Bruce Hunt

Joplin, MO — Attorney Bruce Hunt successfully defended a Joplin, MO internist against allegations he directly contributed to cause a woman’s death in late December, 2001.

Decedent Alta Fern Brown was admitted by neurosurgeon Hish Majzoub, M.D. through the emergency room at St. John’s Regional Medical Center in Joplin, MO on November 23, 2001.  Following a CT scan, Mrs. Brown was diagnosed as having a intracerebellar hemorrhagic stroke.  She was started on Decadron, a high-potency corticosteroid,  to reduce edema caused by the stroke.  An emergent ventriculostomy was performed by Dr. Majzoub to relieve the increased intracranial pressure.  On November 27, Mrs. Brown underwent a suboccipital craniotomy to evacuate the hematoma from her brain.  Mrs. Brown made “dramatic steady improvement” following the craniotomy and was transferred to the Skilled Nursing Unit at Freeman Hospital on December 7, 2001 where she was to continue her recovering from her stroke.  Her Decadron dosage was decreased upon transfer.

On December 20, 2001, nurses at Freeman noted brownish drainage coming from the previously healed craniotomy site.  They attempted to contact Dr. Bettasso once by phone and made no other attempts to get him involved until December 25 when her neurological status worsened.  When Dr. Bettasso saw her on the 25th, he immediately suspected an infection and started her on antibiotics.  He also had her transferred to the ICU at St. John’s.

At St. John’s, neurosurgeon Cherylon Yarosh, M.D. took Mrs. Brown to the operating room to debride her head wound.  At the time of surgery she was able to express copious amounts of pus from the wound.  This was cultured and identified as staphylococcus aureus (not MRSA, the hospital-acquired form of staph aureus).  Mrs. Brown was continued on antibiotics but eventually succumbed to meningitis on December 30, 2001.

The specific allegations in this case relate to two main issues: Decadron and physician visits.  Plaintiffs contended that Dr. Bettasso kept Mrs. Brown on Decadron too long and that by doing so an infection she acquired during the craniotomy was allowed to remain latent and was not diagnosed until she reached a “point of no return” on December 24th.  Defendants countered that Mrs. Brown continued to have swelling in her brain as shown by subsequent CT scans and that the Decadron continued to be indicated.

Plaintiffs also contended that Dr. Bettasso did not personally see the patient in the Skilled Nursing Unit on a frequent enough basis.  Plaintiffs brought up a document drafted by nursing staff at Freeman Hospital that recommended physician visits to patients in the Skilled Nursing Unit every 72 hours.  However, there was no evidence that this was an actual policy of the hospital that had ever been adopted nor was it binding on physicians for establishing standard of care.

Plaintiff hired three experts to criticize the health care providers in the case.  Dr. Richard Jacobs, a physician who practices infectious disease medicine in San Francisco,  Dr. Loren Lipson, a physician who practices geriatric medicine in Los Angeles and Dr. Gregory Hornig, a pediatric neurosurgeon from Kansas City.

Defendant’s experts were Dr. Kenneth Scott, a board-certified family practitioner from Clinton, MO, Dr. Paul Jost, a board-certified infectious disease expert from Kansas City and Dr. Thomas Briggs, a board-certified neurosurgeon from Springfield, MO.

The jury deliberated for 39 minutes before coming back with a unanimous defense verdict on behalf of Dr. Bettasso and his employer, Mercy Clinics, Inc.