John Joseph Ratkowitz's Legal Cases (22)

Medical malpractice

$1,060,000 Settlement at Trial on Behalf of Livingston, New Jersey, Resident Who Suffered a Stroke During Surgery.

Sep 30, 2013

OUTCOME: Settlement at trial

On September 30, 2013, the remaining defendant, my client’s cardiologist, settled all claims asserted against him during trial before he was scheduled to testify in our case in chief. Earlier, my clien ... t’s primary care physician settled all claims asserted against her the week before the trial began. The plaintiff was a resident of Livingston, New Jersey who suffered a stroke during prostate cancer surgery on June 11, 2007. The theory of the case was that his primary care physician and his cardiologist should have bridged him on Lovenox because his medical history revealed that he was hypercoaguable. When patients have a propensity to develop blood clots, they are sometimes medicated with Coumadin, which thins their blood and decreases the chance that they will form blood clots. When these patients have to undergo surgery, however, the dangers posed by their clotting disorder competes against the danger that they will bleed excessively during an operation because their ability to clot has been diminished as a result of medication. Patients who take anticoagulants like Coumadin usually take that medication orally. When doctors bridge patients who are on Coumadin, instead of taking a patient off of Coumadin five days or a week before surgery, doctors will substitute Coumadin with Heparin or Low Molecular Heparin which is easier to control because it is shorter acting. When patients are bridged, they can be kept on anticoagulants for up to a few hours before surgery, and they can be restarted on anticoagulants right after surgery. This reduces the time that patients have to be off of anticoagulants and decreases the window in which a patient’s hypercoaguability can cause a complication. The plaintiff was placed on life-long Coumadin during a hospital admission in January 2006, after he developed a blood clot and a pulmonary embolism while on prophylactic anticoagulants following knee surgery. During that episode he also developed atrial fibrillation. He was seen as an inpatient by the defendant cardiologist. Unfortunately, the cardiologist’s partners rounded on the patient while he was in the hospital thereafter, and the cardiologist was not aware that the other physicians caring for the patient had determined that he was genetically hypercoaguable and that he needed to be on lifelong anticoagulants. A year and six months later, the plaintiff was sent to his cardiologist and his primary care physician for preoperative clearance because he was scheduled to undergo prostate cancer surgery. Neither the cardiologist or the plaintiff’s primary care physician recommended that the plaintiff undergo bridging therapy, and the plaintiff was taken off anticoagulants a week before the surgery. While off anti-coagulants, the plaintiff experienced heart palpitations, which he ascribed to nerves in anticipation of surgery. According to some of his treating physicians and some of the experts who testified in the case, those palpitations were caused by recurring atrial fibrillation. As a result of atrial fibrillation, the plaintiff formed an embolus in his heart, which eventually went on to cause his stroke in the perioperative period. The case was tried in Newark, New Jersey between September 23, 2012 and September 30, 2013. I was in the middle of our case in chief when the defendant cardiologist consented to settle and his carrier began to negotiate. We had already called the plaintiff, his wife and son as witnesses. One of our experts, an ophthalmologist had already testified. The plan was to put the defendant cardiologist on the stand and to call our remaining experts, a cardiologist and a hematologist, and then rest.

Medical malpractice

Starr Gern resolves medical malpractice case on behalf of man sufferring neurological damage following surgery to his knee.

