Date of Verdict: November 21.

Court and Case No.: C.P. Montgomery No. 07-11128.

Judge: Arthur R. Tilson.

Type of Action: Medical malpractice.

Injuries: Death.

Plaintiffs Counsel: Frank P. Murphy, Murphy, Haskins & Dengler, Norristown, Pa.

Defense Counsel: Gary M. Samms, Eileen K. Keefe, Obermayer Rebmann Maxwell & Hippel, Philadelphia.

Plaintiffs Experts:Dr. James Rosenthal, emergency room, Rockville, Md.; Dr. Alan B. Kravitz, general surgery, Germantown, Md.

Defense Experts:Dr. Dennis J. Dollard, emergency medicine, Philadelphia; Dr. John Morris, general surgery, Philadelphia.

Comment: A Montgomery County jury has handed down a defense verdict in favor of a Pennsylvania doctor alleged to have failed to diagnose the stomach condition that precipitated a woman’s ailing abdominal health and contributed to her death.

The estate of Edwina Fanaro, administrated by Richard J. Fanaro, pled that Fanaro’s death was related to a “downward spiral” from a number of infections that was precipitated by the negligence of the defendants — Dr. David M. Perry, Pottstown Memorial Medical Center (where Perry worked) and Fanaro’s family doctor.

Despite the plaintiff’s naming all three defendants in the lawsuit, only Perry ended up going to trial.

According to Perry’s attorney, Gary M. Samms of Obermayer Rebmann Maxwell & Hippel, Foley settled and the hospital was released from the matter.

Samms said the Thanksgiving Eve verdict followed what jurors said was a superior performance by Perry’s experts and Perry’s own testimony.

“We made no offers,” Samms said, noting the $2 million demand. “He was hellbent that his care was appropriate.”

The pretrial filings in the case of Fanaro v. Pottstown Hospital Company show Fanaro’s medical history in the last two years before her death to be a voluminous one.

At the end of March 2005, Fanaro had a colonoscopy at Pottstown Memorial, which turned up findings of diverticulitis — a condition that occurs when pouches that form in the walls of the colon get inflamed or infected.

It was that condition that Fanaro’s estate pled Perry failed to diagnose when Fanaro saw him in the emergency room, just more than one month later.

On May 12, 2005, Fanaro presented to Pottstown Memorial, where she first came under Perry’s care. According to Perry’s pretrial statement, Fanaro complained of abdominal pain in both lower quadrants and constipation.

The defense theory of the case, Samms said in an interview, was that Fanaro did not show the “cardinal signs” of diverticulitis, which Samms identified as fever and pain in the lower left quadrant.

The plaintiff pled Perry should have ordered a CT scan, which allegedly would have turned up the condition.

According to Perry’s pretrial statement, an examination of Fanaro showed no signs of weight loss, shortness of breath or chest pain, as well. She had a sore throat, constipation, cough and skin bruising. She had a soft, nondistended abdomen, moderate superpubic tenderness and normal bowel sounds, according the statement. An abdominal X-ray was interpreted as showing “two loops of small bowel that were mildly distended,” which the defendant pled represented an early or partial bowel obstruction.

The plaintiff also pled in a pretrial statement that Fanaro complained of pain in both lower quadrants. Additionally, the plaintiff’s statement said, an assessment included pelvic pain, bruising on the stomach, “recent (early-April) colonoscopy constipation,” increased pain with attempts to move her bowels, and blood in her stool.

Perry administered magnesium citrate and prescribed a laxative, according to the plaintiff’s statement. She was diagnosed with constipation and released at about 10:30 that night, with instructions to contact her general practitioner — F. Lamar Foley Jr. — for a follow-up.

Foley, who settled, pled that Fanaro presented to him with pain above her pelvic bone. Foley’s attorney, Richard E. Geschke, could not be reached for comment.

Foley, according to his pretrial statement, noted Fanaro had a soft abdomen and normal bowel sounds and some bruising of the abdomen. According to the statement, Foley was uncertain whether he had the results of the colonoscopy during Fanaro’s May 13, 2005, visit.

On May 16, 2005, Fanaro’s sister took her to the emergency room at Mercy Suburban Hospital; Fanaro was having constant abdominal pain at that time, court records indicate.

A CT scan revealed that Fanaro did have diverticulitis, along with a microperforation of her bowel. Doctors deferred surgery, though, because Fanaro was having trouble breathing, was wheezing and had elevated enzymes. Doctors at Mercy also diagnosed her with acute coronary syndrome.

She was transferred to Lankenau Medical Center for subsequent abdominal surgery for the diverticulitis; a Hartmann procedure, a type of colostomy surgery, was administered.

In February of the following year, about nine months later, Fanaro had the colostomy reversed, but developed an incisional hernia from the operation. She had the hernia repaired June 23, 2006.

Shortly thereafter, Fanaro developed a large abscess within her abdomen, related to the hernia repair. On July 4, an exploratory laparotomy was performed, the mesh used to repair the hernia was removed and the abscess was drained.

Over the next several months, the plaintiff pled, Fanaro developed necrotizing fasciitis, a bacterial infection, the result of which the estate pled was an infected abdominal wall and a “wall defect requiring multiple hospitalizations.”

She was hospitalized or in a nursing home between July 4, 2006, and May 26, 2007, the date of her death, with few exceptions, according to the plaintiff.

Plaintiffs counsel, Frank P. Murphy of Murphy, Haskins & Dengler, did not return calls requesting comment. 


— Ben Present, of the Law Weekly