In Fairfax malpractice case, family awarded $1.25 million

By Tom Jackman
Washington Post Staff Writer
Saturday, February 27, 2010

A Fairfax County jury has awarded nearly $3 million to the family of a man who died after his esophagus tore while he was swallowing a piece of steak, finding an Alexandria radiologist liable for misdiagnosing the man's condition as a hiatal hernia.

Large civil jury verdicts are rare in Fairfax, and Virginia's cap on medical malpractice judgments required the jury's award of $2,933,500 to be cut by more than half, to about $1.25 million.

Just before trial, the Fairfax anesthesiology group involved in the man's death agreed to pay a settlement of $600,000.

Hector Alvarez, 52, of Springfield first went to the Inova HealthPlex at Franconia-Springfield on July 6, 2006, complaining of chest pains and trouble swallowing after he had barbecued a steak and taken a bite. The piece of meat had gotten stuck in his throat, attorney John J. Sellinger said, and "he later said it felt like it went down the wrong way."

According to court records, Alvarez was given a number of tests at Inova HealthPlex, including X-rays, an EKG and a CT scan of his chest. The CT studies were sent electronically to William J. Dunwoody III, a radiologist with the Association of Alexandria Radiologists, who was working that evening at Inova Alexandria Hospital, Sellinger said.

Dunwoody's computer notes indicated that his impression was that Alvarez was suffering from "a large hiatal hernia," according to court papers. Sellinger said doctors continued to treat Alvarez with various oral medicines, but his pain did not decrease. Dunwoody and his attorney, Stephen L. Altman, did not return calls for comment.

About midnight, Alvarez was taken by ambulance to Inova Fairfax Hospital. Doctors continued to search for the cause of his severe chest pain and continued to give him oral treatment. About 4 p.m. on July 7, Sellinger said, a surgeon looked at Alvarez's CT scan and spotted the perforated esophagus.

The surgeon ordered that Alvarez be immediately prepared for an operation to repair his esophagus. The surgeon also ordered that Alvarez be given an epidural catheter, so that he could receive pain medication after the operation, Sellinger said.

But after the catheter was inserted and anesthetic applied, Alvarez went into cardiac arrest, records show. Court documents show that a doctor at Fairfax Anesthesiology Associates performed the procedure. The attorney for the anesthesiology firm, Richard L. Nagle, did not return calls.

Sellinger said Alvarez had been severely weakened by having a perforated esophagus for nearly 24 hours, and "if he hadn't been so sick when they put the epidural in, he wouldn't have arrested."

There was difficulty resuscitating Alvarez, Sellinger said, and he suffered irreparable brain damage. The surgery was not performed.

Alvarez died July 17, 2006.

He had retired from a career in the Air Force and worked as an information technology specialist for the Defense Information Systems Agency, where Sellinger said Alvarez's salary was $100,000. He was married with two adult children and was "an incredibly nice guy," Sellinger said.

Alvarez's widow, Deborah A. Alvarez, filed a wrongful death suit in March 2007, naming Dunwoody, the Association of Alexandria Radiologists and Fairfax Anesthesiology as defendants. Neither the individual anesthesiologist nor Inova was named.

After a lengthy pretrial process, Fairfax Anesthesiology agreed in January to pay $600,000, court records show. But the Alexandria radiology firm, which Sellinger said was insured by ProAssurance, did not make a settlement offer and elected to go to trial.

The trial began early this month before Fairfax Circuit Court Judge Jane Marum Roush. It was postponed for a week by snow.

The trial resumed Feb. 16, when the jury issued its verdict against Dunwoody and the Association of Alexandria Radiologists. The jury was not told of the state cap on medical malpractice awards, which is $1.85 million for actions that occurred in 2006.

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