Sep 07, 2011

OUTCOME: Settlement at trial

Partner John Ratkowitz resolved an orthopedic malpractice claim on behalf of a 28-year-old resident of Brick, New Jersey, who suffered nerve damage following orthopedic surgery to his left knee. The ... plaintiff underwent knee surgery on September 13, 2005. Following the surgery, his left leg was placed in a cylinder cast that went from his foot to his thigh. On September 14, 2005, he began to notice increased swelling in the lower part of his left leg in the ankle and foot area. As the day went on the swelling continued. He developed first a tingling sensation, then later in the day numbness and pain. Eventually, later in the late afternoon or early evening, as his symptoms increased, and the plaintiff telephoned the operating surgeon's office. No physicians were availableÂ¸ and the answering service advised that they would have an on-call physician return his call. Approximately an hour later a physician telephoned the plaintiff and advised him that he should elevate his foot and apply ice to his leg to reduce the swelling and symptoms. Elevation and ice did not alleviate the plaintiff's symptoms and the next morning, September 15, 2005, he and his mother both telephoned the orthopedic practice several times to see what they should do about this. Around 10 o'clock in the morning, a person from the practice telephoned the plaintiff's mother, advising that she could either bring the plaintiff into the office to be seen that morning or she could wait until Friday which was the next day and bring him in to his regularly scheduled appointment. The plaintiffs were told that if they visited that morning, they wouldn't be able to see the operating surgeon, because he was at the hospital. They elected to wait until the next day, since the operating surgeon was the only orthopedist the plaintiff had ever seen. While the plaintiff did not know this, the tingling and pain was peroneal nerve compression due to swelling inside the cast. Between the calls and the first doctor visit, the problem became irreversible. The plaintiff took the position that injury to the peroneal nerve as a result of swelling inside a cast is a well-known potential complication that is entirely avoidable and that accepted standards of medical care required the defendant to immobilize the plaintiff's leg in a way that didn't put that nerve at risk. Mr. Ratkowitz settled the case shortly after it was assigned to a trial judge. The terms of the settlement are confidential.

Lawsuits and disputes

Starr Gern Obtains $3.9 Million on Behalf of Two Ironworkers Injured at a Construction Site.

Nov 19, 2009

OUTCOME: $3.9 Million Settlement

On October 11, 2006, two union ironworkers were severely injured while working at the Broad Street Station Restoration Project in Newark, New Jersey. The project was owned by New Jersey Transit, which ... had hired a general contractor, Conti Enterprises, Inc. of South Plainfield, New Jersey. Conti had full responsibility for managing the project, both by contract and safety regulations. The ironworkers were working for a subcontractor on the project, Railroad Construction Co., Inc. of Paterson, New Jersey. On the date in question, they were operating a scissors manlift on a precast concrete platform, which would eventually be used by train passengers when the station was fully operational. At about 2:30 am, on the late shift, they were "bolting up" a canopy at the station, which would be used by train passengers for protection from the elements. Suddenly, as they were traveling on the motorized scissors lift across the platform, one of the precast planks flipped onto the railroad tracks, catapulting the lift and both workers to the tracks below, causing traumatic bodily injuries. As it developed, the precast platform had not been properly secured by the general contractor, Conti, who had supervisory and contractual responsibility for doing so, and responsibility for alerting its subcontractors of any such dangers. One ironworker sustained a lower back injury requiring surgical fusion with pedicle screw instrumentation, which required a bone graft at L5-S1. He also fractured his dominant right hand, which required two surgeries and pinning due to a malunion. He also had an open fracture of his left knee, and lost approximately one-third of his left patella, as a result of an open reduction and extensor mechanism repair, with associated scarring. A vocational/economic expert that his past and future net wage loss would amount to between $1.5 and $1.9 million. The second ironworker sustained ten fractured ribs with painful chest wall syndrome, a concussion, traumatic structural damage in the right inner ear which required two surgeries and resulted in vestibular dysfunction with dizziness and loss of balance, and a profound hearing loss in the same ear, which required a hearing aid. Vocational testimony was presented that this disability forced him to give up a 22 year career as an ironworker and take other jobs in non-union positions that did not pay as well. A vocational expert asserted that he would lose between $1.35 and $1.6 million in past and future wages, by virtue of the physical limitations that prevented him from continuing as union steel worker. John Ratkowitz and Amos Gern tried the case between November 3 and November 19, 2009. The first ironworker settled his case after one week of trial, on November 13, for $2.9 million. The claims of the second ironworker went to verdict on November 19, before a jury which returned a gross award of $494,138, reduced by 34% for comparative negligence. However, Starr Gern was able to negotiate a high-low settlement of $1,000,000 to $2,000,000 prior to the verdict. As a result, the second ironworker will receive a settlement of $1,000,000 in spite of the jury verdict, and all potential appeals were waived.

