BRECKENRIDGE - The obstetrician who took over the care of Susanna Martens and her unborn baby on the evening they died in 2000 recounted from a courtroom stand on Thursday how he became involved in trying to save Martens' life.

Dr. Alan Dulit assumed care of Martens after being called to her case by former Frisco doctor Patricia Duletsky, who is being sued by Martens' husband in a medical malpractice case seeking $1.5 million for the wrongful death of Martens and the couple's unborn baby girl.

Unlike every other doctor who testified in the trial, Dulit was called as a fact witness not an expert witness, meaning he could not express any opinion of Duletsky's care on the evening in question, March 14, 2000.

The case is being pressed by Rob Small of Silverthorne and is being tried in Summit District Court before Judge Terry Ruckriegle.

Martens, who was 36-and-a-half weeks pregnant, died after going into a cardiac arrest that was triggered by the uterine bacterial infection Group A streptococcus. The baby died about an hour before Martens.

Seven hours before her death, Martens had gone to Duletsky's office because she had vomited and experienced two uterine contractions. Duletsky also discovered Martens to have a temperature of 101.2 degrees.

Duletsky diagnosed Martens with the stomach flu and sent her home. Martens was admitted to Summit Medical Center at about 9:45 p.m. because she still wasn't feeling well.

The plaintiff's attorneys are arguing that Martens and her baby would have survived if Duletsky had administered antibiotics anytime before about 10:30 p.m. that evening.

Dulit, who was the on-call obstetrician at Summit Medical Center (SMC) on the evening of March 14, 2000, testified that Duletsky telephoned him once at 11 p.m. and again at 12:30 a.m. to discuss Martens' symptoms.

After the second call, Dulit drove to SMC and arrived as Martens was being walked from her original hospital room to a labor and delivery room.

"She seemed fine," Dulit said of Martens. "She was pleasant, responsive. She said hello, I said hello."

Fifteen minutes later, Martens stopped breathing, Dulit said.

After arriving and briefly discussing Martens' case with Duletsky, Dulit said he physically examined Martens and heard her lungs filling with liquid.

He also determined that Martens' uterine contractions were consistent with placental abruption, a potentially dangerous situation that occurs when the placenta prematurely separates from the uterine wall.

He was also concerned that the fetal heart monitor hadn't been picking up the baby's heart tones.

Martens was in "moderate distress," he said.

Dulit immediately directed a nurse to get the ultrasound machine from his office and ran to the emergency room to tell them he may need assistance.

At this point, Martens was "upset and concerned about the well-being of the baby," Dulit said.

At about 1:10 a.m., he performed the ultrasound and realized the baby did not have a heartbeat.

"I turned to tell her the bad news that the baby wasn't alive," Dulit recalled. "I looked at her and realized she wasn't responsive and she wasn't breathing."

Attempts to resuscitate Martens were unsuccessful and she was pronounced dead at 2:30 a.m.

Dulit testified that he didn't recall what Duletsky was doing during this time or whether or not she was in the room.

Also Thursday, a Denver cardiologist testified that Martens' myocardial bridge played a role in her death, although he said the bridge alone did not cause her death.

The bridge is a heart condition when the artery that normally runs on the surface of the heart, dips into the muscle creating a small tunnel.

It was undetected before Martens' death.

Last week, cardiologist Dr. Raymond Magorien testified that the bridge was not a contributing factor in Martens' death.

Wolf said Martens "had two lethal processes" going on concurrently - sepsis in the preterm stage of pregnancy and a congenital heart abnormality.

Sepsis is the stage of an infection when toxins get into the bloodstream.

The flow of blood to the heart is compromised during sepsis and the tunnel created by the bridge reduces the flow even more, Wolf said.

Sepsis also causes leaky blood vessels in the lungs and capillaries leak fluid into the air spaces, causing pulmonary edema, or liquid in the lungs.

Martens' autopsy showed pulmonary edema was a cause of death.

Last week, a doctor called by the plaintiff's attorneys testified that Martens' pulmonary edema was caused by the two doses of Terbutaline Duletsky had ordered for her on the evening of her death.

Terbutaline is administered to stop preterm contractions.

During cross-examination, Wolf agreed that if Martens was not allowed to become septic, she probably wouldn't have had pulmonary edema and would not have died.

Before he stepped down, Small's attorney asked Wolf if a heart rate of 100 in a pregnant woman, like Martens had, is part of a picture of a woman who is acutely ill.

Wolf agreed and said any doctor would know that just by virtue of attending medical school.



Nicole Formosa can be reached at (970) 668-3998 ext. 229 or at nformosa@summitdaily.com.

News Tracker • Last we knew: Dr. Duletsky complete testifying, maintaining that she provided Martens with care consistent with her knowledge, training and experience as a family practice doctor. A pathologist called by the defense testified Martens’ baby contracted the infection before Martens. • The latest: Dr. Alan Dulit, the on-call OB-GYN on the night of Martens’ death, testifies to his involvement in her care. The defense also called a cardiologist who testified that Martens’ previously undetected heart abnormality was a factor in her death. • What’s next: The defense will call its last witness today, followed by possible rebuttal from the plaintiffs. Rob Small is expected to testify briefly again. The case should be handed over to the jury on Monday.