Sunni Jenkins v. Allen Leblanc, M.D.

STATE OF LOUISIANA
COURT OF APPEAL, THIRD CIRCUIT

13 -763

SUNNI JENKINS

VERSUS

ALLEN LEBLANC, M.D.

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APPEAL FROM THE
NINTH JUDICIAL DISTRICT COURT
PARISH OF RAPIDES, NO. 238,219
HONORABLE HARRY FRED RANDOW, DISTRICT JUDGE

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JOHN E. CONERY
JUDGE

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Court composed of Elizabeth A. Pickett, Billy Howard Ezell, and John E. Conery,
Judges.

AFFIRMED.

Victor Herbert Sooter
Sooter & Associates
A Limited Liability Company
Post Office Box 1671
Alexandria, Louisiana 71309
(318) 448-8301
COUNSEL FOR DEFENDANT/APPELLEE:
Allen LeBlanc, Jr., M.D.

Eugene A. Ledet, Jr.
Dalrymple & Ledet, LLC
1450 Dorchester Drive (71301)
Post Office Drawer 14440
Alexandria, Louisiana 71315
(318) 442-1818
COUNSEL FOR PLAINTIFF/APPELLANT:
Sunni Jenkins

CONERY, Judge.

This is a medical malpractice claim filed by Sunni Jenkins (“Ms. Jenkins”)

against her former obstetrician-gynecologist (“OB-GYN”), Dr. Allen LeBlanc, Jr.

(“Dr. LeBlanc”). Ms. Jenkins claims Dr. LeBlanc failed to inform her of the risks

associated with the insertion and use of an intrauterine device, a Mirena™ IUD, a

form of birth control. Ms. Jenkins claims that as a result of Dr. LeBlanc’s failure

to properly inform her of the risks of the use of the Mirena™ IUD, she suffered a

perforated uterus, resulting in pelvic inflammatory disease (“PID”), that ultimately

lead to her undergoing a total hysterectomy.

The trial court, after a two day bench trial and receipt of post-trial briefs

from the parties, issued written reasons on March 18, 2013. In its written reasons,

the trial court found Dr. LeBlanc had breached the standard of care in failing to

inform Ms. Jenkins of the material risks of the use of an IUD, but the insertion of

the IUD by Dr. LeBlanc was not casually related to Ms. Jenkins undergoing a total

hysterectomy. The judgment dismissing Ms. Jenkins’ claims was signed on April

2, 2013, from which she now appeals. For the following reasons, we affirm.

FACTS AND PROCEDURAL HISTORY

Dr. LeBlanc was Ms. Jenkins’ OB-GYN, and delivered two of her three

children without complication. Ms. Jenkins was twenty-six years old at the time of

her second delivery on November 19, 2006. She returned to see Dr. LeBlanc on

December 8, 2006 with complaints of breast pain, for which he prescribed

Clindamycin.

On December 27, 2006, Ms. Jenkins’ next office visit, her examination was

normal, and she requested some form of birth control. Ms. Jenkins claims that

although various forms of birth control were discussed, both Dr. LeBlanc and his

nurse recommended a Mirena™ IUD. Ms. Jenkins claims that she was not given

the Mirena™ IUD pamphlet outlining the risks of the IUD prior to its placement.

Further, she testified that Dr. LeBlanc did not verbally advise her of the risk of

perforation of the uterus, which could result in PID and thereby necessitate a total

hysterectomy. Dr. LeBlanc, after giving Ms. Jenkins fifteen or twenty minutes to

decide, performed the procedure and inserted the Mirena™ IUD. It is undisputed

that Ms. Jenkins did not sign a consent form for the procedure. Thus, Ms. Jenkins

claims that failure to give informed consent for the placement of the IUD violated

the standard of care.

Dr. LeBlanc testified that Ms. Jenkins initially requested a hysterectomy,

which surprised him, given her age of twenty-six. However, he recommended the

Mirena™ IUD, as it is as effective as tubal ligation and lasts up to five years before

removal is required. Also, the Mirena™ IUD has the lowest risk of adverse side

effects of any means of birth control for lactating mothers. Additionally, the IUD is

safe for both mother and child, and the risk of PID is only within the first twenty

days following insertion. After the first twenty-day period, the risk of PID is the

same for women without the Mirena™ IUD.

