NEW ULM - Three doctors working in other states testified Tuesday in a trial involving a wrongful death lawsuit against Allina Health System and New Ulm Medical Center (NUMC) in Brown County District Court.
A complaint filed Sept. 30, 2010 in Brown County seeks more than $50,000 for the next-of-kin plus $10,000 for funeral and burial expenses of 45-year-old Iowa trucker Verlyn Buls who collapsed and could not be resuscitated Oct. 25, 2006 in the NUMC emergency department.
Buls was admitted to the NUMC ER in the morning of Oct, 25, 2006 with urticaria of unknown origin (aka hives, a skin rash notable for pale red, raised, itchy bumps), hypotension (86/54, abnormally low blood pressure), with a history of being on anti-hypertensives (drugs used to treat hypertension (high blood pressure) and tachycardia (heart rate exceeding 100 beats per minute), according to court documents.
On the evening of Oct, 25, 2006, Buls was re-admitted to the NUMC ER, where he collapsed and could not be resuscitated. An autopsy determined the cause of death was cardiac dysrhythmia (irregular heat beat) with underlying coronary artery disease, according to the complaint.
During Tuesday proceedings, Minneapolis attorney Lindsay G. Arthur, representing Allina and NUMC, said Dale W. Bohlke, M.D., followed standards of care, measuring Buls' heat beat and checking other vital signs. However, Buls didn't inform NUMC medical personnel about the chest pains that his wife Karen testified he told her about in the final weeks of his life.
Earlier Tuesday, Leslie Zun, M.D., Chief of Emergency Medicine at Mount Sinai Medical Center, Chicago, testified on behalf of the plaintiffs and said Bohlke did not follow standards of care with Buls.
"Bohlke testified he listened to Buls' heart and timed it against a wall clock and listened to his lungs," Arthur said. "Do you care to retract your testimony that Dr. Bohlke not following standards of care?"?he asked Zun.
"My opinion was based on facts I had at the time," Zun said.
Waterloo, Iowa attorney James H. Cook, representing Karen Buls, trustee for the heirs and next-of-kin of Verlyn Buls, said Buls was taking two drugs for high blood pressure, so his low blood pressure symptoms were a red flag that something was wrong.
Zun said an electrocardiogram (EKG) should have been ordered after Buls' heat rate of 128 was discovered, but it never was.
Jeffrey A. Breall, M.D. cardiologist at the University of Indiana at Indianapolis, said an EKG, which could have been done in several minutes, would have more shed light on Buls' condition.
"A heart rate above 120 is critically high. Dr. Bohlke couldn't discover Buls' irregular heat beat with a stethoscope," Breall said. "Buls had poor control of his blood pressure and other life-threatening values. If you have insufficient blood flow to the heart, you arrest and die."
Breall said 25 percent of Buls' heart muscle was replaced by scar tissue, but people can cope with the condition if they are properly treated.
Arthur said Buls never told NUMC doctors and nurses he had earlier chest pains and had recently vomited.
"Mrs. Buls testified her husband told her he had chest pains for quite some time. She told him to go to a doctor earlier and he refused," Arthur said.
Daniel Spitz, M.D., a forensic pathologist licensed in Florida and Michigan, said Buls' autopsy showed plaque in his coronary artery reduced the amount of blood to his heart by about 75 percent.
"This was not a sudden attack," Spitz said. "It was precipitated by poor blood flow to the heart."
Testimony from Dennis Gremel, M.D., a Mankato clinical pathologist who performed Buls' autopsy a day after his death, was presented via videootape. Gremel said Buls had an enlarged heart and liver, weakened heart muscle and lung congestion.
"He weighed 400 to 450 pounds, more than 100 pounds overweight, which is referred to a "morbid obesity," Gremel said. "He had moderate to extreme heart fibrosis. He was at risk for sudden death with 70 to 80 percent blood vessel blockage."
Toby Freier, NUMC president, talked with The Journal outside the court room after Tuesday's testimony.
"The medical center is saddened by the loss experienced by the Bulses. We're confident the evidence presented shows our caregivers give appropriate care," Freier said.
The trial continues at 8:30 a.m. today.
(Fritz Busch can be e-mailed at firstname.lastname@example.org).