The Court of Appeals of the State of Washington Division Three (“Washington Appellate Court”) held in its unpublished opinion filed on April 21, 2022 in a medical malpractice case involving the death of a two-year-old: “The Pittmans have produced ample evidence to overcome summary judgment on their breach of standard of care claim. Dr. Cummins has opined that the standard of care in Washington is to have a radiologist review and interpret any x-rays ordered of a patient in the emergency room prior to discharging that patient. YVM challenges Dr. Cummins’s opinion by claiming he lacks sufficient expertise to testify as to the standard of care for emergency room administration. We disagree. A physician can testify regarding the standard of care applicable to a corporate health care provider. Douglas v. Freeman, 117 Wn.2d 242, 250, 814 P.2d 1160 (1991) (defendant doctor supplied sufficient evidence of breach of corporate duty). Dr. Cummins has extensive emergency room experience in Washington. He was competent to testify as to the standard of care … The issue of whether YVM breached the standard of care by not having a policy directing that a radiologist review and interpret x-rays ordered in the emergency room prior to patient discharge is a question of fact that must be resolved by a jury.”
The Washington Appellate Court further held: “the Pittmans have also produced sufficient evidence to overcome summary judgment on their causation claim. Although Dr. von Allmen opined that Jayne would have had very little chance of survival even if she had been referred for surgery when she presented to YVM on June 3, Dr. Cummins disagreed with this assessment. Like Dr. von Allmen, Dr. Cummins reviewed the autopsy report and Jayne’s treatment records. He opined, to a medical degree of certainty, that had Jayne been provided timely interventions she would have survived.”
Jayne Alazne Pittman was a two-year-old girl who suffered from cystic fibrosis and chronic pseudomonas. In May 2015, Jayne began experiencing intermittent moderate abdominal pain. On May 26, 2015, Ms. Pittman brought Jayne to the emergency room at YVM where a doctor ordered x-rays with two views of Jayne’s abdomen. After reviewing the films himself, the doctor diagnosed Jayne with constipation, prescribed a laxative, and sent the child home with her mother.
About a week later on June 3, Jayne’s parents again brought Jayne to YVM, this time because of abdominal pain, abdominal distension, abdominal cramping, vomiting, and diarrhea. The attending emergency room physician, Mark Livingston, M.D., conducted a physical examination of Jayne and ordered an x-ray. Dr. Livingston interpreted the x-ray and determined Jayne had “[d]ilated loops of bowel filled with stool and gas, similar to [the] x-ray performed [on] May 26.” Dr. Livingston diagnosed Jayne with “acute vomiting likely viral syndrome” and prescribed an anti-nausea medication. Dr. Livingston discussed his interpretation of the x-ray and his diagnosis with Jayne’s parents, and the Pittmans returned home early the next morning around 1:30 a.m.
According to the autopsy report, Jayne and Ms. Pittman fell asleep around 2:30 a.m., with Jayne falling asleep on her mother’s chest. When Ms. Pittman awoke about 6:00 a.m., Jayne was no longer breathing and unresponsive. Later that morning, Joseph Gouveia, M.D., a radiologist with staff privileges at YVM, reviewed Jayne’s x-ray from the night before, unaware that Jayne had since died. In his written report, Dr. Gouveia described “rather notable obstipation,” bowel distension, and “a small amount of bowel dilation.” This interpretation was very similar to that of Dr. Livingston.
A subsequent autopsy performed by forensic pathologist Jeffrey Reynolds, M.D., identified the cause of Jayne’s death as “[s]evere malabsorption syndrome secondary to cystic fibrosis” and concluded the mechanism of death was “[a]cute cardiac pump failure secondary to right heart air embolism.” Dr. Reynolds indicated that Jayne had suffered “torsion of the omentum,” leading to “avascular necrosis of [a] considerable portion of [the] small bowel.” Jayne’s necrotic small bowel was found to be grossly dilated, extending from the mid-jejunum to the mid-ileum area. The compromised, distended, and air-filled bowel was the source of the “[d]issection of gas into the submucosal venous and lymphatic system” with eventual venous air embolus to [the] right heart,” due to the omentum torsion, leading to “acute cardiac pump failure.” Put simply, due to Jayne’s severe bowel condition, air was able to escape from her bowels and eventually reach her heart, causing an air embolism in the right portion of the heart.
Source Pittman v. Virginia Mason Health System, No. 38054-8-III.
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