It is undisputed that Dr. LeBlanc inserted the Mirena™ IUD on December

27, 2006 and performed an ultrasound to confirm its proper placement. Ms.

Jenkins returned on January 3, 2007 for her scheduled follow-up appointment.

There was no evidence of any infection, and a second ultrasound was performed

again confirming the proper placement of the IUD. Ms. Jenkins confirmed that she

was able to palpate the strings attached to the IUD and once again voiced no

complaints. The January 3, 2007 appointment was the last time Ms. Jenkins was

seen as a patient by Dr. LeBlanc, as she did not return for her annual exam.

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Approximately ten months later, on November 1, 2007, Ms. Jenkins, saw Dr.

Amy Griffin (“Dr. Griffin”) in order to establish a doctor-patient relationship with

a family practitioner. Dr. Griffin’s records reflect Ms. Jenkins complained of hot

flashes, headaches and anxiety. Her physical examination revealed no abdominal

or pelvic complaints of pain. Appropriate medication was prescribed and baseline

laboratory work was ordered, the results of which showed a normal white blood

count, and thus, no evidence of infection.

On December 11, 2007, Ms. Jenkins returned to Dr. Griffin, this time with

complaints of dyspareunia (painful intercourse), and bladder incontinence. Dr.

Griffin’s exam revealed a retroverted uterus, non-tender, the IUD strings were in

place, and there was no clinical evidence of PID.

Dr. Griffin referred Ms. Jenkins to Central Louisiana Imaging Center for a

pelvic ultrasound on January 4, 2008, due to Ms. Jenkins complaints of pelvic

pressure and stress incontinence. The results of the January 4, 2008, pelvic

ultrasound revealed a retroverted uterus, the IUD within the endometrial canal,

multiple bilateral ovarian cysts and complex fluid collection adjacent to the right

ovary, containing a large septation. An ovarian cyst with septation is made up of

both solid and liquid matter, and may become malignant. The January 4, 2008,

pelvic ultrasound did not show that the IUD had perforated Ms. Jenkins’ uterus.

On January 8, 2008, a follow-up CT scan of Ms. Jenkins’s abdomen was

conducted in order to further address the fluid collection in the right ovary,

previously discovered in the January 4, 2008 ultrasound. This CT scan revealed

for the first time the IUD perforation at the top of her uterus. Based on the findings

in the ultrasound and CT scan, Dr. Griffin referred Ms. Jenkins to Dr. Amy Babin

(“Dr. Babin”), an OB-GYN, for a work-up.

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On January 9, 2008, Ms. Jenkins saw Dr. Babin and reported having pelvic

pain for the last three months, a complaint not reflected in Dr. Griffin’s notes. Dr.

Babin reviewed the January 4, 2008 ultrasound and the January 8, 2008 CT scan

and determined the best course of action was to remove the IUD under

laparoscopic observation. Dr. Babin, however, did not see the need for the

immediate removal of the IUD and left on vacation.

On January 13, 2008, Ms. Jenkins went to the emergency room of the

Christus St. Francis Cabrini Hospital (“Cabrini”) where Dr. James Gates (“Dr.

Gates”), Dr. Babin’s partner, was the attending OB-GYN physician on call. Ms.

Jenkins complained of worsening abdominal pain, dysuria (painful urination), and

constipation with mild nausea, but had no fever. After a pelvic examination, Dr.

Gates diagnosed Ms. Jenkins with probable endometritis from a perforated IUD.

He admitted her to the hospital, administrated IV antibiotics and on January 14,

2008, performed a diagnostic laparoscopy removing the IUD. Ms. Jenkins was

discharged the same day with pain medication and instructions to forego heavy

lifting for one week and to follow-up with Dr. Babin in two weeks.

Dr. Gates’ operative notes reflect a normal procedure, with no evidence of

any PID. The perforation in the anterior uterine wall did not bleed and required no

sutures or cauterization. Intra-operative photographs of the procedure did not

reveal any evidence of PID, and Dr. Gates described the photographs as depicting a

“stone cold normal pelvis.”

On January 20, 2008, Ms. Jenkins once again went to the Cabrini

emergency room complaining of fever and nausea. She was diagnosed with

possible endometriosis and admitted for antibiotic treatment by Dr. Babin. Dr.

Babin later noted a diagnosis of PID. Ms. Jenkins was discharged from the

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hospital on January 24, 2008, and ordered to continue Augmentin for ten days,

return to see Dr. Babin in seven to ten days, and to call with any acute changes.