Medical malpractice

Starr Gern Obtains over $1.4 Million in Orthopedic Malpractice Case following Jury Selection.

Nov 15, 2009

OUTCOME: $1.4 Million Settlement at Trial

The plaintiff injured his left elbow when he fell after his scooter struck a hole in a residential street. The following day, he came under the care of the defendant, a pediatric orthopedic surgeon, wh ... o performed surgery. Following the surgery, the plaintiff was casted. Approximately six weeks later, when the cast was removed, the plaintiff had little range of motion in the left elbow joint. Within weeks, the joint completely froze. After visiting several orthopedic surgeons in New York City for second opinions, the plaintiff was advised that he required major reconstructive surgery because his left elbow fractures healed in a place higher than their original location. Suit was filed against the defendant physician and two entities who had responsibilities related to maintaining the street where the accident occurred. The case was litigate for three years and it involved complex issues of causation and apportionment of responsibility. The plaintiff's medical expert opined that the elbow fractures healed in the wrong position because they were pinned in the wrong place by the defendant during the surgery. The expert further opined that if the defendant had performed the surgery appropriately, the plaintiff would have been left with a functioning pain-free left elbow, with minimal loss of motion. The defendants argued that the fractures were pinned correctly, but drifted following the removal of the surgical pins six weeks later. Despite undergoing multiple surgeries to correct the malaligned joint, the plaintiff is left with a 30% functioning left elbow. Partners John Ratkowitz and Amos Gern settled the case following jury selection prior to opening arguments.

Medical malpractice

Starr Gern Resolves Medical Malpractice Claim on Behalf of man Injured by Negligent Spinal Surgery.

Feb 09, 2009

OUTCOME: Settlement (Confidential).

he plaintiff underwent spinal surgery on October 12, 2004. During the operative procedure, a surgical screw was negligently placed, and as a result it was lost when it fell outside the operative field. ... After three hours of unsuccessfuly searching, the surgeon elected to leave the screw inside the plaintiff's body. Additional hardware that was inserted into the plaintiff's spine was also left inadequately secured. Post-operatively, the plaintiff and his wife consulted another spinal surgeon, who recommended a second operation to remove the screw and resecure the additional hardware. This occured, but was followed by several additional operative procedures because of the development of a post-opertive infections. Mr. Ratkowitz resolved the case after the depositions of the plaintiffs and the defendant.

Medical malpractice

Starr Gern Law Firm Settles Malpractice Case on Behalf of Stroke Victim Who Lost Vision

Sep 25, 2008

OUTCOME: Settlement (Confidential).

The plaintiff was a resident of Lakehurst, New Jersey. He underwent a second spinal surgery on November 27, 2000. It was the plaintiff's contention that the defendant anesthesiologist utilized an anest ... hesia technique of induced hypotension, and that during the operative procedure the plaintiff's blood pressure was allowed to drop too low, causing an ischemic stroke to occur. The plaintiff further contended that the defendant anesthesiologist failed to perform an appropriate preoperative evaluation, and failed to take into consideration in his anesthesia plan that the plaintiff suffered from hypertension, was obese, smoked and had other underlying cardiovascular problems that required his blood pressure to be higher during surgery. Further, the plaintiff took the position that he was not provided with adequate or timely blood replacement during the operative procedure, and that intraoperative monitoring of his condition was inadequate. The defense denied that the induced hypotension was contraindicated, and took the position that the plaintiff suffered from only "white coat hypertension," and that his stroke was not due to negligence. Lawyer John Ratkowitz resolved the case while awaiting a trial date.

Medical malpractice

Starr Gern Settles Traumatic Birth Injury Case for Defendant's $1 Million Insurance Liability Limits.

