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Cahill v. Alves

Superior Court of Rhode Island

February 5, 2016

HELEN M. CAHILL and ROBERT W. CAHILL
v.
CYNTHIA M. ALVES, M.D. and COASTAL MEDICAL, INC.

Providence County Superior Court

For Plaintiff: Mark J. Brice, Esq.

For Defendant: Michael G. Sarli, Esq.

DECISION

PROCACCINI, J.

Before the Court is Defendant Cynthia M. Alves, M.D.'s (Dr. Alves or Defendant) renewed Super. R. Civ. P. 50(b) motion for judgment as a matter of law on Count II of Plaintiff Helen M. Cahill's (Mrs. Cahill or Plaintiff) Amended Complaint. This case was tried before a jury in November 2015. The Defendant properly moved for judgment as a matter of law on Count II at the close of all evidence. Decision was reserved on the motion, and the issues were submitted to the jury. The jury was unable to return a verdict, resulting in a mistrial. For the reasons stated herein, the motion is hereby denied.

I Facts and Travel

In 1998, Mrs. Cahill was diagnosed with atrial fibrillation (AFib). AFib is a heart rhythm disorder that occurs when the left chamber of the heart, the atria, beats too fast and out of rhythm, reducing the ability of the heart to pump blood. The most serious risk associated with AFib is thromboembolism. See Pl.'s Prelim. Hr'g Mem. 2. Thromboembolism occurs when blood clots form, break away from the heart, and travel to the brain or other critical organs. Therefore, patients diagnosed with AFib are at an increased risk of thromboembolic stroke.

Mrs. Cahill was particularly concerned about the possibility of suffering a stroke as her mother passed away due to a stroke in her 50s. Her primary care physician, Dr. Ruggieri, placed her on Coumadin (a common blood thinner used to prevent blood clots) and hypertension medication and referred her to Dr. Alves. Dr. Alves's ultimate treatment plan included both chemical and electrical cardioversion. From October 30, 1998 to October 22, 2006, Dr. Alves electrically cardioverted Mrs. Cahill a total of seven times at Roger Williams Hospital.

A cardioversion is performed in an attempt to "shock" the patient's heart back into normal rhythm, reducing the chance that the AFib will cause a blood clot to form and break away. See Trial Tr. 17:7-19, Nov. 2, 2015; Pl.'s Prelim. Hr'g Mem. 3. Yet, at the same time, the procedure that alters AFib actually puts the patient at an increased risk of a clot breaking off- the very fear that induces the patient to get the electrical cardioversion in the first place.[1] See Trial Tr. 28:16-29:24, Nov. 2, 2015; Pl.'s Prelim. Hr'g Mem. 4-5. Therefore, most patients are prescribed a blood thinner prior to undergoing a cardioversion and continue the medication following the procedure as well.[2] See Trial Tr. 25:19-28:3, Nov. 2, 2015; Pl.'s Prelim. Hr'g Mem. 3-4. If a patient is not taking a blood thinner, it is important that the electrical cardioversion be performed shortly after AFib begins. See Trial Tr. 68:15-22, Nov. 2, 2015; Pl.'s Prelim. Hr'g Mem. 4-7. These precautions reduce the chance that a blood clot will form during AFib and subsequently break off during or after the electrical cardioversion.[3]

Following Mrs. Cahill's fourth electrical cardioversion, a bleeding issue was discovered, and her prescription for Coumadin was substituted with aspirin and Plavix (a different blood thinner). From November 2005 to April 2006, Mrs. Cahill went into AFib repeatedly and was safely treated with both chemical and electrical cardioversions. Mrs. Cahill was placed back on Coumadin in August 2006, but removed after she was diagnosed with a subdural hemorrhage on October 17, 2006. Two days later, Mrs. Cahill again exerted signs of AFib. A chemical cardioversion was attempted, but Mrs. Cahill went back into AFib the next day. On October 22, 2006, more than seventy-two hours after the initial onset of Mrs. Cahill's AFib, Dr. Alves performed Mrs. Cahill's seventh electrical cardioversion. Mrs. Cahill was not taking a blood thinner at the time of the procedure. The next morning, a blood clot broke off from Mrs. Cahill's heart and traveled to her brain. As a result, Mrs. Cahill suffered a stroke in the middle cerebral artery, affecting the left temporal and parietal areas of her brain.

On July 28, 2008, Mrs. Cahill filed a two count Complaint against Dr. Alves and Coastal Medical, Inc. Mrs. Cahill alleged that Dr. Alves acted negligently by performing an electrical cardioversion without adequately investigating the duration of Mrs. Cahill's AFib and while Mrs. Cahill was not taking a blood thinner. The Complaint was amended on December 18, 2013 to include a lack of informed consent count against Dr. Alves. Mrs. Cahill alleged that Dr. Alves did not obtain sufficient consent to perform the above procedure because she failed to adequately inform Mrs. Cahill of the increased risk of stroke if the procedure was performed over forty-eight hours after the onset of the AFib and while Mrs. Cahill was not taking a blood thinner.

A jury trial was held in November 2015. At the close of Plaintiff's case, Defendant moved for judgment as a matter of law on the informed consent count pursuant to Super. R. Civ. P. 50 (Rule 50). The motion was renewed at the close of all evidence but before the case was submitted to the jury. The Court reserved ruling and submitted the case to the jury. The jury returned deadlocked and unable to reach a verdict. A mistrial was declared, and Defendant again renewed her motion for judgment as a matter of law.

Prior to turning to the renewed Rule 50(b) motion, this Court must decide the threshold question of whether the trial judge is required to rule on such a motion following a hung jury, or whether ...


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