578 N.E.2d 916
No. 85-10880.Court of Claims of Ohio.
Decided May 18, 1989.
Gerald S. Leeseberg, for plaintiffs.
Anthony J. Celebrezze, Jr., Attorney General, an Elizabeth Tarpy Kerns, Assistant Attorney General, for defendant.
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LOWELL B. HOWARD, Judge.
On November 18, 1985, the plaintiffs, Mearl and Rita Kokensparger, filed this wrongful death action against the defendant, the Athens Mental Health Center (herein “AMHC”), alleging it was negligent during the treatment of their son, Jeffrey Kokensparger. On March 6, 7, 9 and 23, 1989, trial was conducted in this case pertaining to the sole issue of liability. The court has considered the evidence and arguments presented and renders the following findings and conclusions.
Findings of Fact
Jeffrey Kokensparger was hospitalized in late September 1978 and early October 1978 at Bethesda Hospital in Zanesville, Ohio, suffering from a sleeping disorder, weight loss and various other health-related problems. In late October 1978, Jeffrey Kokensparger was transferred to AMHC, which was the commencement of five years of continuous contact between Jeffrey and AMHC.
From October 1978 through May 1979, Jeffrey Kokensparger was a patient at AMHC; he was permitted, however, to visit the home of his parents, Mearl and Rita Kokensparger, on weekends. During this period, his parents noticed that Jeffrey would consume uncharacteristically large amounts of liquid and food.
From May 1979 through August 1981, Jeffrey Kokensparger was sporadically discharged from the hospital and permitted to live away from AMHC; this arrangement, however, was unsatisfactory and thus culminated with Jeffrey’s hospitalization in August 1981. For the next four years Jeffrey almost continuously remained on the premises of AMHC. Jeffrey Kokensparger’s medical records for this time period are replete with notations regarding his excessive eating and drinking, as well as his complaints of abnormal discomfort in his head.
On April 14, 1985, Jeffrey suffered a grand mal seizure while at AMHC. He was transferred to O’Bleness Memorial Hospital in Athens, but he never regained consciousness and subsequently died on April 22, 1985. Plaintiffs thereafter requested that an autopsy be performed by Davidson Pathology Associates, Inc. The results of the autopsy precipitated a letter from Dr. Gary E. Cordingley, the intermittent attending physician of Jeffrey Kokensparger, which was directed to the plaintiffs, wherein he stated: “Jeffrey’s autopsy showed the brain tumor we thought he must have.” (Plaintiffs’ Exhibit 16). The certificate of death for Jeffrey Kokenparger states the cause of death “as brain death as a consequence of Diabetes Insipidus as a consequence of a Hypothalamic Brain Tumor.”
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Conclusions of Law
Plaintiffs’ complaint, framed as a wrongful death action, raises two central issues: (1) Did defendant, through its agents, fail to exercise the skill, care and diligence expected of others in the same profession when evaluating and diagnosing Jeffrey Kokensparger’s health problems? and (2) Did the plaintiffs prove by a preponderance of the evidence that there was a tumor present in the hypothalamic area of Jeffrey Kokensparger’s brain?
In view of the allegations asserted, plaintiffs have the burden of proof to show by a preponderance of the evidence that AMHC was negligent under the circumstances. It is generally accepted in Ohio that the essential elements of negligence are (1) a duty of care owing to the plaintiff, (2) a breach of that duty by a negligent act or omission, and (3) an injury proximately resulting from such breach. 70 Ohio Jurisprudence 3d (1986) 46, Negligence, Section 9; Strother v. Hutchinson (1981), 67 Ohio St.2d 282, 21 O.O.3d 177, 423 N.E.2d 467; Di Gildo v. Caponi (1969), 18 Ohio St.2d 125, 47 O.O.2d 282, 247 N.E.2d 732.
Under the circumstances presented, it is evident that AMHC owed a duty of proper medical care to the decedent. In this regard, the defendant had the obligation to render medical care which was warranted due to the decedent’s condition.
In Bruni v. Tatsumi (1976), 46 Ohio St.2d 127, 75 O.O.2d 184, 346 N.E.2d 673, paragraph one of the syllabus, the Ohio Supreme Court enunciated a physician’s standard of care as follows:
“In order to establish medical malpractice, it must be shown by a preponderance of evidence that the injury complained of was caused by the doing of some particular thing or things that a physician or surgeon of ordinary skill, care and diligence would not have done under like or similar conditions or circumstances, or by the failure or omission to do some particular thing or things that such a physician or surgeon would have done under like or similar conditions and circumstances, and that the injury complained of was the direct and proximate result of such doing or failing to do some one or more of such particular things.” See, also, 67 Ohio Jurisprudence 3d (1986) 30, Malpractice, Section 20.
In the case at bar, there was considerable testimony from various medical experts as to what treatment a physician of ordinary skill, care and diligence should have administered to evaluate and treat the medical problems experienced by Jeffrey Kokensparger.