Sep 24, 2008

OUTCOME: $1 Million Settlement

At 4:00 a.m. on May 24, 2001, the mother was admitted to Labor and Delivery. Initial fetal heart rate measurements were noted to be in the 100-110 beat per minute range. The defendant physician arrived ... at 4:30 a.m. Shortly afterward, at 4:35 a.m., the fetal monitoring strips became non-reassuring. Oxygen was applied to the mother, and position change was employed. An internal fetal scalp electrode was not applied, and a good portion of the fetal monitoring strips thereafter were uninterpretable. At 5:05 a.m., due to continuing concerns about the fetal heart rate, the defendant applied a vacuum extractor while the baby was at +2 station, with the vertex in the occiput position. At 5:22 a.m., the baby was delivered with a midline episiotomy under local anesthesia, with Apgar scores of 2/2/5 at 1/3/10 minutes. When the plaintiff was born, resuscitation was necessary, and she was intubated. The plaintiff was diagnosed with metabolic acidosis and persistent pulmonary hypertension while admitted at the hospital. Additionally, she demonstrated irritability though fisting, clonus and bicycling movements. Following discharge from the hospital, an MRI of the brain demonstrated findings consistent with the chronic phase of profound asphyxia. The plaintiff suffered from aspiration pneumonia and gastroesophageal reflux and failure to thrive and required the insertion of a gastronomy tube. She then went on to develop a spastic quadriplegia and developmental delay. The plaintiffs contended that the defendant's failure to employ an internal fetal scalp electrode was a breach of accepted standards of care, and prevented the defendant from knowing the true status of the baby's condition, and led to an inappropriate decision to move forward with operative vaginal delivery rather than taking further resuscitative measures during labor and potential cesarean section. The defense contended that the fetal tracings were intermittently reassuring, that the mother was combative during labor and that the extremely rapid pace of labor made the defendant's anticipation of imminent vaginal delivery logical, and therefore his decision to forego a cesarean section was within accepted standards of medical care. The case settled after parties and witnesses were deposed and expert reports were exchanged.

Car accident

Starr Gern Law Firm Resolves Automobile Accident Case on Behalf of 20-Year-Old Somerset, New Jersey, Resident for $300,000

Sep 23, 2008

OUTCOME: $300,000 Settlement

On November 29, 2004, between 9:00 and 10:00 p.m., the defendant was traveling south on Middlebush Road in Franklin Township, New Jersey, when without warning, she veered into the northbound lane of Mi ... ddlebush Road and struck the plaintiff's 1995 Toyota Corolla. The defendant advised the police that she fell asleep at the wheel and did not wake up again until after the accident occurred. The plaintiff was removed from his vehicle with the "Jaws of Life." He was taken to Robert Wood Johnson University Hospital. Multiple radiographic studies were performed, which disclosed multiple broken bones. An x-ray of his right tibia and fibula demonstrated comminuted fractures of the distal tibia and fibula, with overriding of the fracture fragments and a lateral tilt of the distal fragments. A chest x-ray and x-ray of my left shoulder revealed a displaced fracture of the mid-shaft of the left clavicle, with inferior displacement of the distal fragment. Finally, a CT scan of the lumbar spine revealed a comminuted and displaced fracture of the left transverse process of the L3 vertebral body, and a non-displaced fracture of the left transverse process of the left vertebral body at L4. These fractures were accompanied by a diffuse disc bulge at L4-5 and a moderate diffuse disc bulge with a small central disc herniation at L5-S1. The plaintiff underwent surgery which included intramedullary nailing with the insertion of a tibial traction pin to set and stabilize his leg fractures. The plaintiff made a remarkable recovery, although his leg and back injuries have restricted his recreational and leisure activities. The plaintiff is currently an engineering student at college out of state. Lawyer John Ratkowitz was able to resolve the case following a settlement conference before the Honorable Victor Ashrafi.

Personal injury

Starr Gern Law Firm Settles Negligent Security Case for $375,000 During Trial.

