Wednesday, August 22, 2012

Improper training of Employees Regarding CPR Can Cause Injury or Death

Worker/Workplace Negligence

Wife: Improper CPR caused husband's brain damage


(P) $14,640,784.00 Negligent Training Mel-Alfonso Alegre and Mary Jennifer Alegre v. LA Fitness International, LLC and Mark M. Dang, M.D., No. RIC512506 Superior Court of Riverside County, Corona, CA Dallas Holmes 06-15-2012
Plaintiff(s):
Attorney(s):
  • Marsha E. Barr-Fernandez; Heimberg Law Group, LLP; Los Angeles, CA, for Mel-Alfonso Alegre, Mary Jennifer Alegre
  • Bruce A. Broillet; Greene Broillet & Wheeler, LLP; Santa Monica, CA, for Mary Jennifer Alegre, Mel-Alfonso Alegre
  • Steven A. HeimbergM.D.; Heimberg Law Group, LLP; Los Angeles, CA, for Mary Jennifer Alegre, Mel-Alfonso Alegre
  • Alan Van Gelder; Greene Broillet & Wheeler, LLP; Santa Monica, CA, for Mel-Alfonso Alegre, Mary Jennifer Alegre

Expert(s):
  • Sharon Kawai M.D.; Physical Medicine; Fullerton, CA called by: Marsha Barr-Fernandez, Bruce Broillet, Steven Heimberg, Alan Van Gelder

  • Jeffrey Goodman M.D.; Cardiac Electrophysiology; Los Angeles, CA called by: Marsha Barr-Fernandez, Bruce Broillet, Steven Heimberg, Alan Van Gelder

  • Anthony Abbott Ph.D.; Exercise Physiology; Pompano Beach, FL called by: Marsha Barr-Fernandez, Bruce Broillet, Steven Heimberg, Alan Van Gelder
  • Tamorah Hunt Ph.D.; Economics; Santa Ana, CA called by: Marsha Barr-Fernandez, Bruce Broillet, Steven Heimberg, Alan Van Gelder
Defendant(s):
  • R. Gregory Amundson; Wood, Smith, Henning & Berman LLP; Newport Beach, CA, for LA Fitness International, LLC
  • Linda J. Burden; Smith & Susson, LLP; Newport Beach, CA, for LA Fitness International, LLC
  • Scott A. Smith; Smith & Susson, LLP; Newport Beach, CA, for LA Fitness International, LLC
  • None reported; null, null, for Mark M. Dang, M.D.

Expert(s):
  • Wayne Lancaster Ph.D.; Economics; Fullerton, CA called by: R. Amundson, Linda Burden, Scott Smith

  • Jay Schapira M.D.; Cardiology; Los Angeles, CA called by: R. Amundson, Linda Burden, Scott Smith

  • Karen Preston P.H.N., R.N.; Physical Rehabilitation; Sacramento, CA called by: R. Amundson, Linda Burden, Scott Smith
Insurers:
  • Axis Surplus Insurance Co. (primary carrier, $1 million policy) for LA Fitness International, LLC
  • Chartis Insurance (excess) for LA Fitness International, LLC

