Hospital defends care of Smedley

WINCHESTER – The nurse caring for John H. Smedley Sr. at the time he began an abrupt descent toward death in Winchester Medical Center said he appeared to be progressing toward recovery when she left him to go to the restroom.

Melanie Spiva, a registered nurse, returned to Smedley’s room and found everything had changed. Several people were already working on Smedley, whose electronically monitored readings of physical well-being were dropping fast.

“It was horrible because he was doing so well,” Spiva said of Smedley during testimony Wednesday, the third day of a scheduled five-day jury trial in Winchester Circuit Court. “It was so completely sudden. It came out of nowhere. There was no warning to it.”

Spiva’s actions are at the center of a lawsuit filed by Doris Smedley, John Smedley’s widow, against Winchester Medical Center and Valley Health Systems. She is asking for $3 million, citing medical malpractice as the cause of her husband’s death a day after he underwent the first of two open-heart surgeries.

Smedley, 64, was Warren County’s Commissioner of the Revenue from 1988 until his death.

The lawsuit accuses Spiva of failing to give enough time and attention to Smedley on the evening of Aug. 23 in the hours before his condition visibly worsened. Smedley’s attorneys have cited electronically monitored readings that should have alerted Spiva to internal bleeding and caused her to notify Smedley’s attending surgeon of an impending crisis.

By the time Smedley had coded – medical jargon for a loss of breathing, heartbeat or both – it was too late, the plaintiffs insist.

Much of Wednesday’s testimony was taken up by explanations of a procession of charts, tables and graphs documenting the encouraging start Smedley had made toward recovery in the hours following the first of his heart operations. Spiva was called as a witness by defense lawyer Ruth T. Griggs of Richmond.

Spiva, a nurse for seven years, said she saw no signs of trouble lurking in the readings for heartbeat, blood pressure, temperature, oxygen levels in the blood and other indicators tracking Smedley’s well-being on the evening before his death.

She had spoken to him and noted nothing amiss in his responsiveness, the color and feel of his skin or other visible clues to physical health, Spiva testified. Smedley was breathing on his own after the removal of a ventilator tube hours before.

At about 10:50 p.m., Spiva testified, she made a routine blood draw and sent the sample on for laboratory analysis. Shortly thereafter, she asked someone to cover for her while she took a restroom break.

By the time she returned, Smedley’s condition was deteriorating and the hospital staff was scrambling to save him. Spiva testified that she called Dr. Kenneth Saum, who had operated on Smedley’s heart. Saum, who had gone home, returned to the hospital and took Smedley to the operating room to repair a bleeding blood vessel.

Smedley never recovered.

Under questioning by plaintiff’s attorney Catherine Bertram, Spiva admitted that Saum had left orders that he should be called if any of a list of digital readings should register abnormal. One of those readings was for central venous pressure, which measures how much blood is returning to the heart and how much is being pumped into the arteries. Saum’s orders said the central venous pressure readings should not rise above 18 or fall below six.

Smedley’s central venous pressure readings fell to two and four during Spiva’s shift and rose to acceptable levels of eight and 10, all before the rest of his readings plummeted later in the night, and Spiva called Saum back to the hospital.

Spiva called central venous pressure readings “very variable” and affected by “many, many things” as Bertram pressed her on the importance of Saum’s orders and the significance of the readings.

The defense and plaintiff’s lawyers each took turns reading parts of a deposition given outside of court by Saum. Saum, through the deposition, said he did not place much “faith” in central venous pressure readings by themselves and regarded the trend of the readings as more significant than single measurements.

Emilie Ormond, a registered nurse who testified as an expert defense witness, said Spiva’s performance did not fall below the standards of care for nurses attending to post-operative heart patients.

Ormond, who works at a hospital in Newport News, said she would consider all of a patient’s readings before deciding to summon an attending physician, even if the central venous pressure readings were abnormal.

“You wouldn’t necessarily call the doctor right away,” Ormond testified.

Contact staff writer Joe Beck at 540-465-5137 ext. 142, or jbeck@nvdaily.com