Jason James lost his lawsuit against the BVI Health Services Authority on April 15 even though a judge found that Peebles Hospital made mistakes while diagnosing his 25-year-old wife in the days leading up to her death.

Mr. James claimed the staff failed to properly diagnose and treat his wife Chivarane during her four admissions to the hospital in September and October 2011, while the BVIHSA contended that the hospital took all reasonable steps to save her life, according to Justice Vicki Ann Ellis’ judgment.

Although Ms. Ellis acknowledged that there was evidence that the hospital failed to provide Ms. James with the appropriate diagnostic testing, she said the court was unable to conclude that this negligence caused her death, in part because the autopsy report provided no definitive conclusion.

“It became clear that the deceased’s condition may result from a number of possible causes, some of which would have been treatable while others would not,” the judge stated.

Hospital visits

Mr. James alleged that the deceased was admitted to the emergency department at the hospital on Sept. 20, 2011, complaining of a nosebleed. Her oxygen saturation level had dropped below 80, and she was diagnosed with a lower respiratory tract infection.

She was discharged from the hospital on Oct. 4, 2011, but returned four days later complaining again of a nosebleed, and she was treated for a sinus infection before returning home.

On Oct. 14, 2011, Ms. James was taken to the emergency room again after she stopped breathing in the shower. The claimant alleged that a medical team advised that she might have a seizure disorder, and she was given two EKGs and a chest x-ray over the next two days, the results of which suggested she had pulmonary hypertension and a heart abnormality, according to the judgment.

On the evening of Oct. 16, 2011, she went into respiratory distress at the hospital and was pronounced dead early the next morning.

Inadequate post-mortem?

A Barbados-based pathologist, Dr. David Gaskin, conducted a post-mortem analysis on Oct. 22, 2011, and concluded that the cause of death was cardiopulmonary failure and chronic primary pulmonary hypertension.

However, Dr. Charles Gaymes, a medical expert brought in by the claimant, claimed that the post-mortem was inadequate, and testified that his diagnosis for the deceased was acute pulmonary embolus, which should have been treated with anticoagulation.

Based in part on Dr. Gaymes’ testimony, Mr. James — who claimed the deceased’s estate incurred medical and funeral expenses in the amount of $29,000 — contended that the hospital failed to perform a needed echocardiogram during his wife’s first admission to the hospital and thus incorrectly evaluated his wife’s condition.

Ms. Ellis, however, pointed out in her judgment that Dr. Gaymes discussed the cause of death only in his testimony, not in a report that he submitted to the court.

“The court considered it glaring that the claimant’s expert asserted no positive opinion on the issue of causation in his report,” she stated. “Instead, this critical factor was only addressed on cross-examination by counsel for the claimant.”

Defence witness

Dr. Stephen Brecker, a medical expert brought in by the defence, agreed that the post-mortem was “very unsatisfactory” because it provided only a brief summary with no description of the deceased’s hearts or lungs, and he also agreed that an echocardiogram should have been done after Ms. James’ abnormal EKG.

Dr. Brecker, however, concluded that the most likely cause of death was primary pulmonary hypertension, and he said it was unlikely given the timeframe in question that any treatment could have altered the outcome.

Ms. Ellis said the claimant’s expert failed to satisfy the court that Dr. Brecker’s views should be discredited, and therefore she ruled in favour of the BVIHSA, which was also awarded costs.