TOWSON, MD
On March 14, 2023, Rusty Arbaugh and Carmelo D. Morabito of Smith, Gildea & Schmidt, obtained a $3 million jury verdict against Francis Tat-Tee Khoo, M.D., a doctor practicing at Carroll Hospital, after a six-day medical negligence trial in the Circuit Court for Baltimore County, Maryland.
THE MEDICAL NEGLIGENCE CASE
The medical negligence case involved a 70-year-old man who presented to Carroll Hospital in July of 2018 with complaints of fatigue and dizziness. He had previously been diagnosed with Stage IIB esophageal cancer in January of that same year. His cancer treatment involved surgery in February where portions of his esophagus were removed. Tests showed signs of cancer in the margins of the surgery – but no lymph node involvement. He was then treated with chemotherapy and radiation, which concluded approximately 5 weeks prior to his visit to Carroll Hospital in July of 2018.
While in the emergency department at Carroll Hospital, he vomited blood twice and he was quickly diagnosed with an upper GI bleed and admitted. An endoscopy was scheduled, and the man vomited blood just prior to it being performed. The endoscopy showed that the surgical site from the cancer treatment was not the cause of the bleeding. The top portion of the stomach also showed no bleeding source, but the remaining portions of his stomach could not be seen due to the presence of blood, blood clots, and food. The gastroenterologist recommended that a nasogastric tube be placed to suction the contents of his stomach so that another endoscopy could be performed in 24 hours to see if a source of the bleed could be found.
The gastroenterologist also recommended that if the patient became unstable overnight, or before the second endoscopy could be done, that a surgical consultation, such as interventional radiology, should be requested.
Eventually the man is transferred to Carroll Hospital’s Critical Care Unit (“CCU”) where his care is taken over by the doctor, Francis Tat-Tee Khoo, M.D. The doctor diagnoses the man as being in hemorrhagic shock and orders a single unit of blood for him around 10:30 PM.
Throughout the course of the night, the man continued to vomit blood, but the doctor chose not to order any additional blood to replace what was lost. The man’s wife never left his side. The nurse documented that the man vomited blood more than 20 times overnight and that the doctor was made aware. When asked questions under oath during a deposition, the nurse also testified consistently with the man’s wife that the two of them worked together to catch the man’s bloody vomit in basins. One would dump the bloody vomit in the toilet and wash the basin as the other assisted the man as he vomited again. At 6:42 AM, just 18 minutes before the doctor’s shift ended, he placed a non-STAT order for a surgical consult.
The man’s blood loss eventually led to a cardiac arrest at 11:18 AM the following morning. While his pulse returned after 25 minutes of resuscitation, he was placed on a ventilator and never regained consciousness. He was eventually flown to Shock Trauma at the University of Maryland Medical Center very late into the evening after his condition was stable enough for transfer. Shock Trauma described his condition as being “in extremis” or “at death’s door.” The family had to make the difficult decision to let him go.
THE MEDICAL NEGLIGENCE TRIAL
At the jury trial, the doctor’s attorneys strongly argued that the man’s condition throughout the night had remained stable – despite the numerous times he vomited blood. The doctor’s attorneys showed the jury the man’s vitals, such as blood pressure, heart rate, respiration, oxygen, etc., which remained fairly consistent throughout the night. They also pointed to a small pulmonary embolism, a blood clot in the lungs, and right-heart failure, both of which were found at Shock Trauma after the man’s cardiac arrest. The doctor’s attorneys argued to the jury that these conditions were the cause of the man’s death, and not the blood loss that was not replaced throughout the night.
Rusty Arbaugh and Carmelo D. Morabito showed the jury evidence that the upper GI bleed was caused by an ulcer that could have easily been stopped by an interventional radiologist through a catheter angiography and embolization – had the doctor bothered to order a STAT surgical consultation.
The doctor’s attorneys also argued that the man’s bleed was due to an extraordinarily rare condition called radiation-induced hemorrhagic gastritis. They argued that this rare condition would have been impossible to treat with embolization by an interventional radiologist.
Finally, the doctor’s attorneys attacked the man’s life expectancy and claimed he had a 47% chance to live another 3 years after his stage IIB esophageal cancer diagnosis.
THE MEDICAL NEGLIGENCE VERDICT
After approximately 3 hours of deliberation, the jury came back with a full verdict in favor of our clients. The jury found that the doctor breached the standard of care and that his negligence was a cause of the man’s death. The jury awarded $3 million – $1 million to the man’s wife, $1.5 million to the man’s estate for his pain and suffering and $250,000 in non-economic pain and suffering to each of the man’s two adult sons.