Murray v. UNMC Physicians

Facts

Robert Murray (Robert) (Plaintiff), individually and as special administrator of the estate of his wife, Mary K. Murray (Mary) (Plaintiff), brought suit against the Nebraska Medical Center, the Board of Regents of the University of Nebraska, UNMC Physicians (UNMC) (Defendant) and others claiming Mary's (Plaintiff) death was caused by their negligent failure to treat her pulmonary arterial hypertension with the administration of Flolan therapy. Pulmonary arterial hypertension is a chronic medical condition where blood vessels in the lungs constrict causing pressure on the heart that leads to heart failure. Flolan is a vasodilator that relaxes blood vessels and prevents blood clotting. Flolan is short acting and very expensive, so patients on Flolan treatment need a constant supply of the drug, because if it stops being administered, pulmonary blood pressure rebounds and can be life threatening. Because Flolan is a chronic treatment, patients who start Flolan basically need to stay on it for the rest of their lives. It must be administered 24 hours a day and costs approximately $100,000.00 per year. Mary's (Plaintiff) treating doctor was preparing to treat her pulmonary arterial hypertension with Flolan. Plaintiff underwent a heart catheterization to confirm her diagnosis and eligibility for Flolan. Her doctor had written the Flolan order before the catheterization, pending results of the catheterization and insurance approval. The catheterization showed pulmonary arterial hypertension, significant heart failure, and reduced blood flow. After another hospitalization, Plaintiff was discharged and was going to begin Flolan. However, Plaintiff went back to the emergency room with shortness of breath and a rapid heartbeat. She then began to have a seizure and died. At trial, the parties argued both the cause of Plaintiff's death and whether the standard of care had been breached by Defendant. Plaintiff's medical expert presented testimony that Mary's proximate cause of death was pulmonary arterial hypertension and that the immediate administration of Flolan, even a day or two before Plaintiff's death, would have prevented her death. Defendant presented expert testimony that Flolan would not have made a difference. The Defendant's attending physician during Plaintiff's hospital stay explained that because Flolan treatment can last for years and costs hundreds of thousands of dollars, it was important to make sure the treatment would be continued before even beginning. There was testimony from another doctor of "horror stories" about patients who were forced to discontinue treatment and, he said it would be "irresponsible" not to have lifelong financial support for the drug which could be "devastating" if stopped. The doctor testified the process is required by the standard of care. Another doctor explained that the standard of care required obtaining a source of payment for a patient, but that if insurance was not available, another form of payment could usually be found on a "compassionate need basis." In Plaintiff's motion for a directed verdict on the standard of care, he argued that insurance, as a matter of law, could not dictate what doctors do, but he was overruled. Plaintiff requested a jury instruction that it is not a defense to a claim that the standard of care has been violated, that a drug would not be provided unless it were approved by an insurer. The request for jury instruction was rejected. At the time of the jury verdict for Defendant, Plaintiff's motion for a new trial was granted and Defendant appealed.