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Iacano v. St. Peter's Medical Center

October 23, 2000


Before Judges Pressler, Kestin and Ciancia.

The opinion of the court was delivered by: Ciancia, J.A.D.


Argued September 26, 2000

On appeal from the Superior Court of New Jersey, Law Division, Middlesex County.

In this medical malpractice case, defendants Baab and Dennigan, nurses employed by defendant St. Peter's Medical Center, were found to have deviated from accepted medical standards in the treatment of plaintiff Rose Iacano. Baab was found five percent responsible and Dennigan ninety-five percent responsible. The jury awarded plaintiff $l.5 million in damages which was subsequently reduced to $500,000 on defendants' motion for a new trial or, alternatively, a remittitur.

All defendants appeal contending that the verdict was against the weight of the evidence and the product of prejudice, partiality or passion. The alleged disproportionate allocation of responsibility between the two nurses is presented as indicative of an improper verdict that can be remedied only by a new trial. Plaintiff, although having accepted the remittitur, cross-appeals contending that the verdict award of $1.5 million was not excessive and should not have been reduced. Defendants' appeal allows plaintiff's cross-appeal. Fanoli v. Sea-Land Services, Inc., 251 N.J. Super. 443, 452 (App. Div. 1991), certif. denied, 127 N.J. 557, cert. denied, 505 U.S. 1220, 112 S. Ct. 3031, 120 L. Ed. 2d 901 (1992); Mulkerin v. Somerset Tire Service Inc., 110 N.J. Super. 173, 177 (App. Div. 1970). We find, however, that there is insufficient merit in the appeal and cross-appeal to warrant a new trial or modification of the final judgment as reduced.

Iacano was being treated for non-Hodgkin's lymphoma as an outpatient at St. Peter's Medical Center. Every third Friday she came to the medical center to receive injections of various chemicals through an intravenous (IV) line. It was plaintiff's allegation that on one of those occasions the nurses negligently administered the chemotherapy and caused an extravasation in plaintiff's right hand with consequential severe injuries.

Extravasation is a term used to describe the escape of substances being injected into a blood vessel from the vessel into the surrounding tissue where they are then absorbed. This can be caused by a needle that has broken through a blood vessel. Extravasation was a concern in the treatment of plaintiff because two of the drugs being used in her chemotherapy were vesicants -- i.e., drugs that could cause damage by irritation, inflammation and tissue destruction if they escaped from the blood vessel. A nurse who is administering vesicant drugs intravenously should look for a "good return of blood." This means that as the needle is drawn back, the tube connecting the needle to the patient's arm will fill with blood, indicating the needle is inside the blood vessel. However, an extravasation can occur even in the presence of a return of blood. Any complaint of pain by the patient should be responded to immediately. If there is evidence of extravasation, the IV should be switched to a different location.

Plaintiff's chemotherapy involved the use of four drugs, three of which were given intravenously and one orally. The three drugs given intravenously were Cytoxan, Oncovin and Adriamycin. The latter two are vesicants and are administered via an "IV push." That term means that a nurse is present and physically injecting the drug into the vein. Cytoxan, on the other hand, is a non-vesicant and is administered through an IV drip. Plaintiff's procedure typically began with a nurse setting up the IV line and then, by IV drip, administering a combination of saline and an anti-nausea drug, Kytril. Thereafter, the Oncovin and Andriamycin are administered.

On December 2, 1994, plaintiff went to the medical center for her chemotherapy accompanied by Muriel Brady, a long-time friend. An IV line to plaintiff's right hand was started by Dennigan at approximately 12:15 p.m. and saline and Kytril were run through the drip. Plaintiff and Brady both testified that plaintiff twice complained of discomfort during this stage to Dennigan. Dennigan did not recall any such complaints and there was no log of those complaints having been made. Brady further testified that during this time plaintiff's hand appeared red, puffy and swollen.

After the saline and Kytril had been administered, Baab entered the room to perform an IV push of the Oncovin and Andriamycin. Baab testified that she got good blood return before injecting the vesicant drugs and that there had been no complaint of pain or indication of swelling prior to the commencement of the IV push. On depositions, Baab had indicated she could not remember if she had, in fact, inquired of plaintiff prior to the IV push how she was feeling. It was not part of Baab's practice to specifically ask if the patient was feeling any pain. The entire dose of Oncovin was administered and the Andriamycin was started when plaintiff complained of a burning sensation in her hand. At that point the IV was removed from her right hand and placed in her left, where the treatment was concluded without incident. Dennigan was apparently not present while Baab was conducting the IV push. The doctor on call at the time was notified that an extravasation had occurred while Andriamycin was being injected and he instructed that cold soaks be placed on the right hand. It is undisputed that extravasation had occurred and caused tissue damage in plaintiff's right hand. It was also uncontroverted that plaintiff had complained of a burning sensation and it was that complaint that caused the IV to be switched to the left hand. Nevertheless, the nurses failed to indicate this on their progress notes.

Plaintiff returned to the hospital the following Monday complaining of pain in her hand. She was seen by a doctor but no treatment was prescribed.

In early January plaintiff developed a temperature and came under the care of Dr. Joseph Leddy, an orthopedic surgeon, who testified via a videotaped deposition concerning the procedure he used to treat plaintiff's right hand:

Basically the name of the procedure was excision of the eschar on the dorsum of her right hand and the debridement of the wound. In English we took off that entire dead area of scab and scar on the back of her hand. We cleaned all the purulent material away by elevating the tissue and cleaning it out as ...

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