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Witnesses: Doctor acted appropriately

NICOLE FORMOSAsummit daily news

BRECKENRIDGE – An expert defense witness testified Tuesday that former Frisco Dr. Patricia Duletsky did not contribute to the death of Susanna Martens, while a second witness said that he didn’t see “any indication” for Duletsky to administer antibiotics.Martens’ husband, Silverthorne resident Rob Small, is suing Duletsky for the wrongful deaths of Martens and the couple’s unborn baby girl.The $1.5 million medical malpractice suit is being tried at Summit District Court in front of Judge Terry Ruckriegle.Martens was 36-and-a-half weeks pregnant when she visited Duletsky on the evening of March 14, 2000, because she had vomited and was feeling ill. At that time, Martens was also discovered to have a temperature of 100.4 degrees. Duletsky diagnosed Martens with the viral gastroenteritis, or the stomach flu, and sent her home to rest. Martens went to the Summit Medical Center several hours later when she still wasn’t feeling better.She died early the next morning of a cardiac arrest triggered by the bacterial infection Group A streptococcus in her uterus. The baby died, in utero, about an hour before.Last week, the plaintiff’s attorney argued that Martens and the baby would have survived if Duletsky had administered antibiotics at several times throughout the evening.Dr. Jack Westfall, who is a family physician based in Denver, said Martens’ complaints at her first doctor visit wouldn’t have given Duletsky any reason to believe that her patient needed antibiotics.The symptoms were most consistent with the stomach flu and it would have been premature to administer antibiotics at the 6 p.m. appointment, Westfall said.”We don’t indiscriminately treat patients with antibiotics or any drug that could harm them,” Westfall said, adding that antibiotics are often overused.He said the first time Duletsky may have considered antibiotics was at 11 p.m. when the results of Martens’ blood test came back, showing an elevated white blood cell count.Westfall added that Duletsky acted appropriately by calling the obstetrician on duty to discuss Martens’ case.He said a family practice doctor is trained in a wide breadth of topics, leaving the more complicated issues to specialists.”The goal is to provide most of the care to most of the patients, most of the time,” Westfall said.Westfall also testified that Duletsky’s administration of two doses of Terbutaline throughout the evening of March 14 was “typical.” Terbutaline is a drug used to stop contractions.The plaintiffs have argued that the Terbutaline caused Martens’ lungs to fill with liquid, or pulmonary edema.Westfall said he has never seen a case in which Terbutaline triggered pulmonary edema.During its cross-examination, the plaintiff’s attorneys presented a medical article published in 1991 that said symptoms of Group A streptococcus are similar to those of gastrointestinal problems and that antibiotics are advised when the infection may be present.Dr. Donald Kearns, an internal medicine and infectious diseases specialist, agreed that Duletsky made the proper diagnosis based on the complete clinical picture, and that Duletsky’s actions did not play a role in Martens’ death. Doctors are taught to gather information and take everything into account, not just one factor, Kearns said.”Ms. Martens did not walk in with a sign that said I’m going to die in seven hours and the autopsy will show Group A strep,” Kearns said.At the 6 p.m. appointment, based on the fact Martens had vomited once, had experienced two contractions and had a fever, Duletsky had four possible diagnoses, Kearns said. A urinary tract infection, appendicitis, a uterine infection or the stomach flu were the options, and in every situation but the flu, Martens would have been experiencing some sort of pain, which she was not, he added.For that reason, the flu was the best diagnosis at the time, Kearns said.He added that antibiotics are not recommended for patients with the stomach flu because they can do more harm than help.When asked whether the administration of antibiotics would have changed the outcome of the case, Kearns was skeptical.”Even if you do everything right, some patients are still going to die,” he said. “When it moves this quickly, it’s unlikely that antibiotics would have made a difference in its course.”In his cross-examination, Kearns agreed that Martens had signs and symptoms consistent with a bacterial infection at several stages throughout the night, but said he believes the term “consistent with” is misleading because it doesn’t necessarily mean “supportive of.”Duletsky took the stand shortly Tuesday afternoon to begin the cross-examination portion of her testimony.Her questioning began Monday morning and will continue throughout the week.Nicole Formosa can be reached at (970) 668-3998 ext. 229 or at nformosa@summitdaily.com.


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