Edward V. Ricci, an associate at West Palm Beach law firm Searcy Denney Scarola Barnhart & Shipley, helped a client secure a $4.9 million award in a medical malpractice suit in Polk County.

A jury ordered the seven-figure verdict in July in favor of Samuel Gray, a then-61 year-old Polk County resident who had his leg amputated while under the care of Dr. Panagiotis Iakovidis in January 2013.

Iakovidis, an on-call vascular surgeon at Winter Haven Hospital, was alleged to have been negligent in treating Gray's acute lower-leg ischemia. According to the complaint, it was Iakovidis' delay in ordering surgery — and not the ailment — that necessitated the removal of Gray's lower left leg.

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Ricci tells the Daily Business Review that had Iakovidis acted with the swiftness and urgency Gray's condition required, there might have been no need to amputate.

“[Acute lower leg ischemia] can be treated acutely with an embolectomy, or with what's called thrombolytic therapy,” Ricci said. “If Dr. Iakovidis had chosen to meet the standard of care, he should have gone in and seen Mr. Gray after receiving a call at 7 p.m. Our experts testify that he should have come in within the hour, actually put eyes on Mr. Gray and been there so that when the test results were ready, he could take action.”

Iakovidis' attorneys, Mary Jaye Hall and Thomas Dukes of McEwan, Martinez, Dukes & Hall law firm in Orlando, did not respond to requests for comment by deadline.

The case stemmed from a Jan. 21 2013 incident when Gray, a hospice grief counselor, began complaining of intense leg pain while at work. After being transported to Winter Haven Hospital by Polk County Emergency Services, Gray's condition only worsened: The tint of his leg became increasingly pale before eventually turning purple — a sign that his leg was not receiving proper blood flow.

An ultrasound revealed there was blockage in the main artery in Gray's left leg, around the knee. Ricci said given these test results and Gray's symptoms, Iakovidis ought to have come in to Winter Haven Hospital and immediately ordered an embolectomy or thrombolytic therapy. Instead, because there was a delay in both Iakovidis' arrival and his ordering of a procedure on Gray — in addition to the machine necessary for thrombolytic therapy not functioning properly and requiring a technician to fix it — Gray would not be treated until Jan. 23, a full two days after arriving to the hospital.

“On the 24th, the interventional radiologist concluded that the leg was no longer viable, and so the leg was amputated on the 25th,” Ricci said. “The only procedure that Dr. Iakovidis actually did himself was the amputation.”

During the trial, Ricci argued that Iakovidis failed to perform the duties expected of him as a medical professional.

“He was an on-call physician, he had a job to do and he didn't show up for work. In fact, Dr. Iakovidis admitted that he received the call from the E.R. physician at 7 p.m. [on Jan. 21] and he just said, 'I didn't need to come in. This wasn't an emergency, I didn't need to,'” Ricci said. “Our experts strongly, strongly disagreed. [In court] they said, 'No. Acute lower limb ischemia is an emergency and needs to be dealt with. It's a ticking time bomb to have a clot like this blocking flow of the leg, because if you don't have blood going to the leg, then it's going to die.”

The 'Stat' Order

The defense argued that no action — or alleged inaction — on Iakovidis' part caused Gray's leg to be amputated. Rather, it claimed that several chronic conditions afflicting Gray led to the amputation.

“[The defense] claimed that there was an acute clot that was superimposed on a chronic condition, and the chronic condition, they said, was a mixture of atherosclerosis and prior emboli that had lodged in his leg and had been there for a long time,” Ricci explained. “[According to the defense] Gray had a preexisting clot that they wouldn't be able to treat, and so it had nothing to do with the timing, it was simply the fact that he had this long-standing condition.”

Furthermore, Ricci says the defense described Gray's medical emergency, acute lower limb ischemia, as a condition that allows up to 72 hours for effective treatment. Ricci disputes this claim, although he was hamstrung in his capacity to do so in court.

“They took the position that this was a condition that you had up to 72 hours to treat and that [Gray] was treated within 72 hours. We're not allowed to cite the medical literature and things in court, but that's wholly not supported by the medical literature on this condition,” Ricci said. “This is an emergency condition that usually [needs to be treated in] six to 12 hours or you're going to lose a leg, [especially] when it's as acute as what Mr. Gray was going through.”

Ricci said that the turning point in the trial came when Iakovidis denied the existence of a “stat” order authored by another doctor emphasizing the seriousness of Gray's ailment. A “stat” order is meant to convey a sense of urgency and denotes that there is a need to move quickly in order to best treat them.

“He denied three times that it was a stat order. I didn't confront him with it while he was on the stand because I didn't want to give him an opportunity to try to make excuses up there, but he denied it three times — 'It wasn't a stat order, it wasn't a stat order, it wasn't a stat order,'” Ricci said.

Ricci brought up Iakovidis' emphatic denial — and the evidence contradicting it — up to the jury in his closing statements.

“I stood up and showed the jury that it was a stat order; I thought it was pretty damaging to his credibility,” Ricci said. “It called into question the veracity of the litany of other excuses that he gave that weren't documented anywhere.”

Read the stat order that helped cinch the case against Iakovidis:

The jury ultimately awarded more than $4.9 million to Gray and his wife, Belva J., for pain and suffering. Ricci said that although he and his co-counsel from Searcy Denney Scarola Barnhart & Shipley, Matthew Schwencke, did not suggest a number, the jury likely reached their nearly $5 million verdict after seeing the effect Gray's amputation has had on his everyday life.

“We had a very compelling day in the life video that Mr. Gray narrated on the stand. [The video] showed what it was like for him in having to put on the prosthesis, how he's able to get around and the challenges he has there,” Ricci said, adding that the video also showed the skin problems the amputation has caused as well as how vulnerable it has left Gray in emergency situations such as a fire.

“I trusted that the jurors understood the magnitude of the harm, and truth be told, the number that they came to was extremely close to the number I had considered us asking for,” Ricci said. “There were co-defendants who chose to settle the case for a confidential amount, and for whatever reasons I still don't quite understand, Dr. Iakovidis didn't make the same choice.”

Case: Samuel C. Gray and Belva Jean Gray vs. Panagiotis Iakovidis, M.D., Bond & Steele Clinic, P.A. d/b/a Bond Clinic

Case no.: 2015CA003137000000

Description: Medical malpractice

Filing date: Aug. 26, 2015

Verdict date: July 3, 2018

Judge: Polk County Circuit Court Judge Catherine Combee

Plaintiffs attorneys: Edward V. Ricci and Matthew K. Schwencke, Searcy Denney Scarola Barnhart & Shipley, West Palm Beach

Defense attorneys: Mary Jaye Hall and Thomas Dukes, McEwan Martinez Dukes & Hall, Orlando

Verdict amount: $4,914,512.59

Read the complaint: