The Superior Court of Pennsylvania (“Pennsylvania Appellate Court”) held in its opinion filed on February 27, 2019 that although it was error for the trial judge to instruct the Pennsylvania medical malpractice jury with regard to the two schools of thought doctrine in a Pennsylvania medical malpractice case where the plaintiff alleged that the defendant surgeon placed unnecessary cardiac stents in various cardiac vessels, “we see no indication that the erroneous two schools of thought instruction contributed to the verdict. Although the instruction should not have been given at all, the jury was told that it did not apply to claims of unnecessary stenting. The jury rejected [the plaintiff’s] claim that the stenting procedures were unnecessary when it specifically found that [the defendant interventional cardiologist] did not fail to obtain informed consent, did not commit a battery, and was not negligent in his treatment of [the plaintiff}.”
Two Schools Of Thought Doctrine
The two schools of thought doctrine in Pennsylvania medical malpractice cases provides that where competent medical authority is divided, a physician will not be held responsible if in the exercise of his judgment he followed a course of treatment advocated by a considerable number of recognized and respected professionals in his given area of expertise. A medical practitioner has an absolute defense to a claim of negligence when it is determined that the prescribed treatment or procedure has been approved by one group of medical experts even though an alternate school of thought recommends another approach, or it is agreed among experts that alternative treatments and practices are acceptable.
In the case the Pennsylvania Appellate Court was deciding, the Pennsylvania medical malpractice plaintiff alleged that the defendant interventional cardiologist performed medically unnecessary stenting procedures on him (i.e., that his left anterior descending vessel (“LAD”) and circumflex arteries were less than seventy percent occluded, and that intervention with a stent was unnecessary, negligent, and contrary to the standard of care). The medical experts on both sides agreed that the standard of care was to stent any lesion or blockage of seventy percent or more as depicted on an angiogram. The experts disagreed, however, on the extent of the blockages in the plaintiff’s LAD and circumflex arteries and whether placement of a stent or stents in those vessels was medically indicated.
In order to refute evidence that the corporate defendant knew or should have known that there was unnecessary stenting being performed, the defendants introduced evidence that there were two generally recognized approaches to stenting. Some cardiologists adhered to the belief that a single stent should be placed only at the location of the occlusion, a method called spot stenting. Others advocated in favor of the use of multiple stents, if necessary, to cover the entire lesion and connect healthy tissue to healthy tissue. The defendants subscribed to the latter approach.
The defendants requested that the two schools of thought jury instruction be given and the plaintiff objected. The trial court agreed with the plaintiff (i.e., that the plaintiff’s claims against the defendant interventional cardiologist were based on the physician’s stenting of vessels that were not sufficiently occluded to warrant placement of any stent at all). Nonetheless, the trial judge instructed the jury with regard to the two schools of thought doctrine, followed by instructions on the liability of a health care institution that violates its duty to ensure its patients’ safety and well-being.
At the conclusion of the two-week Pennsylvania medical malpractice trial, the jury returned a verdict in favor of the defendants. In response to special interrogatories, the jury found that the defendant interventional cardiologist did not fail to obtain the plaintiff’s informed consent, did not commit a battery, and was not negligent in his treatment of the plaintiff. Based on those findings, the jury did not reach the claims of corporate negligence against the defendant’s employer and civil conspiracy among all the defendants.
The Pennsylvania Appellate Court stated that the two schools of thought doctrine operates to insulate physicians from liability when the allegedly negligent medical treatment is one accepted by a considerable number of respected physicians. The Pennsylvania Appellate Court held that the two schools of thought defense had nothing to do with whether the corporate defendant had the requisite notice of the unnecessary stenting procedures, and therefore the trial court erred in instructing the jury to find for the defendants if it found two schools of thought.
Nonetheless, the Pennsylvania Appellate Court held: “We find the language used by the trial court herein sufficient to apprise the jury that the instruction was inapplicable to the unnecessary stenting claims, which were the only claims the jury reached in rendering its verdict … the court herein specifically told the jury that the instruction was not applicable to the claims of unnecessary stenting against [the defendant interventional cardiologist] and that it could not consider it with regard to those claims … The court’s direction was clear and explicit. The only claims upon which the jury reached a verdict were those unnecessary stenting claims. We must presume that the jury followed the direction of the trial court and did not consider the defense with regard to those claims.”
Source Sensenich v. Morcos, 2019 PA Super 61.
If you or a loved one had an unnecessary stent procedure in Pennsylvania or in another U.S. state, you should promptly seek the advice of a Pennsylvania medical malpractice lawyer or a medical malpractice lawyer in your state who may investigate your stent claim for you and represent you in a stent malpractice case, if appropriate.
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