While working as an employee of Norwegian Cruise Line, Ilija Loncar relied on his right arm to perform his job. As a waiter, Loncar was responsible for carrying trays and dishes to and from patrons as well as ensuring the general cleanliness of the Breakaway, the ship on which he worked.
But on March 28, 2016, Loncar lost his arm at the hands of a fellow Norwegian Cruise Line employee.
Loncar admitted himself to the Breakaway’s infirmary for relief of nausea and flu-like symptoms. He instead left with a much larger problem: His entire right arm required amputation after an on-board physician, Dr. Sebastian Campuzano, prescribed him promethazine, an antihistamine, which the plaintiff claimed was injected in a massive dose over a small window of time, causing an intense and harmful reaction.
On June 13, Loncar received a $3.34 million arbitration award for past and present pain and suffering, loss of earning capacity and medical expenses. He was represented in his suit by Thomas B. Scolaro, a partner at Miami-based firm Leesfield Scolaro, and Mason Kyle Kerns of Mason Kerns Law in Miami.
Read Loncar’s complaint against Norwegian Cruise Line here:
Scolaro did not mince words when discussing what befell his client. According to the personal injury lawyer, the doctor acted negligently on several counts.
Campuzano “gave the wrong medication, the wrong dosage by the wrong route through the wrong injection site, and it was administered over the wrong time and by the wrong method,” Scolaro said.
Scolaro added that an administration of promethazine intravenously was an overreaction to his client’s complaints of nausea and Campuzano instead ought to have given Loncar the an anti-nausea medication Zofran. Scolaro maintains that drug would have been a more reasonable way to address Loncar’s discomfort.
Furthermore, the 25-milligram dosage of promethazine far exceeded the generally accepted dosage for treatment, plaintiffs counsel argued.
“All the medical data out there strongly suggests six and a quarter milligrams is a perfectly therapeutic dose,” Scolaro said. “Campuzano orders it by intravenous injection when there is a pill, there’s a suppository, there’s a syrup. … He orders it by IV injection into the vein when — if you are going to order this medication through the injectable method — there’s a FDA black box warning on IV promethazine, which says the preferred route is deep intramuscular, which is a shot in the tush.”
But for reasons “still unknown” to Scolaro and his client, Campuzano ordered the promethazine to be injected intravenously. What’s more, it was injected in 10 to 15 seconds instead of the generally recommended 10- to 15-minute window, the plaintiff argued.
Loncar reportedly began experiencing pain almost instantly.
“As soon as the medication went in he immediately reported burning,” Scolaro said.
At that point, the attorney said, Campuzano and his nurse ought to have altered their course of action, given the patient’s negative reaction.
“All the warnings out there say when there is a reported burning, you stop,” Scolaro said. “You don’t continue. You don’t pass go. You don’t collect your $200. You stop immediately.”
When Loncar awoke several hours later, his arm had grown red and his fingers had turned black and blue due to a lack of oxygen, according to court pleading. Campuzano and his staff opted to massage Loncar’s arm and fingers over a near-24-hour period, rather than call for a medical evacuation.
Once the ship docked, Loncar was transported to a hospital. But it was too late. His right arm was amputated due to a case of acute compartment syndrome, a condition that arises from pressure buildup caused by internal bleeding and swelling of tissues.
Loncar’s suit alleged negligence and maintained that even though he had been prescribed the wrong medication, his arm could still have been saved from amputation had his symptoms of a poor reaction been properly addressed.
“They gave [Loncar] the most dangerous type of medication they could give to treat this very simple, common problem that can be treated with a very light and easy medication — Zofran. It’s all they needed to do,” Scolaro said. ”It’s like taking a Howitzer to destroy something when all you need to do is take a little BB gun and it would do the same thing. The Howitzer will destroy everything in its path. It was overkill.”
Scolaro told the Daily Business Review that Norwegian Cruise Line’s counsel deferred to the Food and Drug Administration in its defense of Campuzano’s behavior.
“It was a very strange defense: There’s nothing wrong with prescribing IV promethazine. It’s an FDA-approved medication; there is nothing wrong with ordering 25 milligrams, that’s FDA approved; there’s nothing wrong with doing it intravenously — it’s FDA approved; there’s nothing wrong with administering it over the course of two minutes — that’s FDA approved; and there’s nothing wrong with administering it with a syringe — that’s FDA approved,” Scolaro said.
NCL’s attorney, Curtis Mase of Mase Mebane & Briggs, did not respond to requests for comment before press time.
“They tried to use the FDA warnings as its assent to the doctor’s conduct in this case when it’s the furthest from the truth,” Scolaro said. “It’s pretty telling just how graphic the warning is that they give you. This is a black-box warning medication, the highest warning they can give. And for a doctor to deliberately ignore the warnings. … that’s a bit much.”
The defense also argued that Loncar had what they called a “venous anomaly,” predisposing him to the adverse reaction he experienced with the IV promethazine. Scolaro described this defense as “something I’ve never heard of, our experts had never heard of, the treating doctors had never heard of, and even their own expert that they found from Cleveland, he says he’s heard of it. There is no medical literature. Nothing.”
“So we essentially called that out as junk science. And I think our arbitrator likely found this … given how he dismissed this expert’s causation,” Scolaro said, referring to the “venous anomaly” theory as a “last-ditch effort at a defense.”
Read the $3.34 million award here:
“It was not hemodynamically possible, and quite frankly we thought it was completely incredible,” Scolaro said.
In Scolaro’s estimation, the most dramatic point of the case took place during the deposition of Dr. Carlos Gonzalez, Norwegian Cruise Line’s chief medical officer.
“We got Dr. Gonzalez to admit under oath that his own doctor violated and breached the standard of care,” Scolaro said. “Once that occurred, then it was essentially a damage-control situation from that point on.”
Although the case ultimately resolved favorably for their client, Scolaro said that it was a hard-earned award.
“It was certainly aggressively fought,” he said.”But we think that the right result occurred and that justice actually prevailed in this case for a wonderful and deserving client.”
Case: Ilija Loncar v. NCL (Bahamas)
Case No.: 01-16-0004-3640
Description: Medical malpractice
Filing date: Oct. 17, 2016
Verdict date: June 13, 2018
Judge: Peter Abraham, International Centre for Dispute Resolution International Arbitration Tribunal
Plaintiffs attorneys: Thomas Scolaro and Mason Kerns, Leesfield Scolaro, Miami
Defense attorneys: Curtis Mase and Laurence Krutchik, Mase Tinelli, Miami
Verdict amount: $3.34 million