Jury Unanimous In Ruling On Case Of Renowned Doctor -- Surgeons At UW Not Negligent In Death Of Marchioro

Three University of Washington Medical Center surgeons were not negligent in their treatment of heart patient Dr. Tom Marchioro, himself a renowned UW surgeon, a King County Superior Court jury unanimously decided yesterday.

Marchioro's widow, Karen, and their seven adult children had asked for $5.4 million in damages in Marchioro's Feb. 5, 1995, death. While recovering from treatment of complications of heart surgery, he bled to death in front of his wife after his heart ruptured when he coughed.

Dr. Mika Sinanan, a general surgeon and defendant in the lawsuit, was relieved but subdued after the monthlong trial.

"As good as our medical care is," he said, "the mere fact of this misunderstanding crystallizing in a lawsuit means that we have room to improve in our communication with patients and family."

Besides Sinanan, who was a longtime friend of Tom Marchioro's, defendants in the civil lawsuit were the UW Medical Center; Dr. Edward Verrier, UW chief of cardiothoracic surgery; and Dr. Richard Rand, chief of plastic and reconstructive surgery.

Karen Marchioro said she was not surprised by the verdict and charged again that the doctors were negligent.

"I would have hated myself if I had not (sued); it would have haunted me," she said.

Tom Marchioro, 66 when he died, was a pioneer in kidney transplant surgery, vice chairman of the UW Department of Surgery and taught for 28 years at the UW. He was nationally known in his profession and revered by patients for his personal, down-to-earth, supportive style.

"As both sides noted many times during this trial, something that was never at issue here was that Dr. Marchioro's death was a profound loss to his many friends and colleagues at the University of Washington Medical Center," said Dr. Eric Larson, medical director of the center.

Karen Marchioro, former chairwoman of the state Democratic Party, contended her husband's three former colleagues had not properly cared for him through much of his battle with heart disease. A longtime smoker, he had a three-vessel coronary bypass surgery in October 1989, a five-vessel bypass on Sept. 15, 1994, and two surgeries to deal with complications in January and February 1995.

Marchioro's attorney, Ron Perey, argued repeatedly during the trial that surgeons should have removed scar tissue that bound the back of Tom Marchioro's breast bone, or sternum, to the wall of his heart.

A crack in the sternum was left slightly open as part of treatment for a surgical-wound infection. When Marchioro coughed, the separated bone portions moved, pulling the scar tissue with them and pulling the heart wall apart. Perey cited one expert's estimate of a 15 percent risk of such a rupture occurring.

Perey also argued that a tiny piece of suture wire inadvertently left in the sternum could have helped tear Marchioro's heart wall when he coughed.

At the least, he said, Marchioro, with an open sternum, should have been kept immobile until his chest could be wired together again. He said the heart tear possibly could have started when Marchioro reached to catch his falling intravenous fluid stand while being transported to an X-ray room.

William Leedom, the defendants' attorney, argued that the manner of Marchioro's death was extremely rare. He called on outside experts who testified there is significant risk of a heart rupture in such situations only when infection is present deep in the chest. The experts could recall hearing of fewer than 10 such cases of rupture.

"If the risk were 15 percent, many other patients would have had this problem. . . . We would have seen many (medical journal) papers on it," Rand, one of the defendants, testified.

Marchioro's doctors testified that he didn't want them to open his chest beyond the sternum to remove the scar tissue. Like the doctors, he feared that would expose the interior of his chest, near the heart, to an exterior-wound infection. In fact, the surgeons said, Marchioro helped to direct much of his care and was fully informed about significant risks every step of the way.

Perey countered that Marchioro's medical record didn't reflect his sentiments about his care or that he was fully informed.

Much testimony centered on whether Marchioro's inner chest, or mediastinum, was infected. Perey said that because pericardial fluid, normally found around the heart, leaked from Marchioro's wound, there was a good chance the inner chest had been open to infection. But Leedom argued that lab tests had not shown evidence of such infection.

Leedom also called on witnesses who said it was unlikely the suture wire or accident involving the IV pole had damaged Marchioro's heart. An autopsy was not performed.

In his closing argument, Leedom said Marchioro had handpicked the three defendant surgeons because they were the best at the UW.

He told the jury, "Does anyone here believe these three doctors didn't do the absolute best they could for their friend, their colleague, their teacher and their mentor?"

Superior Court Judge Jeffrey Ramsdell presided over the often-tense trial in which 23 witnesses testified: 10 physicians for the defense; nine physicians for the plaintiffs; Karen Marchioro and three of her children, Kathy Johnston, Stephen Marchioro and Joan Marchioro.

The lawsuit was obviously painful to the Marchioro family, friends and former colleagues, including the defendants. Sinanan said he hoped someday to re-establish communication with Karen Marchioro, including her participation in the Marchioro Education Center, a training division of the UW Department of Surgery.

"I hope that some of her bitterness can be healed," he said.

Larson, the medical-center director, said after the trial that Marchioro received "the best care possible." It is time, he said, "to put the painful lawsuit behind us; and in so doing, we again express our profound sorrow to all the members of Dr. Marchioro's family."

Warren King's phone message number is 206-464-2247. His e-mail address is: wkin-new@seatimes.com