Facts:
On Jan. 29, 2008, plaintiff Mel-Alfonso Alegre, 39, a quality control inspector, was playing basketball at an LA Fitness in Temecula when he went into cardiac arrest. Prior to the incident, Alegre suffered to a low-grade arrhythmic episode in 2004 and started treating with cardiologists. He was subsequently placed on Flecainide, an anti-arrhythmic drug, by his treating cardiologist, Dr. Mark Dang. Thereafter, Alegre was periodically examined and tested by Dang, and he underwent numerous EKGs that were read by computer analysis as abnormal to varying degrees. However, after further testing, Alegre's treating physicians determined that the readings reflected a normal variant, and that there was not any structural damage with his heart. In September 2007, Dang took Alegre off a heart rate medication, Verapamil, due to complaints of lightheadedness, while continuing to treat him with Flecainide. In late December 2007, Alegre was given another EKG, which was positive for mild ventricular hypertrophy. However, two treating physicians claimed that post-incident testing demonstrated that Alegre's heart did not reflect significant structural damage. As a result, Alegre continued with his normal daily activities. In January 2008, Alegre was playing basketball at LA Fitness when his heart went into ventricular fibrillation -- a temporary, life-threatening, abnormal beating of the heart. He subsequently went into cardiac arrest and collapsed on the court. CPR was administered, but Alegre suffered brain damage as a result of the incident. Mary Alegre, acting individually and on behalf of her husband, sued LA Fitness International, LLC. She alleged that LA Fitness was negligent in the training of its personnel, specifically regarding the improper performance of resuscitation attempts, the delay in performing the resuscitation, and the delay in calling 911. Mrs. Alegre also added Dang as a defendant after LA Fitness' interrogatory responses implicated the physician. However, due to a binding arbitration agreement, Dang was severed out of the action and the binding arbitration was stayed pending the outcome of the trial against LA Fitness. Mrs. Alegre claimed that prior to 2004, Mr. Alegre was in excellent health and regularly played games of full-court basketball without an issue. However, she alleged that in February 2004, her husband had an episode of dizziness and palpitations, which was diagnosed as being caused by a paroxysmal atrial fibrillation -- an intermittent, abnormal rhythm of the upper chamber of the heart. She claimed that Mr. Alegre was then started on the anti-arrhythmic drug Flecainide and the heart rate medication Verapamil, and thereafter, had few complaints and no major episodes prior to the event at LA Fitness. The plaintiffs' cardiology expert opined that Mr. Alegre was previously healthy and capable of being resuscitated after a sudden cardiac arrest. The expert further opined that, given the findings of brain damage at the time it occurred, proper and timely CPR was not performed. In addition, the plaintiffs' expert testified that "a perfect storm" occurred at the time of the incident: Mr. Alegre's prior alcohol consumption, the presence of a viral infection for which Mr. Alegre was taking Robatussin, Mr. Alegre's dehydration, and an electrolyte imbalance. However, the expert acknowledged that he could not rule out Flecainide as a factor in causing the arrest. Plaintiffs' counsel presented evidence that it was part of LA Fitness' employees' job responsibility to properly respond to members who suffered a cardiac arrest at the facility. However, counsel argued that there was a substantial delay between when personnel were notified and when any of the LA Fitness' employees came to the basketball court. They also argued that there was an even longer delay before any of these personnel tended to Mr. Alegre and that an employee complained about inappropriate CPR being performed during the incident. Thus, plaintiffs' counsel asserted that it was over 2.5 minutes before 911 was called, that it was as long as five minutes before CPR was started, and that CPR was performed incorrectly. According to plaintiff's counsel, testimony, published standards, and regulations were presented to prove this. Plaintiffs' counsel contended that LA Fitness was required to have, but did not have, an adequate emergency response system, including a written emergency response plan and preparation of its staff to properly respond to a cardiac arrest. Counsel asserted that, in turn, proper emergency response preparation should include training on the emergency response plan, a regular review of that plan, and physical practice, rehearsals and drills of that plan. Thus, plaintiffs' counsel contended that LA Fitness' failure to comply with these requirements resulted in delays in calling 911 and in performing resuscitative measures, as well as resulted in the improper performance of CPR. LA Fitness' cardiology expert opined that the medication Flecainide should not have been used on Mr. Alegre in the first place, since the package insert for the medication warned that it should only be used if symptoms were disabling, which they were not, and should not be used if there was evidence of structural heart damage. The expert also opined that Mr. Alegre should have been further tested, taken off the medication, and restricted in exercise activities. Thus, the defense's expert testified that Dang's treatment of Mr. Alegre fell below the standard of care for a treating cardiologist. According to defense counsel, the plaintiffs' cardiology expert had previously authored a book chapter in which he warned that Flecainide, which Dang placed Mr. Alegre on, could actually cause proarrhythmias, leading to sudden cardiac arrest. Defense counsel also claimed that the plaintiffs' cardiology expert acknowledged that such medication can make resuscitation efforts more difficult on a person with structural heart damage, as it raises the threshold for defibrillation. However, plaintiffs' counsel countered that Mr. Alegre did not have structural heart damage. Defense counsel contended that Mr. Alegre continued to play basketball and consume alcohol, which was contrary to Dang's advice, and that marijuana was found in Mr. Alegre's system during post-incident testing. Counsel maintained that marijuana accelerates the heart rate (which was dangerous because Mr. Alegre was no longer taking the heart rate medication) and coagulates the blood, making circulation more difficult. The defense's expert also opined that the marijuana in Mr. Alegre's system, which accelerated his heart, and the lack of heart rate medication led to the arrest. In addition, defense counsel argued that sudden cardiac arrest is an inherent risk of playing basketball, which Mr. Alegre assumed, especially knowing of his heart condition and prior experience of nearly fainting while playing the game. Counsel further argued that Mr. Alegre's body was additionally compromised due to his own use of drugs and alcohol, and failure to properly hydrate himself. Thus, defense counsel contended that Mr. Alegre's brain was not receiving blood, leading to his collapse on the basketball court. However, plaintiffs' counsel countered that under the facts of this case, and under the law, assumption of risk did not apply. Regardless of what caused the cardiac arrest, LA Fitness claimed that another basketball player saw Mr. Alegre struggle with fatigue and breathing five minutes before he collapsed, and that the plaintiff fell violently to the floor. LA Fitness also claimed that Mr. Alegre was attended to for one to two minutes before staff members were notified. In addition, a club member testified that LA Fitness' staff responded "instantly" and "immediately," as if they had a "protocol." Also, the defendant claimed that two club members had cell phones on the court, but didn't feel the need to call 911 themselves. LA Fitness claimed that within approximately five minutes of first notification of Mr. Alegre's collapse, a total of eight people responded to the event (four staff and four club members) and either participated in the CPR efforts, made themselves available to assist or were controlling the scene. It also claimed that CPR analysis and efforts were initiated within 20 seconds of notification of the collapse, and that all four staff members that responded were CPR certified. LA Fitness noted that a club member initially performed chest compressions in conjunction with the rescue breaths and that the first staff member that arrived at the scene initiated mouth-to-mouth without waiting for a mouth guard, even though Mr. Alegre was foaming at the mouth. LA Fitness claimed that when a second staff member arrived on scene, he used his cell phone to call 911, described the plaintiff's condition to the operator, ran to obtain the automated external defibrillator, and then ran back and initiated the placement, analysis and shock. The defendant claimed that the two-staff personnel then continued breaths and compressions, stopping to let the AED analyze the plaintiff's condition for the purposes of a further shock, but that Mr. Alegre's heart was not in a shockable rhythm and CPR was continued. LA Fitness claimed the last persons to arrive and assist within the five-minute period were a doctor and a nurse, both of who were club members. It claimed that upon on their arrival, staff deferred to the medical professionals, who assumed CPR efforts until the arrival of paramedics. A total of nine club members testified, including the doctor that took over administering CPR and a CPR-certified female that watched the CPR efforts. According to defense counsel, none of these members criticized the defendant's employees' rescue efforts, and no one testified to a delay in their efforts or in calling 911. Defense counsel contended that the arrest itself produced brain seizures and pulmonary edema, and that combined with the stoppage of the heart, the brain could not receive the oxygen necessary to prevent brain damage, despite adequate and timely CPR efforts. Counsel further argued that Mr. Alegre's Flecainide medication made resuscitation difficult, and that it was not until a second set of paramedics injected his heart three times with medications and used a more powerful defibrillator that his heart rhythm was restored. Thus, LA Fitness claimed that it had an adequate emergency response plan. It alleged that drills and rehearsals were not used in the industry, and that any lack thereof in this instance was of no effect, as its personnel responded timely and appropriately, as evidenced by the four certified responders and the nine club members that testified.
Injury:

