The family of a woman who died after refusing a blood transfusion on religious grounds will receive $225,000 to settle a claim that she wouldn't have needed blood if doctors at St. Joseph Medical Center hadn't delayed in diagnosing her.
Barbara Ann Mosby, a Jehovah's Witness who lived in Baltimore, died five days after surgeons were forced to treat a ruptured tubal pregnancy without benefit of a transfusion.
Early on, she had insisted that transfusions were forbidden by biblical teachings. Later, her family refused to go against her wishes, and their beliefs, even though doctors warned that hemorrhaging could kill her.
In a court hearing held in the hospital while she was failing, a judge ruled that she had a constitutional right to refuse blood if accepting it clashed with her religious beliefs.
"I think she was courageous, strong," said Dr. Ronald Broadwater, a Jehovah's Witness who was not her doctor but served as her advocate at the hearing. "She felt that she was going to live, and she had kept her integrity to God. If she didn't live, she would certainly be back soon in the resurrection."
Mrs. Mosby was 42 when her heart stopped on March 18, 1991. She was survived by her husband, Purnell C. Mosby, and their son, Michael Henry Mosby, who is now 6. Both were plaintiffs in the suit.
Lawyers for the hospital and the plaintiffs reached a settlement Monday, averting a trial that had been scheduled for January before the Maryland Office of Health Claims Arbitration.
Courts on the state and federal level -- including the U.S. Supreme Court -- have repeatedly upheld the right of Jehovah's Witnesses to refuse blood transfusions even when lives are at stake. But attorneys on both sides of the St. Joseph case said they were aware of no cases in which church members have recovered money following the death of someone who refused blood.
In Mr. Mosby's malpractice suit, he claimed that doctors should have diagnosed his wife's condition soon after she showed up in the emergency room March 8 with intense abdominal pains. Doctors performed a variety of tests but didn't diagnose the problem until a sonogram three days into her hospital stay revealed the tubal pregnancy.
A tubal, or ectopic, pregnancy is a fertilized egg that gets caught in the fallopian tubes rather than descending to the womb. If not removed early, the growing egg can stretch the tube to the point of rupture. Ectopic pregnancy is the leading cause of pregnancy-related death. Mr. Mosby, 49, the owner of an auto body shop, said his wife wouldn't have needed a blood transfusion had doctors prevented the rupture and the subsequent hemorrhaging.
"When I first reviewed the circumstances surrounding Mrs. Mosby's death, I was skeptical about undertaking Mr. Mosby's representation because it became evident that [she] assumed the risk of her death by refusing to accept blood," said Gary I. Strausberg, the plaintiffs' attorney.
"However, I learned that when it comes to Jehovah's Witnesses, to conclude that the patient assumed the risk of death is overly simplistic," Mr. Strausberg said. He said it became evident that she was exercising her First Amendment right to practice religion and that she shouldn't have needed the transfusion in the first place.
John R. Penhallegon, a lawyer assigned by an insurance carrier to represent the hospital, said yesterday that he had been prepared to argue that she assumed the risk of death, and that he had expected to win if the case went to trial. He said a settlement was reached to avoid the high cost of litigation.
He said most of the settlement was paid by insurance carriers for doctors who cared for Mrs. Mosby, even though they were not named as defendants in the suit. It was in the physicians' interest to help settle the case, he said, because the hospital could have sought damages from them had the plaintiffs prevailed.
The hospital's insurance company paid about 10 percent of the settlement money "as a nuisance payment," he said. "It would cost us substantially more than that to defend the case and win the case."
Medical records indicated that Mrs. Mosby had a tubal ligation in 1989, and this apparently caused doctors to downplay the possibility of an ectopic pregnancy. In rare cases, however, ligations fail to prevent fertilization. The fetus is then at risk for developing outside the womb.
Jehovah's Witnesses oppose blood transfusions because verses in the Old Testament and New Testament warn against accepting blood in any form, Dr. Broadwater said. Often, doctors are able to treat patients who have lost blood by infusing them with nonblood fluids.