On February 1, 2008, Ms. Jenkins returned to see Dr. Babin. Ms. Jenkins

asked Dr. Babin to perform a vaginal hysterectomy. Dr. Jenkins determined that

the hysterectomy was the only course of action due to Ms. Jenkins’ “unrelenting

pain,” two weeks after the removal of the IUD. Although Dr. Babin listed a

diagnosis of PID for Ms. Jenkins, she acknowledged at trial that there were no

clinical signs to support the diagnosis. The pre-surgical laboratory results did not

show an elevated white blood count, which would be indicative of an infection,

and the operative report subsequent to Ms. Jenkins’ hysterectomy revealed no

evidence of PID, as both her tubes and ovaries were noted to be normal.

After the hysterectomy procedure, Ms. Jenkins’ uterus, cervix, bilateral

tubes, and ovaries were sent to Dr. Irene Manlapaz, a pathologist for examination.

Her pathology report determined that Ms. Jenkins was suffering from adenomyosis,

which occurs when the endometrial tissue which lines the uterus moves to the outer

walls of the uterus. Dr. Manlapaz testified that the adenomyosis was the cause of

her abdominal pain, and her condition was not caused or related to the perforation

of the uterus by the IUD.

Dr. Joel Hall, a member of the medical review panel, noted adenomyosis can

only be “suspected” as a cause of abdominal pain and only confirmed by

pathological examination after the hysterectomy is performed. There was no

evidence of PID in Dr. Manlapaz’s pathology report on Ms. Jenkins. Ms. Jenkins

did not call an expert pathologist in an effort to refute the findings of Dr. Manlapaz.

Only her treating physicians were called to testify as experts at trial.

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Ms. Jenkins filed a timely complaint against Dr. LeBlanc and requested the

matter be properly submitted to a medical review panel. The panel found that Dr.

LeBlanc’s actions in recommending and inserting the Mirena™ IUD were

appropriate and that in this respect, he did not breach the standard of care. The

panel, however, found a material issue of fact remained concerning whether or not

Ms. Jenkins was informed of the potential risks of the use of an IUD.

After the medical review panel decision was rendered, Ms. Jenkins timely

filed suit alleging Dr. LeBlanc breached the standard of care by failing to inform

her of the risks associated with the Mirena™ IUD, which she claimed caused her

to develop PID and resulted in her undergoing a total hysterectomy. Ms. Jenkins

reduced her claim for damages to less than $50,000, which resulted in her case

being heard by the trial court and not a jury.

The trial court, after a two day bench trial and receipt of post-trial briefs

from the parties, issued written reasons on March 18, 2013. In its written reasons

the trial court found Dr. LeBlanc had breached the standard of care in failing to

inform Ms. Jenkins of the material risks of the use of an IUD, but the insertion of

the IUD by Dr. LeBlanc was not casually related to Ms. Jenkins undergoing a total

hysterectomy. A judgment dismissing Ms. Jenkins’ claims was signed on April 2,

2013, from which she now appeals.1

ASSIGNMENTS OF ERROR

1. The trial court’s determination that Ms. Jenkins failed to show a
causal connection between Dr. LeBlanc’s failure to inform the patient
of the material risks associated with an intrauterine device (IUD) and
the resulting damages was manifestly erroneous and clearly wrong.
1
The brief of Appellee, Dr. LeBlanc argues that the trial court erred in finding that Dr.
LeBlanc breached the standard of care in failing to discuss the risks of the use of an IUD with
Mrs. Jenkins. However, there was no separate appeal of this issue, and therefore, it is not before
this Court on appeal.

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2. The trial court was manifestly erroneous and clearly wrong in
weighing the evidence which overwhelmingly supported Ms. Jenkins’
pain and gynecological problems were associated with the perforated
uterus, not adenomyosis.

3. The trial court abused its much discretion in affording
significant weight to the testimony of James Gates M.D. considering
his blatant attempt at favoritism and advocacy, as well as targeted
change in testimony.

