Doctors' Accounts Vary In Death of Libby Zion

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1 Below are annotated excerpts from three articles (labeled A, B, and C) related to the case of Libby Zion. Please read the three articles and the Conclusion. A. Death of a college student: the obituary Libby Zion, a freshman at Bennington College in Vermont and the daughter of the writer and lawyer Sidney E. Zion and his wife, Elsa, died of cardiac arrest yesterday at New York Hospital after a brief illness. She was 18 years old and lived with her parents in Manhattan. Miss Zion, who had worked recently for the Manhattan Borough President as part of a study project and was to have been employed next summer on the clerical staff of The New York Times became ill several days ago with a flu-like ailment. The cause of the cardiac arrest was not immediately determined. Her father, a former reporter for The Times and former lawyer, is the author of Read All About It. Her mother is a former publishing executive. Besides her parents, Miss Zion is survived by two brothers, Adam and Jed. B. News report of the trial Doctors' Accounts Vary In Death of Libby Zion By JAN HOFFMAN When Dr. Gregg Stone [PGY-2] resumes testifying on Tuesday in the wrongful-death lawsuit brought by Sidney Zion against New York Hospital, he will be trying to bolster the defense's side even as he contradicts a co-defendant's account. Mr. Zion argues that his 18-year-old daughter, Libby, died within eight hours of being admitted to the hospital with a fever in 1984 because doctors ordered Demerol, a

2 medication potentially fatal to patients who, like her, took an antidepressant called Nardil, and because they misdiagnosed and mistreated her. But the multi-pronged defense that the hospital and four doctors have put on in recent weeks tries to justify medical decisions made during that long March night. The defense attributes Ms. Zion's death to the interaction of prescription drugs and cocaine, which they say she took but did not tell doctors. Among the hurdles the defense has to overcome is that Dr. Stone, then a second-year resident, recommended that Ms. Zion be given Demerol to control her extreme shaking, known as rigors. A physician's reference book warns that a patient on Nardil not be given Demerol. Another defendant, Dr. Luise L. Weinstein [PGY-1], has testified that she even checked Nardil in the book that night but overlooked the telltale passage. Dr. Raymond Sherman, a supervising physician who advised the young residents over the phone that night, testified that Dr. Stone had not mentioned Demerol to him -- in essence absolving himself of responsibility. But the last exchange just before the holiday break between Dr. Stone, who was on the stand, and his lawyer, Luke Pittoni, went as follows: Mr. Pittoni: "Did you discuss giving Demerol for rigors with Dr. Sherman?" Dr. Stone: "Yes, I definitely did." Mr. Pittoni: "What was his response?" Dr. Stone: "He actually thought it was a good idea." Three doctors and the hospital are represented by one lawyer, Francis P. Bensel, while Dr. Stone, whose testimony clashes with Dr. Sherman's at this juncture, retained his own lawyer. But the thrust of the defense is otherwise unified: the system worked, even though the patient died. What lifts this case beyond the realm of a straightforward malpractice suit is Mr. Zion's efforts to attack that system of training and supervising residents and so prove that the hospital was grossly negligent. While the case has already wrought changes in state regulations of residents, New York appellate courts have virtually never upheld an award for punitive damages in a medical malpractice suit. A witness for the defense, Dr. Harold Fallon, the former chairman of the committee that accredits residency training programs, said that in the mid-1980's the program at the hospital, which is affiliated with the Cornell University Medical College, received the committee's highest rating. He said New York Hospital's system of multitiered supervision and review was consistent with national standards. One of the most difficult issues for jurors will be to decide how and why Ms. Zion died. To prevail, Mr. Zion, an author and journalist, must prove that the doctors contributed to

3 her death. The medical examiner's report vaguely ascribed her death to "acute pneumonitis." Was her death triggered by the interaction of the two drugs, as Mr. Zion contends? Neither drug showed in up post-mortem laboratory reports. New York Hospital doctors gave Ms. Zion 25 milligrams of Demerol, which, according to testimony, is less than half the dose when the drug is more typically administered as a pain-killer. And Dr. Stone, now a cardiologist affiliated with Stanford University, testified that Ms. Zion told him she had not taken Nardil for several days before going to the hospital. Forty-five minutes after Ms. Zion was given Demerol, according to testimony and hospital records, a nurse called Dr. Weinstein and, saying that the patient was thrashing about, asked her to authorize a restraining jacket to tie her torso to the bed. Eventually Ms. Zion's legs and arms were tied down as well. Fifteen minutes later, at 4:30 A.M., the nurse called Dr. Weinstein again and asked her to visit Ms. Zion and order sedation. Dr. Weinstein, who was in charge of 40 patients on another floor, did not go to Ms. Zion's bedside but ordered that a sedative be administered. C. The result of the trial Plaintiff: Sidney E. Zion Defendants: The New York Hospital, Maurice Leonard, M.D., Raymond Sherman, M.D., Gregg Stone, M.D. (PGY-2), and Luise Weinstein, M.D. (PGY-1) Crime Charged: Medical malpractice resulting in wrongful death Place: New York City Dates of Trial: November 10, 1994-February 6, 1995 Verdict: Doctors Sherman, Stone (PGY-2), and Weinstein (PGY-1) found negligent; New York Hospital cleared of wrongdoing Award: Doctors and hospital to pay Zion family $750,000 (later reduced to $375,000) for pain and suffering. D. Conclusion After the Libby Zion case, the New York State Department of Health accepted the recommendations of a Committee chaired by Dr. Bertrand Bell which included emphasizing the importance of having hospitals... assure that "mature and skilled supervision of residents is provided by attending physicians for all patients at all times."

4 The New York State Department of Health codified this requirement: "The complexity of hospitalized patients' illnesses and the multiplicity of technological diagnostic, monitoring and therapeutic equipment require readily available and competent supervision as residents progress from the stage of just graduated medical students to physicians with sufficient experience to have independent responsibility for the optimal care and welfare of patients. The purpose of the residency system... is to provide the education and the practical experience for... just such independence. To achieve the appropriate balance between educational supervision and... independent decision making...with...attention to benefit and the safety of the patient is the objective of all teaching institutions....the attending physician... has the principal obligation and responsibility at all times for the patients' care and residents' supervision... In hospitals that can document that the patients' attending physicians are readily available in person, the in-house supervising physicians may be in their final year of board preparation... It is to be emphasized that the circumstances must be clearly defined when a resident in his/her final year of training, may be specifically credentialed by hospital policy to assume a supervisory responsibility as a substitute for an attending physician. There must be clearly cited hospital policies which define explicitly the chain of command, the flow of responsibility in that chain, the sharing of responsibility and the generic principles governing independent vs. supervised medical practice, i.e., when residents are expected to call for help, when on-site and in-person supervisors are expected to intervene... It can not be overemphasized that the intent of the Committee was to increase the responsibility of the attending physicians in the supervision of residents." The case of Libby Zion led the New York Department of Health to strengthen regulations that would promote patient safety related to: - attending supervision of residents (including credentialing) - working conditions of residents (including working hours, home call, and ancillary personnel) - standards on the use of physical restraints - identification and prevention of drug interactions

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