The Superior Court of New Jersey Appellate Division (“New Jersey Appellate Court”), in its opinion dated March 12, 2020, held, “Viewing the evidence in a light most favorable to plaintiff, and granting him all reasonable inferences, we conclude that plaintiff presented sufficient evidence to allow the jury to find that defendant’s failure to inform plaintiff that he had Factor V Leiden increased his risk of suffering an arterial stroke. In response to the requests for admissions, defendant admitted that Factor V Leiden increases the risks of a clotting event and of a stroke, and although these admissions did not differentiate between venous and arterial strokes, defendant had the opportunity to deny this statement as overly general and then qualify it as he did with other requests. Defendant also admitted that prophylactic anticoagulants were a treatment option for Factor V Leiden.”
The New Jersey Appellate Court continued, “viewing the evidence in a light most favorable to plaintiff, and granting him all reasonable inferences, we conclude that plaintiff presented sufficient evidence to allow the jury to find that defendant’s negligence was a substantial factor contributing to plaintiff’s arterial stroke. Most importantly, defendant’s February 27, 2014 office notes indicating that plaintiff’s stroke was secondary to smoking and Factor V Leiden was persuasive evidence.”
Factor V Leiden
In March 2000, the defendant physician referred the plaintiff for blood testing because of the plaintiff’s family history of hypercoagulability problems. The plaintiff’s test results showed that he tested positive for Factor V Leiden. Factor V Leiden is a genetic mutation that increases the risk of a hypercoagulable state.
On May 12, 2000, the plaintiff had an appointment with the defendant. The parties disputed whether the defendant informed the plaintiff that he had tested positive for Factor V Leiden and discussed treatment to decrease the risk of any adverse consequences. Office notes from this appointment included a variety of information but neither stated that the plaintiff tested positive for Factor V Leiden nor used the words Factor V Leiden, blood clots, or hypercoagulability. While the notes indicated that the parties reviewed test results, the notes did not explicitly refer to the blood test. None of the office notes concerning the plaintiff from May 12, 2000 through February 26, 2012 indicated that plaintiff tested positive for Factor V Leiden.
On July 29, 2012, the plaintiff suffered an arterial stroke, specifically a “middle cerebral artery/cerebral vascular attack,” causing right-sided weakness.
The plaintiff filed a New Jersey medical malpractice lawsuit. During discovery, the plaintiff served requests for admissions on the defendant and elicited, in part, the following admissions: A Factor V mutation increases the risk of a hypercoagulable state, the risk of a clotting event, and the risk of a stroke; a patient with the heterozygous “Factor V Leiden mutation [that] is not anticoagulated is at an increased risk of stroke”; and prophylactic anticoagulants (blood thinners) are a “treatment option for a patient who is positive for a Factor V abnormality.” These admissions were read into the record at trial.
The defense argued at trial, among other things, that Factor V Leiden affects clotting on the venous side of the body but the plaintiff suffered an arterial side stroke caused by plaque breaking off from the arteries. The defense further argued that anticoagulants or anti-platelet drugs are reasonable treatment options only after an event, such as a clot, pulmonary embolism, or stroke because the risk of complications associated with taking these medications is greater than the risk of suffering an event caused by Factor V Leiden.
The New Jersey medical malpractice jury returned a verdict in favor of the plaintiff, awarding $852,350 in total damages and attributing 55% of the ultimate injury to the defendant’s negligence and 45% to the plaintiff’s preexisting conditions.
The New Jersey Appellate Court held: “the trial judge did not abuse his discretion in ruling on the requests for admissions, and plaintiff presented sufficient evidence to support a claim of negligent treatment. Although defendant presented a greater quantum of evidence to support his case, “[a] reviewing court should not disturb the findings of the jury merely because it would have found otherwise upon review of the same evidence.””
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