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Brooks v. State

Court of Appeals of Iowa

June 7, 2017

NICOLE BROOKS, and BRENDAN BROOKS, ADDISON BROOKS, and AIDEN BROOKS, by their mother and next friend, NICOLE BROOKS, Plaintiffs-Appellants,
v.
STATE OF IOWA, Defendant-Appellee.

         Appeal from the Iowa District Court for Bremer County, Christopher C. Foy, Judge.

         Nicole Brooks appeals the denial of her motion for a new trial. AFFIRMED.

          Alexander E. Wonio of Hansen, McClintock & Riley, Des Moines and Beau D. Buchholz of Engelbrecht and Buchholz, P.L.L.C., Waverly, for appellants.

          Thomas J. Miller, Attorney General, and Joanne Moeller, Assistant Attorney General, for appellee.

          Heard by Vogel, P.J. and Doyle and McDonald, JJ.

          VOGEL, Presiding Judge.

         After suffering a heart attack and being treated by the University of Iowa Hospitals and Clinics (UIHC), Brooks[1] sued the State of Iowa[2] for negligence. Although a jury found the State negligent, it awarded no damages. Brooks appeals two of the district court's rulings at trial and the district court's denial of her motion for a new trial. Specifically, she claims: (1) the district court erred in failing to admit a letter written by UIHC's Chief Quality Officer; (2) the district court erred in giving a jury instruction regarding alternate methods of treatment; (3) juror misconduct occurred; and (4) the verdict was legally inconsistent.

         I. Background Facts and Proceedings

         Around 9:30 a.m. on May 2, 2012, Nicole Brooks began experiencing chest pain. She called her husband, who is a family physician, and he advised her to sit down, drink water, and relax. After a few minutes passed, Brooks was still experiencing pain; she texted her husband, who immediately scheduled her for an evaluation at a clinic in Waverly. At the clinic, Brooks was examined by Dr. Lee Fagre, and an electrocardiogram (EKG) was performed around 11:30 a.m. The doctor believed the EKG indicated Brooks was in the process of experiencing a heart attack. Dr. Fagre then sent Brooks, by ambulance, to the local hospital, the Waverly Health Center.

         After arriving at Waverly Health Center around noon, another EKG was performed, which also indicated an ongoing heart attack, and Brooks was sent to Covenant Hospital in Waterloo to see a cardiologist-Dr. Ahsan Maqsood. Brooks arrived at Covenant Hospital at approximately 12:58 p.m. Dr. Maqsood performed an angiogram, which revealed that two of Brooks's arteries that supply blood to the heart were mostly blocked. During the procedure, Brooks went into ventricular fibrillation arrest-an irregular heart rhythm-which required Dr. Maqsood to shock the heart back into normal rhythm and insert an intra-aortic balloon pump to support the heart. Dr. Maqsood recommended Brooks be transferred to UIHC for coronary bypass grafting surgery (CABG).

         At approximately 3:27 p.m., Brooks arrived at UIHC and was seen by Dr. Elaine Demetroulis, an interventional cardiologist. After Brooks arrived, UIHC cardiology personnel performed another EKG, an echocardiogram, vascular mapping, and an ultrasound of Brooks's carotid artery. Dr. Demetroulis, along with a team of other doctors, reviewed the results of these procedures. Dr. Demetroulis testified that they were still not positive what was causing Brooks's heart issues, so they decided to perform another angiogram. Dr. Demetroulis testified that she concluded the additional angiogram was necessary to determine the best course of treatment for Brooks. When asked about the time delay caused by the additional diagnostic procedures, Dr. Demetroulis said:

Once you get past three hours, the importance of time becomes less. And certainly after six hours it's even less than that. Now, it doesn't mean that it's unimportant. But, again, that balanced with the complexity of what we were seeing on the angiogram and all the other studies, um, and knowing that we potentially had to go to surgery, all of those studies were absolutely necessary to her care.

         After reviewing the results of the final diagnostic procedures around 6:00 p.m., Dr. Demetroulis and several other physicians discussed the merits and risks of performing either a percutaneous coronary intervention (PCI) or CABG. Ultimately, the doctors decided a PCI was the best course of treatment at that time, as the risk of death during the procedure was lower with a PCI than with a CABG. Because of the nature of the injury to Brooks's heart, there was a risk the PCI would not be successful and surgery would still be necessary, so an operating room was prepared prior to Dr. Demetroulis performing the PCI. While attempting to perform the PCI, complications arose, and Dr. Demetroulis concluded that it was less risky to stop and go to surgery, rather than to continue the PCI.

         Brooks arrived in the operating room for CABG at approximately 7:46 p.m. Dr. Robert Farivar performed three grafts on Brooks's heart, but none were successful in restoring blood flow to her heart. Following the unsuccessful surgery, UIHC's cardiac myopathy, or heart failure, team took over Brooks's care to determine whether her heart would regain any functioning. After several days with little improvement, the heart-failure team determined that an Impella device should be implanted to temporarily support Brooks's heart in pumping.

         On May 8, surgery was performed by Dr. Michael Bates and Dr. Phillip Horwitz, and an Impella device was successfully implanted. Brooks was taken from the operating room to the surgical intensive care unit following surgery at around 5:43 p.m. Around 7:30 p.m., four nurses performed a "logroll" maneuver to turn Brooks and change her bedsheets. After turning Brooks over, the nurses noticed she began bleeding from the area where the Impella device had been implanted. Brooks was taken back to the operating room, and the doctors determined that the Impella device had become dislodged. The team then decided to implant a different device to support Brooks's heart. On May 25, a permanent pumping device was placed in Brooks's heart to support it until she could receive a heart transplant. On June 6, 2013, Brooks received a heart transplant at the Mayo Clinic in Rochester, Minnesota.

         On December 9, 2013, Brooks filed a claim with the State Appeal Board, a precursor to a tort suit against the State, alleging negligence against UIHC. Following the required six-month waiting period, Brooks filed her claim in district court. Brooks generally claimed UIHC should have immediately attempted

         CABG and the delay in doing so caused additional damage to her heart, ultimately resulting in the need for a heart transplant. Brooks also asserted UIHC was negligent in several of its procedures, including the "logroll" maneuver that caused her Impella device to become dislodged.

         At trial, Brooks attempted to admit a letter Dr. Richard LeBlond, Chief Quality Officer at UIHC, sent to Brooks's husband in response to complaints regarding Brooks's care. The letter outlined the conclusions of a "formal review" UIHC performed regarding its procedures involving the use of the Impella device. In part, the letter concluded:

Patients should not be repositioned within the first several hours after implantation. This means that patients will leave the procedure suite in the SICU bed with all personal care issues attended to by the team before leaving the procedure suite obviating the need to reposition the patient in the first few hours.

         Following UIHC's objection to admission of the letter, the district court excluded it.

         In sorting out which instructions would be given to the jury, the State requested an ...


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