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Health System Drops Challenge of $32.5M Malpractice Award Upheld on Appeal

Analysis  |  By John Commins  
   August 01, 2018

A physician failed to include in the medical records a warning that the plaintiff had been diagnosed with a potentially deadly brain aneurism. 

A Massachusetts Appeals Court this week upheld a $32.5 million malpractice award for a woman left paralyzed after her primary care physician neglected to include a diagnosis of a brain aneurism in her personal medical file. The health system said it will not challenge the ruling any further.

The plaintiff, Andrea Larkin, a former elementary school teacher and fitness instructor, suffered a brain hemorrhage in 2008, about 12 hours after giving vaginal birth to her daughter using the Valsalva maneuver.

Unbeknownst to Larkin's obstetricians, the woman had been diagnosed with a venous varix in 2004, which was found in an MRI after she had complained of headaches and dizziness.

Larkin's primary care physician, Jehan Johnston, MD, with Dedham Medical–Atrius Health, knew of the diagnosis, but failed to include it in Larkin's medical records.

As a result of the hemorrhage, Larkin is paralyzed and bedridden and is expected to remain so for the rest of her life, which her attorneys estimated at trial to be about 47 years. Larkin was awarded $32.5 million in 2015 following a two-week jury trial in a state court.

During that trial, the jury heard expert medical testimony that the vaginal birth had triggered the brain hemorrhage, which could have been avoided with a Caesarian section.  

Marci Sindell, senior vice president for external affairs at Atrius Health, said the health system has no plans to appeal the ruling

"First and foremost, we continue to extend our heartfelt sympathies to Andrea Larkin and her family," Sindell said in an email to HealthLeaders Media.

"We are disappointed with the judge's decision, which does not reflect our physicians' dedication to the well-being of their patients and our organization's commitment to outstanding care," Sindell said.

The three-judge Appeals Court unanimously rejected Dedham Medical's demands for a new trial, which included an argument that the trial court failed to consider the health system's "charitable status" as a not-for-profit provider protected by a $20,000 liability cap under Massachusetts law.

The panel agreed with the trial judge that Dedham Medical's charitable status claim came too late in the proceedings, and only after four years of litigation and a two-week trial. 

"Such a prolonged delay, the judge found, caused 'manifest' prejudice to the plaintiffs, and made amendment … inappropriate. We agree," the Appeals Court ruled.

The appeals court also rejected Dedham Medical's claims that a neurosurgeon called as an expert witness for the plaintiffs "testified beyond the anticipated testimony" laid out in a pretrial memorandum.

The appeals court said the pretrial disclosure of the expert witness's anticipated testimony "was sufficient" to provide Dedham Medical with notice that the testimony would detail "the nature and causes of the risk of undertaking the Valsalva maneuver in light of the venous varix in Andrea's brain."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


An appeals court upheld the 2015 award against a Dedham Medical–Atrius Health physician who failed to note a brain aneurism in a patient's medical history.

The patient suffered a brain hemorrhage after giving birth to her daughter. Her obstetricians were not aware of the aneurism.

The health system said it is disappointed in the ruling but will drop its legal challenge.

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