At first, it appeared that shock and grief drove Debbie and Mark Troch to ask all those questions, over and over again, and to obsess about the death of their teen-aged daughter. But it turns out the Troches were more rational than you'd expect parents in mourning to be. Their angry suspicions had considerable foundation, and their recollections of the last 13 1/2 hours of their daughter's life appear to have been all too accurate.
Readers of this column might recall that the Troches came away from St. Joseph Hospital that Good Friday morning 1992 with lots of questions:
Had they erred in bringing Tiffany to the Towson hospital the evening before, after she fell 8 feet from a rope swing near her home in Baltimore County? Should she have been taken by ambulance to one of Baltimore's advanced shock-trauma centers instead? Why had doctors taken so long to perform surgery to stop the internal bleeding that resulted from a liver laceration? When, after Tiffany had died, doctors referred to a "breakdown in communication," what did they mean? And why had the surgeon who tried so frantically to save Tiffany's life reacted with far more urgency than the two doctors who examined her earlier?
Last fall, the Troches hired Baltimore malpractice attorney Marvin Ellin and filed a negligence claim with the state Health Claims Arbitration Office in an attempt to get some satisfaction and some answers. "The whole point is getting to the truth," Debbie Troch said at the time. She wanted St. Joe's and the doctors held responsible for a tragedy that could have been avoided. Named as defendants were the hospital, the firm that manages its emergency department (Osler Drive Emergency Physicians Associates) and two doctors, Kerry R. Heeman and Sheldon H. Lerman.
Late last week, after listening to testimony over nearly seven days, an arbitration panel ruled that the actions of all defendants breached standards of medical care and caused or contributed to the death of Tiffany Troch. The panel, chaired by Towson attorney Steven H. Block, awarded the Troches $4.35 million in damages.
"We're pleased with the outcome, and that the panel saw the truth," Mark Troch said. "The panel consisted of a doctor, a lawyer and a businessman. They were very patient, they asked intelligent questions. . . . The lawyer for the hospital tried to blame the doctors, and the doctors tried to blame each other."
When the Troches first told this story in 1992, they alleged that delays in the diagnosis and treatment of their daughter had caused her condition to deteriorate to a point from which recovery was impossible. Drs. Heeman and Lerman, they alleged, had not done enough.
In gripping detail the Troches remembered the moment -- some three hours after they had arrived at the hospital on Holy Thursday -- when a third doctor arrived on the scene.
His name was Friedoon Malek, a surgeon. He had been summoned from his home. He calmly leaned to examine Tiffany's abdominal area with a stethoscope. When he did so, his demeanor changed radically.
Suddenly, Malek pulled off his sport coat, ripped back the privacy curtains in the emergency room and shouted commands to nurses. "They tore down the hall with Tiffany," Debbie Troch said. "And they threw me all the papers [consent forms]. I was dumbstruck."
Mark Troch remembered Malek yelling, "I'm going to try and save your daughter."
Debbie Troch remembers Malek saying Tiffany was "10 minutes from death."
The Troches' suit claimed Tiffany was rushed to the operating room after her lips and fingertips had turned blue and she was "cold, pale, clammy."
Her blood pressure was "down to severe shock level." Surgery commenced at 8:10 p.m.
Malek worked long and hard in an attempt to save Tiffany's life, performing surgery to repair her liver, giving her drugs, fluids and oxygen. But his effort came too late. She died at 6:20 the next morning.
"Had a surgical intervention occurred promptly upon her arrival at the defendant hospital," the suit alleged, "then the blood loss would have been avoided, severe shock would not have occurred and, based on reasonable medical probability, Tiffany Lynne Troch would not have been subjected to becoming critically ill and ultimately dying."
Tiffany's internal bleeding had resulted in the loss of 90 percent of her blood.
"Essentially," said attorney Ellin, "this child bled to death."
A St. Joseph spokeswoman, Lori Vidil, pointed out that no one from the staff of the hospital itself was shown to be negligent. Therefore, St. Joe's liability in the case was only a "vicarious" one, she said, and the hospital was disappointed with the ruling by the arbitration panel. The attorney for Dr. Heeman said the actions of his client did not cause Tiffany Troch's death, and the case would be appealed to Circuit Court. The attorney for Dr. Lerman did not return a phone call Friday.
"This is only the first phase of a long process, I guess," Debbie Troch said. "But at least we're getting the truth about what happened to Tiffany. I want the public to know. I stood by her all those hours. I was there."