LAW AND DISCUSSION

Standard of Review

The appellate court must determine whether the trial court committed an

error of law or made a factual finding that was manifestly erroneous or clearly

wrong. Gibson v. State, 99-1730 (La. 4/11/00), 758 So.2d 782, cert. denied, 531

U.S. 1052, 121 S.Ct. 656 (2000). The reviewing court must review the record in its

entirety to make this determination. Stobart v. State, Dep’t of Transp. and Dev.,

617 So.2d 880 (La.1993). “Even though an appellate court may feel its own

evaluations and inferences are more reasonable than the factfinder’s, reasonable

evaluations of credibility and reasonable inferences of fact should not be disturbed

upon review where conflict exists in the testimony.” Id. at 882. “[W]here two

permissible views of the evidence exist, the factfinder’s choice between them

cannot be manifestly erroneous or clearly wrong.” Id. at 883.

Louisiana Revised Statutes 9:2794

Louisiana Revised Statutes 9:2794 is the applicable law governing a claim

against a physician for medical malpractice and provides the necessary elements

that a plaintiff must meet in order to prevail on a claim of negligence against a

physician. La.R.S. 9:2794(A) provides in pertinent part:

(1) The degree of knowledge or skill possessed or the degree of care

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ordinarily exercised by physicians . . . licensed to practice in the state
of Louisiana and actively practicing in a similar community or locale
and under similar circumstances; and where the defendant practices in
a particular specialty and where the alleged acts of medical negligence
raise issues peculiar to the particular medical specialty involved, then
the plaintiff has the burden of proving the degree of care ordinarily
practiced by physicians . . . within the involved medical specialty.

(2) That the defendant either lacked this degree of knowledge or skill
or failed to use reasonable care and diligence, along with his best
judgment in the application of that skill.

(3) That as a proximate result of this lack of knowledge or skill or the
failure to exercise this degree of care the plaintiff suffered injuries that
would not otherwise have been incurred.

Assignment of Errors One and Two

The trial judge in this case thoroughly considered all the evidence and

comprehensively reviewed all the legal issues presented. The trial court did find

that Dr. LeBlanc breached the standard of care by failing to provide sufficient

informed consent. The trial court then went on to find no causal connection

between the lack of informed consent and plaintiff’s complaints. We quote from

and adopt its findings and well-written reasons for judgment in pertinent part:

However, under both La. R.S. 9:2794 and La. R.S. 40:1299.40, the
plaintiff must prove, in order to receive an award of damages, that
there is a causal relationship between the doctor’s failure to inform
and the damages claimed by the plaintiff. In the present case, the
Court finds that there exists no causal relationship between Dr.
LeBlanc’s failures to inform Ms. Jenkins of the material risks of use
of the IUD with the damages she claims.

At trial it was shown that Dr. Babin was the one who diagnosed
Ms. Jenkins with PID. When Ms. Jenkins again presented to the
emergency room on January 14, Dr. Babin diagnosed her as suffering
from PID. Dr. Babin prescribed antibiotics and discharged her four
days later. Plaintiff returned to Dr. Babin, where it was discussed and
decided that plaintiff would undergo a total hysterectomy as a
definitive surgical treatment for her pain. The hysterectomy was

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performed on February 5, 2008, where again, Dr. Babin noted that Ms.
Jenkins was suffering from PID, attributing PID to the perforated
uterus.

While there is an increased risk of perforation of the uterus and
an increased risk of contracting PID as a result of using an IUD; the
use of the Mirena IUD by plaintiff was not the cause of her needing a
hysterectomy. Ms. Jenkins suffered from what has now been
diagnosed as adenomyosis, a uterine disease that occurs when
endometrial tissue, which normally lines the uterus, exists within and
grows into the muscular wall of the uterus. Dr. Paul Crawford, who
served on the Medical Review Panel in plaintiff s case, testified in his
deposition that a woman who has adenomyosis can experience severe
abdominal pain, which such symptoms can overlap those symptoms
that women who contract PID suffer as well. Further, Dr. Crawford
stated that the diagnosis of adenomyosis is not a pre-operative
diagnosis; but rather a pathological diagnosis, meaning that
adenomyosis is generally only discovered upon a review of the uterus
post-hysterectomy.

All doctors who testified at trial indicated that plaintiff did not
suffer from PID. Dr. Babin testified that; after reviewing her notes and
the pathology report, there was no indication of any infection--and
that the adenomyosis finding explained plaintiff’s perforation and
symptoms. She further stated that it was likely that had plaintiff not
suffered from adenomyosis, she would not be in court today. Dr.
Gates testified that it was his opinion that the IUD did not cause Ms.
Jenkins to undergo a hysterectomy. Further, Dr. Christopher Hall,
who served on the medical review panel, testified that upon review of
Dr. Babin’s notes and the pathology report, he did not believe that Ms.
Jenkins suffered from PID, and that it was his opinion she was
misdiagnosed with PID.

