For the week of June 9, 1999 thru June 15, 1999
Doctor defends treatment in third week of case.
Experts support obstetrician in malpractice trial
Poor fetal monitoring was the problem, witness says
By GREG MOORE
Sandy and Quinn Kirklands lawsuit that claims local medical malpractice led to their sons brain damage is being heard in federal court.
Taking the stand for the first time during the fourth week of a medical malpractice trial in which he is a defendant, obstetrician Dr. Ross Donald last week rebutted claims that he had acted negligently in performing a procedure on a pregnant woman four years ago.
A co-worker and an expert witness called by Donalds attorney both buttressed his version of events by telling jurors they believed he had acted with the expected standard of care.
Dr. Donald, Dr. Randall Coriell, a family practice physician, and the Wood River Medical Center are being sued by Sandy and Quinn Kirkland, former residents of Carey.
The suit in federal court in Boise has raised questions about the quality of obstetrical care at the medical center at the time.
Attorneys are expected to complete their cases this week.
The Kirklands contend that irreversible brain damage to their now almost four-year-old son, Bryce, was caused by poor care at the hospitals Hailey campus following an amniocentesis performed by Dr. Donald.
An amniocentesis involves withdrawing amniotic fluid from the uterus through a syringe. The procedure was performed on Sandy to determine whether, at 34 weeks gestation, the babys lungs had matured to the point that he could survive a premature birth.
Sandy was considering discontinuing drugs administered to control contractions due to their painful side effects.
Dr. Donald acknowledged in testimony that the amniocentesis probably punctured a fetal blood vessel in the placenta, reducing the amount of oxygen delivered to Bryces brain.
No one has faulted Dr. Donald for puncturing the vessel, but an expert witness called earlier by the plaintiffs had criticized him for performing the amniocentesis at all because in this case Dr. Donald had determined that it would require inserting the needle through the mothers placenta.
Dr. Donald and the two witnesses called in his defense disputed that criticism.
"A high percentage of babies born at 34 weeks will have problems," Dr. Donald told jurors. "I thought that the benefits of determining the pulmonary maturity, in my experience, in my judgment, outweighed the risks."
Dr. Donald contended that even a trans-placental amniocentesis "hardly ever" results in fetal bleeding.
Dr. Alison Sherer-Depp, who shares office space with Dr. Donald, echoed that view, telling jurors that most of the surface of the placenta is free of blood vessels and that doing a trans-placental amniocentesis "is not taboo."
If bleeding occurs, she said, that should be noted by a fetal heart monitor to which the mother should be connected following the procedure.
Dr. Michael Gravett, a high-risk obstetrician and chief of maternal-fetal medicine at Oregon Health Sciences University, told jurors he performs between 200 and 250 amniocenteses per year and that about 3 percent of those are trans-placental.
Dr. .Gravett said the amniocentesis performed on Sandy "was an indicated procedure."
Dr. Donald also told jurors that though he took responsibility for deciding to go ahead with the amniocentesis, he was performing it at the request of Dr. Coriell and upon the advice of a fetal specialist at St. Lukes Regional Medical Center in Boise.
However, Paul Luvera, one of the plaintiffs attorneys, pointed out that neither of those two was aware of the need to go through the mothers placenta.
The plaintiffs have contended that once Dr. Donald had determined that he would need to go through the placenta to reach the pocket of amniotic fluid, he should have informed Sandy of that fact and notified her of the increased risk.
However, Dr. Gravett said the added risk was not enough to have required Dr. Donald to explain it to Sandy.
An additional issue raised by the plaintiffs has been blood Dr. Donald drew when he first inserted the syringe into the mothers abdomen. Quinn testified two weeks ago that he saw Dr. Donald draw a vial full of blood, a second that was cloudy with blood and a third with clear fluid.
Dr. Donald agreed that a vial full of blood would indicate something was wrong, but told jurors that he drew only a "very small amount" of blood, which he presumed was from tissue in Sandys abdomen. He said that even a few drops of blood will turn a clear fluid bright red, which could look like pure blood to an uninformed person.
The biggest issue in the trial has been the care Sandy received following the amniocentesis. After the procedure, she returned to the Hailey campus of the Wood River Medical Center and was hooked up to a fetal heart-rate monitor. The hospital has already acknowledged that nurses there failed to read the monitoring strip as they should have and to notify Dr. Coriell, Sandys physician, of its warning of fetal distress.
Dr. Donalds attorney, Steve Tolman, asked him if he had had any reason to believe that the monitors strip would not be adequately interpreted. Dr. Donald answered that he had not.
But witnesses for the plaintiffs have also faulted Dr. Donald for not notifying Dr. Coriell and the hospital that he had done a trans-placental amniocentesis, thereby increasing the risk of fetal bleeding and creating a need for especially careful monitoring.
Since Dr. Donalds and Dr. Coriells attorneys are seeking to cast blame on the opposing defendant, Wood River Medical Center, they often act as attorneys for the plaintiffs.
Dr. Coriells attorney, Jeremiah Quane, contended that Dr. Donald acted inconsistently in sending a fax to the Hailey campus calling the amniocentesis "uneventful" while writing in his report on the procedure that he "went through the placenta."
"If you thought that it was so important as to put it in your note, then why didnt you put it in the fax that you sent to the hospital so the hospital people would know about it?" Quane asked.
Dr. Donald responded that he often liked to write more complete records of procedures than what was immediately necessary to be able in the future to compare various aspects of them, and to have complete records for insurance claims.
Dr. Gravett agreed with Dr. Donald that the amniocentesis performed on Sandy could be termed "relatively uneventful."
"The interpretation of the strip is irrelevant to knowing what happened in the amniocentesis," he added.
Dr. Donald and Dr. Sherer-Depp are the only obstetricians practicing in the Wood River Valley. To a question posed by Tolman, Dr. Sherer-Depp told jurors that although she and Dr. Donald have separate businesses, the two often care for each others patients.
"Were very acquainted with what each other is doing," she said.
Dr. Sherer-Depp said she did not believe Dr. Donald had breached the expected standard of care in any way while treating Sandy. In fact, she said, since she first began to work with Dr. Donald in 1991, she had not seen him do anything unsafe, and said his care is at "the highest level."
Dr. Donald and the hospital, who are insured by the same insurance company and represented by the same attorney, rested their case Monday.
Dr. Coriell, who testified early in the trial when called by the plaintiffs, began presenting his own case Monday afternoon and was expected to finish by today.
Much of Dr. Donalds and Dr. Coriells testimony has been contradictory. In arguing for the inclusion of a particular piece of evidence, plaintiffs attorney Luvera told Judge Edward Lodge that "one of the basic issues (in the trial) is the believability of Dr. Donald versus the believability of Dr. Coriell."
The jury will begin to decide that issue when the trial concludes late this week.
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