Local doctor facing trial on wrongful death claim

Friday, Nov. 20, 2009

A jury heard testimony from expert witnesses and family members this week in a wrongful death civil case that accuses a local doctor of failing to properly diagnose a patient and provide health care in the ordinary standards, contributing to the death of the patient in 2007.

Thelma Fowler, 81, of Dunkirk was taken to the emergency room of Calvert Memorial Hospital on April 22, 2007, at about 2:30 a.m. with complaints of chest and upper abdomen pain. After assessments in the ER and lab tests she was discharged with pain medication and a diagnosis of a fractured rib, according to testimony. She returned to the ER about 40 hours later with similar complaints and a bloated abdomen. A CAT scan of the abdomen was performed and her condition was assessed as a ruptured duodenum, or small intestine, causing fluids to leak throughout her abdomen. She was immediately taken by helicopter to Washington Hospital Center where she received surgery; however after a second surgery on May 1 she did not recover and died on May 12, 2007.

Thelma Fowler's husband, James Thomas Fowler Sr., and two sons have claimed that the actions of both Calvert Memorial Hospital and the ER doctor at the time, Clement Samson K. Banda, M.D., attributed to Thelma Fowler's death, the plaintiff's dispositions state.

The claims against Calvert Memorial Hospital were dropped on July 13, according to court records, but the lawsuit against Banda has gone to trial, with Judge Warren Krug presiding.

Attorney Christian Lodowski of Towson, who represents the Fowler family, called expert witness doctors in radiology, surgery, ER protocol and critical care as well as the ER nurse and physician's assistant who assessed Thelma Fowler's medical condition.

While questioning witnesses, Lodowski presented the jury with an array of anatomical exhibits and several poster-size blow-ups of Thelma Fowler's medical assessment documents. ER nurse Sarah Ball reviewed her triage assessment of both of Thelma Fowler's visits where she documented complaints of chest and abdominal pain noting a 10 out of 10 scale of pain and adding additional comments of "upper right quadrant abdominal pain." Ball said there was no listing of pain on the left, near where the fractured rib was later diagnosed after an X-ray.

Both Lodowski and Banda's attorneys on cross examination focused on Ball circling the lower chest area/upper abdomen of Thelma Fowler's pain on a body image drawn on the ER assessments.

During cross examination, Attorney Wade Callender contrasted Thelma Fowler's presentation of symptoms on her two ER visits, showing that her abdomen was only tender and distended during the second visit, alluding that she did not have a perforation during her first visit.

"She was much sicker on April 23," Ball said.

However, a plaintiff's expert witness on surgery and critical care testified that after he reviewed the documents he thought there was "a perforation during the first ER visit" and said protocol would call for a CT scan of the abdomen as part of the assessment.

"The longer exposure occurs [of leaking fluids] the less likely organs will be able to heal," he said.

Banda's diagnosis of a fractured rib was also scrutinized by the plaintiff's expert witnesses, who all testified that they did not see a fractured rib on Thelma Fowler's X-ray, which was also shown to the jury for examination.

After explaining the type of sitting X-ray that Thelma Fowler received and how to read an X-ray, radiologist Dr. Lawrence Holder said, "There's no rib fracture here, period," adding that a series of X-rays or a CT scan should have been performed.

After questioning the plaintiff's expert witnesses' fees, on cross examination Callender also focused on the differences in Thelma Fowler's ER assessment 40 hours later, reviewing her vital signs as well as ER subjective assessments.

The defense also called an expert witness, Dr. Michael Remoll of Anne Arundel Medical Center, who testified that he had "seen hundreds of rib fractures" and hairline fractures can be difficult to diagnose.

Remoll said Banda reviewed the ER nurse and physician assistant's evaluation, Thelma Fowler's presentation of complaints and physical exam and "they arrived at an appropriate disposition."

Defense Attorney David Roling of Annapolis reviewed lab test results with Remoll, who said both Banda and the P.A. "complied to the standard of care."

Opposing the plaintiff's expert witnesses, Remoll testified that there was "not evidence of abdominal perforation" during Fowler's first visit to the ER.

Family members also testified. James Thomas Fowler Sr.'s daughter-in-law Gail Fowler testified about accompanying Thelma Fowler to the ER both times and her presentation of symptoms.

Thelma Fowler's son, James Thomas Fowler Jr., testified Wednesday afternoon about his mother's service to the family and the family farm in Dunkirk and family photos were shown to the jury. He testified about her three weeks in intensive care at Washington Hospital Center, saying the family decided to "end life support on mom" after they talked with nurses and doctors and "saw she wasn't getting any better." She died May 12 of sepsis, a serious condition characterized by a whole-body inflammatory state caused by fluids leaking into organs, Lodowski said.

charvat@somdnews.com