Medical experts testified Thursday morning that Drs. Tibor Kopjas and Michael Mandis did not violate standards of care in treating a patient 10 years ago at Anderson Hospital in Maryville.
On the fourth day of trial in Madison County Circuit Judge William Mudge's court, lawyers defending Kopjas and Mandis rested their case after questioning three doctors who reviewed the medical records of decedent Frederick Simon.
Kopjas is represented by James Neville of Belleville. Mandis is represented by Ted Dennis, also of Belleville.
Simon's daughter Stacey Luber sued Kopjas, Mandis, Anderson Hospital and others in 2006 claiming the defendants failed to timely and properly diagnose and treat Simon for bacterial sepsis.
Simon, who had suffered from a variety of ailments including bladder cancer, was hospitalized at Anderson in mid-March 2005 for treatment of internal bleeding, according to court testimony.
The plaintiff, represented by Colleen Jones of St. Lous and Stephanie Brauer of Belleville, blames the doctors for not having conducted a blood culture that would have revealed an infection before releasing Simon on March 16, 2005. Simon returned to Anderson's ER two days later and was re-admitted around March 21, 2005, after a blood culture taken at the ER tested positive for a blood infection.
Simon's cause of death on Aug. 17, 2005, was pneumonia, according to the court record.
During Simon's admission March 15-16 for GI bleeding, he was cared for by his gastroenterologist and by Kopjas, his primary care physician. Mandis made rounds at the hospital for Kopjas during Simon's hospitalization.
On March 16, 2005, Simon's temperature spiked to 101.4 degrees, and subsequently Kopjas ordered a chest X-ray, urinalysis, Tylenol and an antibiotic.
Defense witnesses Drs. Michael Brewer and Donald R. Graham of the Springfield Clinic in Springfield and retired Dr. George Griffing of St. Louis University said the care provided to Simon by Kopjas and Mandis was proper.
Each defense witness said the spike in Simon's temperature was likely due to the six units of blood he received in transfusions for treatment of his internal bleeding.
Griffing said it would not have been appropriate to call for a blood culture at that point because there wasn't a presence of other clinical signs that would necessitate it, such as high or low white blood count or an elevated respiratory rate.
He also said there would have been no reason to suspect a blood infection. If there was such an infection there would have been signs such as redness, swelling and tenderness at an IV site.
When Simon returned to the ER on March 18, he was diagnosed with influenza. But he also underwent a blood test, and preliminary results that were faxed to Kopjas on March 19 showed signs of a blood infection.
On that day, Kopjas ordered the same antibiotic that Simon had responded well to in the hospital - Levaquin - and scheduled an office appointment for Simon on Monday, March 21.
Levaquin "was a very good choice," Graham said, because it had been effective when one dose was administered days earlier.
When the full results confirmed a blood infection, also known as methicillin-resistant staphylococcus aureus (MRSA), Simon was again hospitalized. He was treated with a strong antibiotic for about 14 days.
Griffing said that Kopjas made "a very good call" when he initially treated Simon with Levaquin.
A stronger antibiotic "is tough on kidneys," he said, "and there were kidney concerns."
After Simon was treated for a blood infection for two weeks, there were no longer any signs of infection, according to testimony.
Subsequently, however, Simon was treated at St. Mary's Hospital in Richmond Heights, Mo. for MRSA.
Griffing testified that 30 percent of MRSA cases recur.
"It's hiding somewhere," he said.
But, he added, the treatment protocol isn't prolonged because "it's expensive and toxic."
On cross examination, plaintiff attorney Colleen Jones asked Graham if MRSA was the cause of Simon's fever on March 16.
"It could have been, but there's no way to know," Graham said.
A panel of 14 jurors were excused shortly before noon on Thursday so the sides could prepare jury instructions.
Closing arguments will begin at 9 a.m. on Friday.
Anderson Hospital and other defendants settled with Luber earlier and were dismissed from the case.
Madison County Circuit Court case number 06-L-661.