NICOLE BROOKS, and BRENDAN BROOKS, ADDISON BROOKS, and AIDEN BROOKS, by their mother and next friend, NICOLE BROOKS, Plaintiffs-Appellants,
STATE OF IOWA, Defendant-Appellee.
from the Iowa District Court for Bremer County, Christopher
C. Foy, Judge.
Brooks appeals the denial of her motion for a new trial.
Alexander E. Wonio of Hansen, McClintock & Riley, Des
Moines and Beau D. Buchholz of Engelbrecht and Buchholz,
P.L.L.C., Waverly, for appellants.
J. Miller, Attorney General, and Joanne Moeller, Assistant
Attorney General, for appellee.
by Vogel, P.J. and Doyle and McDonald, JJ.
suffering a heart attack and being treated by the University
of Iowa Hospitals and Clinics (UIHC), Brooks sued the State of
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.
Background Facts and Proceedings
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
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).
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
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.
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.
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
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,
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
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.
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
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.
UIHC's objection to admission of the letter, the district
court excluded it.
sorting out which instructions would be given to the jury,
the State requested an ...