Virginia Lawyers Weekly VA Lawyers Weekly
Type of action: Medical malpractice, wrongful death
Injuries alleged: Unattended acidosis leading to death
Name of case: Estate of Rita Epps v. Sajid Naveed, M.D., et al.
Court: Petersburg Circuit Court
Case no.: CL18-240
Tried before: Jury
Name of judge or mediator: Judge Dennis Martin
Date resolved: 10/5/2021
Verdict or settlement: Verdict
Amount: $10,000,000
Attorneys for plaintiff (and city): Brewster Rawls, Eric Speer and Jay Tronfeld, Richmond
Description of case: This case involved a 63-year-old woman, Rita Epps, who died at Southside Regional Medical Center because of untreated acute kidney failure and resulting acidosis.
Ms. Epps arrived at the SRMC emergency room a little before 9 a.m. on Dec. 10, 2016. The initial laboratory studies and evaluation showed that she was in acute kidney failure with severe anion gap metabolic acidosis and high potassium. She was admitted to the hospital and evaluated by the first hospitalist defendant. This doctor started medical treatment. She also ordered a lactic acid level and ordered a nephrology consultation.
The nephrologist on call, Sajid Naveed, claimed he never got the consultation. The nephrologist’s phone records showed a call from SRMC’s general number about 40 minutes after the consult was placed in the EMR. However, the hospitalist testified that she never called the nephrologist herself and there is no evidence in the medical record that he took any action that afternoon or evening.
The first hospitalist handed over care around 7 p.m. to the overnight hospitalist, the third defendant. Ms. Epps was experiencing increased pain so the nocturnist ordered Dilaudid on top of the morphine and oxycodone already given during the day.
The nocturnist ordered an arterial blood gas which came back shortly after midnight. It showed that Ms. Epps was severely acidotic. Her pH was 6.6, a level that multiple experts described as incompatible with life. It also meant that the medical management of her acidosis, primarily fluids and bicarbonate, had not worked. At this point, the nocturnist had an ICU nurse call the nephrologist and advise him of Ms. Epps’ condition. This phone call is recorded in the medical record and two minutes later, the records show that Dr. Naveed ordered more bicarbonate. The nephrologist did not come to the hospital, nor did he order emergency dialysis.
Dr. Naveed came to the hospital around 7 a.m. He ordered continuous renal replacement therapy, a form of dialysis. Upon returning from having her dialysis catheter placed, the decedent suffered cardiac arrest and permanent brain damage. Life support was removed several days later.
The trial of the matter was unusual. Everyone agreed that Ms. Epps needed dialysis shortly after her admission to the hospital. The hospitalists argued that Dr. Naveed had responsibility for Ms. Epps from the time of the Saturday afternoon consultation order. Everyone also agreed that the high lactic acid and pH of 6.6 constituted an emergency.
Dr. Naveed tried to make a case that he was never contacted, and that he first found out about Ms. Epps when he came to the hospital.
Plaintiff’s hospitalist expert testified that Ms. Epps’ condition was obvious and that the hospitalists should have taken affirmative steps to make sure the patient was evaluated by a nephrologist. The plaintiff’s nephrology expert testified that Ms. Epps needed dialysis early on and that should have been obvious to any nephrologist.
The hospitalists both put on multiple experts to say that their orders were appropriate, and it was reasonable for them to assume that the nephrologist was on the case. Even with just the order of bicarbonate, reliance on Dr. Naveed’s expertise was reasonable.
No evidence of economic losses or medical bills was presented. In closing, the jury was told that the family had sued for $10 million.
The trial lasted seven days. The jury was out a little more than three hours before returning a $10 million verdict against the nephrologist only. Following the verdict, the judge reduced the verdict pursuant to the Virginia cap on medical malpractice damages. The court immediately overruled Dr. Naveed’s motion to set aside the verdict.
About three weeks after the verdict, plaintiff settled with Dr. Naveed for a nominal discount. The settlement was approved by the court on Nov. 9, 2021.
[021-T-151]Correction: An earlier version of this report contained a correction that stated Jay Tronfeld was not among the “attorneys for plaintiff” in this case. That correction was inaccurate — Tronfeld was among the attorneys for the plaintiff in this case, as the original report stated. Additionally, attorney Wiley Latham was significantly involved in working on the case leading up to trial. VLW apologizes for and regrets the error, and the report has been corrected to how it originally appeared in the Dec. 13 edition.