Dr. Oscar Hunter’s deposition testimony was read into the record at trial. Dr. Hunter, an expert in the field of pathology including neuropathology,
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agreed that the acceptable standard of medical care for a young, otherwise healthy patient who exhibits behavioral disorders, possibly attributable to neurological problems, would require a differential diagnosis to search for a brain lesion. Dr. Hunter concluded that a computerized axial tomography (“CAT scan”) would be included in the differential diagnosis to identify a brain lesion.
Dr. Arthur Boxer, an expert in the field of psychiatry, also testified that reasonable, prudent and acceptable standards of medical care dictated that a CAT scan should have been performed on Jeffrey Kokensparger. Dr. Boxer also commented that the behavioral problems and excessive food/water intake exhibited by Jeffrey Kokensparger, which were predominate in his medical records, required a consideration of some form of organicism when conducting the differential diagnosis.
Jeffrey Kokensparger’s medical records at AMHC, as aforementioned, indicate that he habitually consumed excessive amounts of water and food, complained of pain near the region of his eyes and ears, occasionally exhibited facial grimaces, and experienced other behavioral disorders. Defendant contends that these symptoms suggest the possibility of Jeffrey Kokensparger being a schizophrenic. The court agrees that schizophrenia could have been a possible condition; however, after considering the aforementioned testimony of the medical experts, the court concludes that the possibility of organic problems causing these symptoms should have been considered by defendant. Consequently, it is the opinion of this court that a differential diagnosis should have been performed on Jeffrey Kokensparger, including a CAT scan which would have identified the existence of a brain lesion.
Upon review of the evidence and in consideration of the arguments presented at trial, the court finds that the plaintiffs’ have met their burden of proof in establishing that the care and treatment of Jeffrey Kokensparger at AMHC fell below the acceptable standards of medical care. The defendant’s agents failed to consider anything other than a functional illness, as demonstrated by their conclusion that Jeffrey Kokensparger suffered from a schizophrenic and/or paranoiac type of disorder. In limiting their diagnosis to this type of disorder, the defendant’s agents failed to consider the possibility of a lesion existing in the patient’s central nervous system. If said lesion would have been seriously contemplated, it would have been necessary to have a differential diagnosis including a CAT scan performed. Such evaluation and treatment would have revealed the decedent’s ultimate problem.
The second issue debated at trial was whether there was a tumor present in the hypothalamic region of Jeffrey Kokensparger’s brain. As aforementioned, Jeffrey’s medical records demonstrate that he exhibited symptoms that
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suggest the possibility of a hypothalamic tumor existing. In view of such symptoms, the plaintiffs requested an autopsy of the decedent’s body. The plaintiffs completed an “authority for autopsy” form to effectuate this request and Dr. Cordingley noted on said form that “special attention to the hypothalamic and inferior frontal portions of the brain” would be proper. See Plaintiffs’ Exhibit 7.
Dr. Darryl Cherdron of Davidson Pathology Associates, Inc. performed the autopsy and subsequently rendered a report. Dr. Cherdron testified that an examination of the decedent’s brain revealed an “extremely soft area of atypia in the hypothalamic area.” Dr. Cherdron proceeded to place tissues from the hypothalamic area of the decedent’s brain onto slides. See Plaintiffs’ Exhibit 6. A review of said slides by Dr. Cherdron revealed a finding of astrocytoma, which is a neoplasm of brain tissue or commonly referred to as a tumor. Based on these discoveries from his examination, Dr. Cherdron stated in his report that his final anatomical diagnosis included a finding of “necrosis and atypia consistent with low grade astrocytoma, brain, hypothalmic [sic] area, right.” See Plaintiffs’ Exhibit 5. Consequently, Dr. Cherdron concluded that Jeffrey Kokensparger had a hypothalamic brain tumor.
Dr. Oscar Hunter testified that he reviewed the slides of tissue from Jeffrey Kokensparger’s brain and concluded that astrocytomia in the hypothalamic area of Jeffrey’s brain was present. In addition, Dr. Zelig Weinstein, a neuroradiologist, testified that he reviewed a CAT scan taken of Jeffrey Kokensparger on April 15, 1985. See Plaintiffs’ Exhibit 8. Dr. Weinstein was of the opinion that astrocytomia was “definitely” present in the hypothalamic area of the decedent’s brain.
Upon review of the evidence, particularly the testimony of said medical experts, the court finds that the plaintiffs have proven by a preponderance of the evidence that, more probably than not, there was a tumor present in the hypothalamic area of Jeffrey Kokensparger’s brain when he died on April 22, 1985. The court further finds that this tumor was slowly growing, had been present for a number of years and was causally connected to the death of Jeffrey Kokensparger.
The court concludes that defendant deviated from acceptable medical practice by failing to thoroughly and properly diagnose plaintiffs’ decedent. The court further finds that defendant’s breach of its duty of care was the proximate cause of defendant’s failure to discover the astrocytomia present in the hypothalamic area of the decedent’s brain and appropriately treat this symptom.
Accordingly, the court finds that the defendant was negligent in its care and treatment of Jeffrey Kokensparger and thus is liable for damages as a result
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thereof. A trial on the issue of damages will be scheduled at a time the Clerk of this court deems to be appropriate.
Judgment accordingly.
LOWELL B. HOWARD, J., retired, of the Court of Common Pleas of Athens County, sitting by assignment.
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