Mr. Alegre's heart went into ventricular fibrillation, resulting in a cardiac arrest. CPR was performed, but he sustained severe brain damage. Plaintiffs' counsel argued that the delay in performing proper CPR caused the brain damage. Plaintiffs' counsel contended that Mr. Alegre is now in a minimally responsive state, in which he can experience pain but can otherwise not communicate. Counsel contended that as a result, Mr. Alegre would only live approximately another 22 years. Thus, Mrs. Alegre sought recovery of roughly $14 million in total damages for her husband's past and future medical costs, lost earnings, and pain and suffering. She also sought recovery of damages for her own loss of consortium and loss of household services. Defense counsel argued that Mr. Alegre's brain damage was caused by brain seizures and pulmonary edema, combined with the stoppage of his heart. They contended that this caused Mr. Alegre's brain to be unable to receive the oxygen and blood necessary to prevent brain damage. According to defense counsel, Mr. Alegre has been maintained in a facility on oxygen and lung suction for nearly four years, without major incident or compromise. Thus, counsel argued that this level of care is all that is required, but that plaintiffs' counsel argued for a more sophisticated facility with a patient population of only six patients, resulting in an increase in future care expenses. Defense counsel further contended that due to Mr. Alegre's vegetative state, it believed that he has never perceived pain since the cardiac arrest and that any response to movement of his body is merely reflexive in nature and not evidence of him experiencing of pain.
Verdict Information:
The jury found LA Fitness 100 percent at fault for negligence and gross negligence. Thus, Mr. and Mrs. Alegre were awarded $14,640,784 in total damages.
Mary Jennifer Alegre $200,000 Personal Injury: Past Loss Of Consortium $950,000 Personal Injury: Future Loss Of Consortium $55,374 Personal Injury: Past Loss Of Services $329,166 Personal Injury: Future Loss Of Services Mel-Alfonso Alegre $1,310,000 Personal Injury: Past Medical Cost $8,883,440 Personal Injury: Future Medical Cost $184,037 Personal Injury: Past Lost Earnings Capability $793,573 Personal Injury: FutureLostEarningsCapability $297,722 Personal Injury: Past Pain And Suffering $1,637,472 Personal Injury: Future Pain And Suffering