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Experts: Steroids would not have prevented progression of lung disease – Defense Verdict

On June 25, 2010, plaintiff’s decedent, a 49-year-old female who worked as a computer systems analyst making $175,000 per year, presented to the defendant rheumatologist for diagnosis and treatment of a persistent forearm rash, aching joints, shortness of breath and fatigue. The defendant rheumatologist highly suspected that the patient had dermatomyositis, ordered blood tests to try to confirm the diagnosis, and placed the patient on low-dose corticosteroids to address the rash. The defendant rheumatologist saw the patient again in his office on July 9, July 28, Aug. 12, Sept. 1, and Sept. 17, 2010, as well as on multiple occasions during the patient’s hospitalizations in August and September 2010. The defendant rheumatologist did not order an MRI or muscle biopsy of the patient until Sept. 1, and did not place the patient on high-dose steroids until Sept. 20. By late September 2010, the patient had developed rapidly progressive interstitial lung disease, resulting in a dramatic worsening of her condition. She remained hospitalized from Sept. 20 until dying of respiratory failure on Oct. 13, 2010, leaving behind a husband and three children.

Plaintiff filed suit in the Fairfax County Circuit Court, alleging that the defendant rheumatologist breached the standard of care by failing to take appropriate steps to diagnose and treat dermatomyositis, triggering rapid progression of the decedent’s interstitial lung disease and ultimately causing her death in October 2010. Defendants denied the allegations, and the case was tried starting on Nov. 17, 2014. Plaintiff’s liability expert was Thomas Zizic, M.D., a rheumatologist from Baltimore. Dr. Zizic testified that defendant breached the standard of care by failing to order an MRI or a muscle biopsy (the gold standard of diagnostic testing for dermatomyositis), by failing to refer the patient to a pulmonologist, and by failing to treat the patient with high-dose corticosteroids. All breaches occurred on every day that the defendant rheumatologist saw the patient. Dr. Zizic and Stuart Jacobs, M.D., a pulmonologist from Glen Burnie, Maryland, testified for the plaintiff on causation, asserting that if such testing and interventions had been instituted prior to Aug. 16, 2010, the diagnostic tests would have definitively revealed the presence of dermatomyositis, and the high-dose corticosteroids would have eliminated or significantly lessened the damage to the patient’s lungs such that she could have returned to her prior activity level.

Defense liability expert Neil Stahl, M.D., a rheumatologist from Burke, testified that the defendant rheumatologist met the standard of care by continuing to test for dermatomyositis by performing objective testing for muscle weakness, following serial blood serology results and relying on other specialists to address the patient’s pulmonary issues. Dr. Stahl concluded that the defendant rheumatologist’s approach was reasonable because the patient initially presented with clinically amyopathic dermatomyositis, or dermatomyositis without the characteristic muscle weakness. Dr. Stahl and Kevin Gibson, M.D., a pulmonologist from Pittsburgh, testified for the defense on causation, contending that rapidly progressive interstitial lung disease was unpreventable because dermatomyositis patients on appropriate medication regimens can still unexpectedly develop rapidly progressive interstitial lung disease. Moreover, the patient’s rapidly progressive interstitial lung disease was untreatable because the pathology of her lesion was not steroid-responsive.

After a five-day trial and deliberations for nearly 10 hours, spanning two additional trial days and the Thanksgiving holiday, the jury returned a defense verdict.



Type of action: Medical malpractice – wrongful death
Injuries alleged: Failure to diagnose and treat dermatomyositis
Court: Fairfax County Circuit Court
Tried before: Jury
Judge: Bruce D. White
Date resolved: Dec. 1, 2014
Demand: $5,000,000
Highest offer: None
Verdict or settlement: Defense verdict
Insurance carrier: The Doctors’ Company
Attorneys for defendant:  Michael E. Olszewski and Travis W. Markley, Fairfax

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