Widow accuses doctors of missing signs of pulmonary embolismA 12-person jury was still deliberating this morning over a $2.5 million wrongful death suit filed against Columbia Memorial Hospital and four physicians by the widow of a man who died at age 40 of a massive heart attack four years ago while under their care.

Denise Fuller claims the doctors failed to correctly diagnose and treat the pulmonary embolism that killed her husband, Steven Fuller, on Sept. 28, 1998. She is seeking $500,000 in non-economic damages and $2.015 million in economic damages from CMH and physicians Carolyn Merten, Jason Rahme, George Young and Larry Zagata. PeaceHealth Medical Group, which until last year ran a clinic in Astoria where Rahme practiced, is also named.

The jury trial ended Monday after three weeks of testimony from expert witnesses from both sides on the traits of pulmonary embolism, or PE, in which large blood clots travel into the lungs and pulmonary artery, blocking blood flow to the lungs.

In her closing statement Monday, attorney Linda Rudnick argued that the physicians missed numerous opportunities to diagnose and treat Fuller's condition, from his first visit to the CMH emergency room following an episode of chest pain, to his last visit six weeks later, the day before he collapsed and died at work.

"There were numerous signs, symptoms and red flags," she said.

Rudnick claimed that Young misread a scan ordered by Zagata that showed evidence of abnormalities in his lungs. Merten and Rahme, she said, failed to recognize other warning signs, including a fainting spell Fuller suffered the day before his death, and soreness in his leg, as possible PE symptoms.

But attorneys for the four defendants said that the doctors handled Fuller's case according to all the accepted medical standards, and shouldn't be punished for failing to immediately recognizing signs of PE in Fuller, an otherwise healthy 40-year-old who carried none of the risk factors associated with a condition that is notoriously difficult to pinpoint, and which is more often than not discovered only during the autopsy after a victim's death.

"Dr. Rahme, and the rest of the physicians, provided very thoughtful, compassionate care, with attention to detail," said Jeffrey Street, Rahme's attorney. "It is not right, and not fair, to point the finger at them to say 'you caused his death.'"

Fuller first came to the CMH emergency room Aug. 17 after returning from a trip to Alaska, where he had gone to a hospital with severe chest pain. Zagata, who examined Fuller, ordered a "lung perfusion scan" designed to check for evidence of pulmonary embolism. Young examined the scan and deemed it normal.

Rudnick said Young missed obvious clues on the scan pointing to the possibility of PE.

"It's even clear to the untrained eye, when you know what to look for," she said. "If Dr. Young had done his job properly, this condition would have been nipped in the bud."

Zagata, still concerned Fuller could be suffering from PE, referred him to Rahme for further examination and treatment, but did not conduct other tests that could have revealed the condition, Rudnick said.

Rahme ordered a chest X-ray, but did not investigate the leg pain Fuller complained of for evidence of deep-vein thrombosis, the development of major clots, usually in the large veins of the legs, that often accompanies pulmonary embolism, she said.

Fuller returned to the CMH emergency room Sept. 27, the day before his death, after suffering a brief fainting spell at his home. Rahme and Merten, who saw him that day, failed to share information about Fuller's condition that may have pointed to PE, Rudnick said. The next morning, when Fuller awoke with painful swelling in his leg, he called the hospital, but was told by an emergency room nurse to make an appointment with Rahme, she said.

Had a diagnosis of PE been made at any time during those six weeks, Fuller could have been given Heparin, a medicine that decreases clotting in blood and a standard treatment for the condition, she said.

"Had Steve Fuller been treated with Heparin, he would be here today," she said.

The defense attorneys argued that the suit relies on the testimony of expert witnesses who have the benefit of hindsight in evaluating the physicians' performance.

"In hindsight, every single one of us is an expert," Street said, noting that pulmonary embolism is called the "great masquerader" because its symptoms mimic those of other conditions.

The defense argued the signs of PE weren't as clear as Rudnick claims. Young's attorney, Paul Silver, pointed out that radiology remains an inexact science, and that radiologists disagree on the findings of lung perfusion scans as often as one out of three times.

Street said the leg pain Fuller reported to Rahme went away with an over-the-counter pain reliever, and the other symptoms such as shortness of breath also appeared to clear up over time. The day of the fainting spell, Fuller had no shortness of breath, chest pain or other symptoms indicating it was PE that caused him to pass out, he said.

Larry Brisbee, attorney for Merten and Zagata, noted that some of the tests Rudnick claims the doctors should have given Fuller are themselves potentially harmful and aren't performed without some reasonable suspicion of the condition they're supposed to detect. He also noted that the medicine Heparin "is a deadly drug if not given right."

Brisbee also said that plaintiff witness and former state medical examiner William Brady said the clot that ultimately felled Fuller could have developed as late as 12 hours before his death, after he left the emergency room on Sept. 27.

Attorney Robert Keating, representing Columbia Memorial, told the jury there is no evidence backing Rudnick's claim that the emergency room nurse who fielded Fuller's call on the morning of Sept. 28, Floyd Baker, should have told Fuller to come in immediately. Merten's notes from that day indicate that Fuller was told to come to the emergency room if he was unable to make an appointment with Rahme, he said.

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