The jury rendered a verdict of $35.3 million in damages.

Result: Victory for the defense

Radiology – Small Bowel Obstruction

This jury trial involved claims of negligent medical care following the death of the patient, a 77-year-old female, with a history of severe diverticulitis and lumbar surgery. She was admitted to the hospital for an acute compression fracture and treated with intravenous narcotics. Despite experiencing abdominal pain and nausea by the third day of her hospital admission, she refused enemas.

Imaging studies were ordered, revealing possible small bowel obstruction. The attending physician planned to insert a nasogastric (NG) tube but decided against it after the patient reported feeling better and after she had had a bowel movement. However, she was later found unresponsive and died the next day.

The patient’s daughters alleged negligence for failing to address her abdominal symptoms and suspected bowel obstruction. They sought damages for wrongful death and related expenses. We defended by bringing evidence to support our position that the care provided was appropriate, citing timely imaging and the co-defendant attending physician's reasonable reliance on the patient’s reported improvement.

Both the attending physician, the co-defendant, and our client, took the case all the way to its conclusion in a jury trial. We worked closely with counsel for the co-defendant doctor and maintained a united front for the defense of the two physicians. Ultimately, the jury found no negligence on the part of either defendant, returning a verdict for the defense.

Result: Victory for the defense

Texas Medical Board Complaint

We recently represented a physician who had received a complaint from the Texas Medical Board in which the Board listed the following statutory violations against our client:

164.051(a)(6) Practice Inconsistent with Public Health and Welfare;

164.051(a)(6) Administering/Prescribing in a Manner Inconsistent with Public Health & Welfare; and,

164.052(a)(5) Unprofessional Conduct.

The complaint related to care and treatment of a minor child and allegations of inappropriate prescription of medication, inappropriate failure to conduct testing/monitoring of the patient while taking the medication, and failure to treat the child’s other health conditions.

We met with the doctor and obtained all the pertinent records. Then, we drafted a detailed, multi-document Response Packet, which we submitted to the Board. After a thorough review of the matter, and the documentation we provided, the Board found:

“no evidence of a violation of the standard of care. Dr. * provided the patient with appropriate clinical evaluation, prior to treating the patient for ADHD. When the child was provided another patient’s medication, Dr. * stopped the * and referred the patient to a specialist to evaluate and treat the diagnosis of ADHD. Dr. *’s care was noted to be professional, timely, and met the standard of care. As to the allegations of failure to treat the patient’s asthma, Dr. * again met the standard of care, with referral to a pulmonologist. Care was noted to have been professional and met the standard of care, this complaint is therefore dismissed.”

Result: Dismissal of the complaint.

Texas State Board of Dental Examiners Complaint

We recently defended a dentist who had been accused by a patient of engaging in unfair dealing with the patient, abandonment of the patient, and of refusing to send the patient records when requested. The Board listed allegations of violations of rules 108.2 (a), 108.5(a), and 108.8(g). As part of the standard procedures of the Board, when investigating complaints and allegations against a Texas dentist, the Board requires production of a number of different documents above and beyond copies of the records. These documents required include a written narrative written by the dentist concerning observations and treatment of the patient, a complete copy of 5 years of patient records, diagnostic quality radiographs, and others, totaling 24 required items or sets of items and affidavits.

As always, we met with our dentist and worked closely with him in the gathering of all of the various items. In addition, we drafted his proposed Narrative and then worked with him as he edited and finalized it. We also, as part of the extensive documentation included in our Response Packet, drafted a detailed legal response to the allegations.

After the documentation we provided was thoroughly investigated, the Board concluded:

“… the allegations are unsubstantiated.” The Board concluded that the documentation we provided demonstrated that the patient’s complaints were “Baseless or Unfounded”.

Result: Dismissal of the complaint.

Texas Board of Nursing Complaint

We recently represented a Nurse Practitioner in a matter relating to a complaint from the Texas Board of Nursing in which our client was accused by a patient of inappropriate treatment of an eye infection and inappropriate conducting of testing. The Board’s notice letter indicated that our nurse “may have violated the Nursing Practice Act and/or the Board’s Rules and Regulations Relating to Nurse Education, Licensure and Practice.”

In these administrative board matters, the boards require a response from the accused practitioner, including a narrative signed by the practitioner, all pertinent records, etc. We coordinated with our client and assembled all of the documentation necessary to comply with the Board’s requirements. We assisted our client in the preparation and drafting of her Narrative. We also prepared a legal response to the allegations, prepared our full Response Packet, and filed all with the Board.

After reviewing all of the documentation and records we provided and after conclusion of their investigation, the Board closed its investigation and expunged the file from our nurse’s record.

Result: Dismissal of the complaint.

Orthopedic Surgery – Knee Arthroplasty

In this medical malpractice jury trial, we defended an orthopedic surgeon who performed a right knee arthroplasty (knee replacement) for a 64-year-old female patient who reported severe pain prior to the surgery. Years of conservative therapy had not relieved the patient’s “constant pain” and instability/limited range of motion. Our client, a very experienced, board-certified, orthopedic surgeon, performed the procedure using the Stryker Mayo robotic knee replacement system.

The procedure went well with no complications or problems. Imaging confirmed appropriate placement of the components. Five weeks post-op the physical therapist reported the patient to be “on track” with flexion and strength greatly improved. Approximately two months post-op the patient reported pain in the area of her calf. Ultimately the diagnosis of a torn soleus was confirmed.

The patient’s continued complaints of pain were evaluated and investigated. Further imaging again confirmed proper placement of the knee components and no sign of fracture or dislocation. The patient was convinced that there was something wrong with her knee prosthesis. Unfortunately for the patient, she eventually was seen by another surgeon. At trial, the patient testified that this other surgeon told her that the components used by our client were grossly outsized and should only have been used on a large man. She further testified that the surgeon then explained to her that the components would have to be replaced and that, in particular, the spacer selected by our client was inappropriately sized. The plaintiff testified that this surgeon sold her a “total knee revision” and charged $60,000. Our investigation revealed the details of the records of this surgery, which proved that the surgeon did not replace either of the major components of the knee and only replaced the spacer. In fact, the new spacer he put in was only one millimeter larger than the one our client had selected!

Both our client and our expert witness, another board-certified orthopedic surgeon, testified that the surgery, the components, the size of the components, including the spacer, and the subsequent postoperative treatment of the patient, by our doctor, were appropriate. They were also of the opinion that the billing code used by the subsequent surgeon to bill for his surgery was inappropriate for the procedure he actually performed. It is interesting to note that the subsequent surgeon did not appear to testify at this trial.

After examining the evidence and deliberating for only about 21 minutes the jury returned a unanimous verdict in favor of our doctor.

Result: Victory for the defense