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A Suffolk County, N.Y., Supreme Court jury has awarded $13.1 million to the family of a woman whose uncontrolled internal bleeding after the routine Caesarean delivery of her healthy baby six years ago led to her death. But the all-female jury held the woman’s obstetrician, Dr. Dina E. Weiss, just 50 percent responsible for the failure to diagnose and stanch the loss of blood. Uniquely, the jury apportioned the remaining liability among four other doctors and the hospital where the surgery occurred, finding they failed to intervene after the cause of the trouble should have been clear to all. The case of Elias v. Weiss, No. 014079-2000, turned on the question: “What is the obligation of a doctor who knows that another doctor is not properly taking care of patients?” plaintiffs lawyer Steven Pegalis said. Florence Gibbons of East Meadow, N.Y.’s Rogak & Gibbons, an attorney for two of the defendants — both cardiologists — answered that rhetorical by saying her clients had no such obligation because they were only consultants on the case and lacked the technical skill to save the woman, Sabine Elias. Gibbons said she will file a notice of appeal and argue that the cardiologists had no duty to act after making their opinions known to the obstetrician and her partners. Her co-defense counsel, Clifford A. Bartlett of Mineola’s Bartlett McDonough Bastone & Monoghan, agreed. “You can’t take a gun, put it to someone’s head and say do surgery,” said Bartlett, who represented Weiss and co-defendant Dr. Charles Mann, Weiss’ partner. Midway through the six-week trial before Suffolk Supreme Court Justice Paul Baisley Jr., Bartlett settled his case for $7 million. The settlement covered Weiss, Mann, two other physicians and the hospital, leaving only the two cardiologists as actual defendants before the jurors, who were not told of the settlement. The jury also did not hear from the Suffolk medical examiner, who had reviewed the case and determined that Elias had died of a rare post-partum medical complication, Bartlett said. That complication is known as a delayed amniotic embolism, a condition caused when amniotic fluid from the placental sac becomes absorbed into the blood stream as the sac breaks at the onset of labor. The fluid’s presence in the blood can cause internal hemorrhaging, all sides concede. But in an interview Pegalis, a partner at Pegalis & Erickson in Lake Success, called the amniotic fluid embolism theory “preposterous,” contending that Elias lacked the system-wide bleeding that accompanies such catastrophic events. Instead, he said, her bleeding, while substantial, was confined to the lower abdominal compartment where the surgery took place. Pegalis added that he would have challenged the medical examiner’s ability to testify because it was the hospital’s own pathologist, not the county official, who had autopsied Elias. The examiner’s findings would have been based entirely on second-hand evidence, he said. IN THE HOSPITAL Elias died at St. John’s Episcopal Hospital-Smithtown two and a half days after Weiss operated on her. According to Pegalis’ opening statement, a c-section requires a surgeon to cut through a patient’s lower abdomen muscle before removing the baby from the uterus. After the operation, the tissue and blood vessels are expected to be sutured to minimize post-operative bleeding. In Elias’ case, shortly after the operation was concluded and she had been returned to her room, her blood pressure dropped and she became dizzy. She soon was moved back to the post-operative recovery room where her symptoms continued to worsen and she was subjected to a battery of tests to detect the cause of her condition. Weiss consulted with a cardiologist, Dr. Jyoti P. Ganguly, who, Pegalis said, advised Weiss that whatever was wrong with Elias, it was not a heart problem, but more likely internal bleeding. Pegalis said that Ganguly told Weiss, “You can’t leave this unresolved.” Notwithstanding the admonition, Weiss and the other defendants — her partner Mann; hospital radiologist Dr. Russ Saypoff; and Ganguly’s partner, Dr. Brian Geller — marched through a list of medical possibilities to explain the appearance of fluid in Elias’ abdomen, her falling blood pressure and rising heart rate. But nobody concluded Elias was suffering post-operative bleeding and that the only course of action was to re-open the incision and tie off the source of the blood, Pegalis said. As the hours ticked by, Elias’ condition passed from mild shock, to progressive shock, to a final, irreversible stage where her blood loss led to organ failure. More than 60 hours after the Caesarean, Elias died of cardiac arrest, without the surgeons having ever attempted to reopen the incision. A post-operative autopsy showed more than 10 liters of blood in her abdomen, representing not only her own blood supply but transfusions she had received in an attempt to stabilize her blood pressure. DUTY TO ACT Pegalis contended in an interview that every doctor owes patients the duty to use reasonable care. There was, he added, a physician-patient relationship between Elias and the cardiologists. “By process of elimination, they knew the bleeding was related to the surgery … was continuing … and was a matter of life or death,” he said. Even if Ganguly and Geller lacked the technical expertise to perform the needed procedures themselves, when it became apparent that Weiss was not going to act, the cardiologists should have notified someone who could. “Weiss didn’t have an ownership interest in the patient,” said Pegalis. Bartlett, Weiss’ lawyer, disagreed, saying that in his 35 years of practice he has seen consultants held liable for giving bad advice, but never for failing to act. Bartlett said that Elias was morbidly obese and that given her weight and fragile medical condition, Weiss was “very concerned about going in without knowing that there was a definite cause [of the bleeding] that could be alleviated by further surgery.” That is why she sought out the consultants, he said. Bartlett called the scenario “a very tricky situation.” Gibbons, the cardiologists’ lawyer, concurred. During her closing, Gibbons said that she asked the jury, “What is a cardiologist supposed to do? Call 911? Run down the hall with a scalpel? They didn’t have the authority to operate and didn’t have the expertise.” Gibbons, who is also a registered nurse, said in an interview that she, too, had never seen a comparable case. The jury found Geller 10 percent liable and Ganguly 2.5 percent liable. Weiss’ partner, Mann, was held 25 percent liable and the hospital, on behalf of the radiologist, Saypoff, was held 12.5 percent liable. They awarded Elias’ children $7.6 million in damages, $1.5 million to her husband, John, and an additional $4 million for her conscious pain and suffering. The verdict was rendered Oct. 14.

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