PETER JALOWITZ HAD AN ENLARGED HEART AND A HISTORY OF AORTIC
STENOSIS. The 81-year-old patient who had previously undergone surgery
to repair an aortic valve a year earlier was at risk for sudden death.
The patient's cardiologist referred him to Dr. Terry McEnany. Dr.
McEnany met with the patient,
obtained a history, and performed a
physical examination during their forty to fifty-minute conference. Dr.
McEnany's report states that following a "long
discussion" with the patient, his wife, and son, "regarding
the various options, including surgical and nonsurgical therapy ... the
risks and gains of aortic valve replacement utilizing a pericardial
venograft," the patient agreed to proceed with the surgery. During
the course of surgery, while the patient's chest was being opened,
the innominate vein was torn. Dr. McEnany promptly noticed the tear and
clipped the ends of the vein with surgical clips. According to Dr.
Robert Wuerflein, a medical expert who had reviewed the case on behalf
of the patient's family, indicated that with the exception of the
tearing of the innominate vein, it "was an uncomplicated
surgery," and the valve replacement was "uneventful." The
cardiologist's progress note the day after surgery indicated that
the patient looked great, was awake and alert. However, on October 10,
when the patient was beginning dialysis treatment, he went into cardiac
arrest. Dr. McEnany performed a prolonged resuscitation. The following
morning, the patient's condition had deteriorated. Dr. McEnany
ordered an echocardiogram. The echocardiogram indicated blood pooling
around the heart, causing a tamponade condition. Dr. McEnany performed
an emergency sternotomy to relieve the tamponade. Although the surgery
relieved the tamponade, the patient never recovered from the cardiac
arrest and died on October 24. Suit was brought against the hospital for
alleged negligence in obtaining informed consent, negligence in
performing the surgery, and negligent postoperative care. The complaint
also alleged negligence on the part of the hospital and clinic and
negligent credentialing of Dr. McEnany. There was extensive pretrial
discovery as well as an extraordinary number of pretrial motions. The
court granted the hospital's motion to bifurcate the
plaintiff's claim for negligence and informed consent against Dr.
McEnany from the plaintiff's negligent credentialing claim against
the hospital. Before trial, the parties sought rulings on the
admissibility of Dr. McEnany's record while he was practicing in
California, referred to as the "California Evidence."
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