At trial, the Court was made aware that Dr. Babin’s opinion had
changed and likely had changed due to conversations with Dr. Gates.
Dr. Gates is the senior physician in the clinic where Dr. Babin
practices. In both her deposition and trial testimony, Dr. Babin
admitted that she discussed the case with Dr. Gates on multiple
occasions. She further admitted in her deposition that she “agreed
with him” as to Dr. Gates’ opinion that she had misdiagnosed plaintiff
with PID.

The court has struggled with its determination of how much
credibility to place on Dr. Babin’s opinions and testimony. While it is
concerned as to how and why Dr. Babin changed her opinion as to the
initial diagnosis of the PID, this Court ultimately accepts Dr. Babin’s
testimony. The court is of the opinion that Dr. Gates has influenced Dr.
Babin’s change, but that this change of opinion was further advanced
by Dr. Babin’s own review of her notes and reports. She indicated to

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the court that upon further review of her notes and pathology report,
she came to the conclusion as well that there was no indication of
infection, which would be indicative of PID. While Dr. Babin’s
opinion may have been influenced, the court ultimately accepts Dr.
Babin’s trial testimony, as her change of opinion was further
substantiated by the testimony and opinions of Dr. Gates and Dr.
Crawford.

The Court is of the opinion that the adenomyosis was the cause
of Ms. Jenkins undergoing a total hysterectomy-not the use of the
Minera IUD. As such, while, Dr. LeBlanc may not have discussed all
the material risks associated with using an IUD, this conduct, however
“wrongful” does not dispute the fact that use of the 1UD was not the
cause of Ms. Jenkins undergoing a total hysterectomy. The Court is of
the opinion that Ms. Jenkins has failed to show a causal connection
between Dr. LeBlanc’s failure to inform the patient of the material
risks and the plaintiff s damages.

The trial court thoughtfully considered all of the plaintiff’s claims and

arguments, evaluated the credibility of the witnesses, and the sufficiency of the

evidence. We cannot say that the trial court’s findings were manifestly erroneous.

Thus, Ms. Jenkins assignments of error numbered one and two are without merit.

Assignment of Error Three

Ms. Jenkins argues that the trial court abused its “discretion in affording

significant weight to the testimony of James Gates M.D. considering his blatant

attempt at favoritism and advocacy, as well as targeted change in testimony.” In

this assignment of error, Ms. Jenkins argues that the trial court failed to take into

account the influence that Dr. Gates may have exerted on his partner Dr. Babin.

Dr. Babin was the only physician to diagnose Ms. Jenkins with PID prior to the

hysterectomy. However, once the pathology report of Dr. Manlapaz confirmed

adenomyosis and found no evidence of PID, Dr. Babin reviewed her notes and

changed her diagnosis. As previously stated, Ms. Jenkins did not call an expert

pathologist to refute the pathology report.

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In addition, when Ms. Jenkins came to the Cabrini Emergency Room on

January 13, 2008, her white blood cell count was normal, belying the presence of

an infection, and when the IUD was removed by Dr. Gates on January 14, 2008,

there was no evidence of PID per the intra-operative photographs.

Once again, the records of pre-surgical laboratory blood work, conducted

prior to the hysterectomy done by Dr. Babin on February 5, 2008, did not reflect an

elevated white blood count which would have indicated the presence of an

infection.

These findings and the undisputed pathology report of Dr. Manlapaz,

coupled with the testimony of Dr. Hall that adenomyosis can only be “suspected”

as a cause of abdominal pain and only confirmed by pathological examination after

the hysterectomy is performed, fully supports the trial court’s findings and his

determination of the credibility of Dr. Babin’s testimony. Thus, we find that this

assignment of error is also without merit.

CONCLUSION

For the forgoing reasons, we affirm, in its entirety, the trial court’s Judgment

in favor of Dr. Allen LeBlanc, Jr., dismissing Sunni Jenkins’ claim against Dr.

Allen LeBlanc, Jr. with prejudice. Costs of this appeal are assessed to Sunni

Jenkins.

AFFIRMED.

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