Cardiologist wins malpractice suit

Woman's religious beliefs likely led to her death, jury finds

Florida Today/September 6, 2002
By Brian Monroe

Viera -- After five years of legal maneuvering and six days of court testimony, a local cardiologist felt "great relief" Friday after a jury found him not negligent in the death of a 50-year-old wife and mother who died days he operated on her blocked heart. Dr. Robert Morris, an invasive cardiologist, operated on Susan Rampino in 1997 after she came to him complaining of chest pains that had persisted for nearly seven years. Rampino said she felt fatigued, had aching joints, night sweats and that periodically her heart would race.

But what would make Rampino's usually routine surgery more difficult -- and eventually deadly, some experts said -- was her directive that she not receive blood or blood products because of her beliefs as a Jehovah's Witness.

Morris, in the heart field for 22 years, first performed tests on Rampino and found a 98 percent blockage in one of her cardiac arteries. He advised her to undergo surgery the next morning.

During the operation -- called an angioplasty -- Morris snaked a small metal wire through Rampino's veins to the spot of the blockage. Once there, he inflated a small balloon within a stent -- a fine mesh tube designed to help keep open a blood vessel.

Hours after the operation, however, the area around the stent clotted up.

Other doctors and medical staff at Holmes Regional Medical Center tried to help Rampino, but her condition deteriorated. Morris didn't get a call until 2 a.m. -- four hours after Rampino complained of chest pain.

While trying to force a stronger wire through the more difficult blockage, it punctured a smaller vein. A heart bypass team took over and was able to stabilize Rampino. Still, they said she needed blood to replace what was lost in surgery.

Experts for both sides presented different reasons for why she passed away four days later.

During the trial, some doctors said Rampino's heart was more than 50 percent dead before Morris started operating, others said that a blood transfusion could have saved her life.

Her surviving family members -- husband Dominick and son Chad -- brought the medical malpractice suit in 1999. They sought nearly $2 million in lost wages, medical bills and pain and suffering.

Attorneys for Morris, however, countered that he did nothing wrong and that it was Rampino's decision to not have a blood transfusion that killed her, not any surgical errors.

"I never thought he was negligent," said Morris' attorney Raphael Martinez. "I feel he is an excellent doctor and performed within the standard of care."

Robert Burger, who represents the Rampino family, disagreed.

"We are disappointed that the jury didn't hold Morris to a higher standard of care," he said. "But the family is happy they brought it all the way to the end.

"They wanted to have their day in court. Their hope was to affect the way medicine is practiced so that no other family loses a wife and mother they way they did."

Burger said the family has already settled the case against the hospital and another doctor for an undisclosed amount.

Burger stressed during trial and in closing arguments Friday that Morris should never have tried to push through such a thick blockage, but instead called a heart bypass team first to go around it.

Had that happened, he said, the puncture that eventually killed Rampino wouldn't have occurred.

Martinez, instead, said that his client had done nothing wrong. He called experts in the stent procedure to watch a videotape of Rampino's operation and comment on the movements as they occurred. One doctor told the jury Morris' actions were "totally appropriate."

In his closing, Martinez said the puncture happened because the dead and dying tissue wasn't as pliable as living cells. Further, he added, so much time had passed that most of Rampino's heart already was dead before the doctor even started to operate.

Another forensic expert testified cells without oxygen start dying in less than 15 minutes.

"It was just a very sad situation," Martinez said. "You have to respect other people's faith and wishes but, then again, also accept the consequences."