Jun 23, 2008

OUTCOME: $375,000 Settlement

On October 9, 2003, at approximately 12:30 p.m., the plaintiff, who was a freshman in high school, was exiting a bathroom when two female students, who were seniors at the school, assaulted her by pinn ... ing her against the wall and inappropriately touching and fondling her. The plaintiff alleged that the assault took place in the vicinity of a security desk, and was witnessed by a security guard who failed to act to stop the attack. Additionally, the plaintiff alleged that defendants routinely failed to follow their own security policies and procedures, creating an environment in which individual security guards were largely unaccountable for their work performance. Six days following the attack the plaintiff had to be hospitalized for anxiety attacks. She began psychiatric care on an outpatient basis following the hospitalization. She returned to school after being released from the hospital approximately one week later. At plaintiff's mother's request, the school assigned the plaintiff an aid to walk her back and forth from classes, and began bussing the plaintiff to and from school because she feared retaliation from her attackers for pressing criminal charges. The plaintiff's condition throughout the remainder of the 2003-2004 school year ebbed and flowed in conjunction with run-ins with her attackers and alleged teasing about the attack from her peers at school. She remained under psychiatric care for medication monitoring and she received psychological counseling once a week. Plaintiff alleged that when she returned to the high school for the 2004-2005 school year, the teasing about the October 9, 2003 sexual assault continued. Ultimately, the plaintiff was placed on a home schooling program after leaving the high school in November 2004. Shortly before her home schooling program was set to expire, she attempted suicide by overdosing on Paxil. A month later, she attempted suicide a second time by taking Paxil, this time consuming more pills. The plaintiff was then admitted into an intensive outpatient therapy program and completed her 2004-2005 school year there. In addition to the negligent security claim, the plaintiffs alleged that the teasing she experienced at the Newark highschool denied her a harassment free school environment in violation of the New Jersey Law Against Discrimination, pursuant to L.W. v. Tom's River Regional Schools Bd. of Educ., 189 N.J. 381(2007). At the recommendation of her social worker, the plaintiff was transferred into another school district after she was released from her outpatient treatment following her second suicide attempt. Although she remained under the care of a psychiatrist, the plaintiff excelled in her new educational environment. She was elected student body president at her new school and graduated valedictorian of her class. Lawyer John Ratkowitz represented the plaintiff. The case settled on the third day of trial.

Medical malpractice

Starr Gern Obtains Confidential Medical Malpractice Settlement on Behalf of a Resident of Monroe Township, New Jersey.

Feb 15, 2008

OUTCOME: Settlement (Confidential).

The plaintiff began to suffer flu-like symptoms in August 2002. When they persisted, he became concerned that he might be suffering from Lyme disease. Two weeks earlier he was bitten by an insect at a ... golf outing. When he reported this history to the defendant, his primary care physician, he was placed on prophylactic antibiotics and blood tests were ordered to rule-out the possibility of Lyme disease. Three years before he began to suffer from flu-like symptoms, the plaintiff was found to have a heart murmur during an Executive Physical performed by another physician. The plaintiff advised the defendant of this diagnosis, and the defendant primary care doctor referred the plaintiff to a cardiologist for an echocardiogram. Investigation revealed that the defendant failed to follow-up on the echocardiogram he ordered, and never ascertained the results of that test and did not know that the plaintiff was suffering from a grade III/IV diastolic murmur and aortic regurgitation, a condition which made the plaintiff susceptible to bacterial endocarditis. Although the plaintiff's lab studies were available on September 5, 2002, the defendant did not review them until September 16, 2002. Despite the fact that the test results came back negative for Lyme disease, the defendant continued to treat the plaintiff for that condition throughout the remainder of September and into October 2002. Ultimately, the plaintiff suffered a stroke on October 21, 2002. He was admitted to the hospital and found to have vegetations on his heart caused by bacterial endocarditis. The plaintiff underwent intravenous antibiotics to combat the infection. In early 2003 he was admitted to the hospital for aortic valve replacement surgery and repair of the mitral valve. It was the plaintiffs' contention that accepted standards of medical care required the defendant physician to entertain Bacterial Endocarditis in his differential diagnosis, and that he failed to do so because he did not obtain the results of the echocardiogram he ordered and did not know that the plaintiff was susceptible to this disease. The defendant maintained that accepted standards of medical care did not require him to diagnose the plaintiff with Endocarditis because it is a rare disease. Attorney John Ratkowitz represented the plaintiffs. The case was assigned to trial. Jury selection and opening statements took place. The plaintiffs called the defendant doctor as their first witness. The case settled prior to the conclusion of his testimony.

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