Coroner's opinion bolsters plaintiff's case in Vioxx trial

Associated Press
ANGLETON, Texas - The pathologist whose 2001 autopsy of a Texas man is central to the nation's first Vioxx-related civil trial told attorneys in a deposition that his death from arrhythmia, or an irregular heartbeat, was probably brought on by a heart attack. "Arrhythmia does not spontaneously occur. Something must trigger it," Dr. Maria Araneta told attorneys on both sides of the lawsuit, according to a transcript of the deposition obtained by The Associated Press. She said Robert Ernst, whose widow, Carol, is the plaintiff in the case, probably had a heart attack because a blood clot blocked blood flow in an artery already clogged with plaque. However, vigorous CPR conducted on Ernst - including pounding on his chest that fractured some of his ribs - probably dislodged the clot and his sudden death left no time for his heart to show damage, she said.

"Vigorous CPR could dislodge a clot. Also, the clot may be small. It doesn't have to be a big clot to cause a myocardial infarction," she said, using the medical term for heart attack. Araneta also conceded that sudden cardiac death with clogged arteries can occur without a heart attack. The legal team for Vioxx maker Merck & Co. has relied heavily on Araneta's autopsy report, which attributed Ernst's death to arrhythmia secondary to blocked arteries.

The company pulled the popular painkiller from the market last year when a study showed it doubled risk of heart attack or stroke, but Merck contends no studies link Vioxx to arrhythmia and therefore the drug couldn't have caused Ernst's death. Ernst took Vioxx to ease pain in his hands. He took the drug for eight months before he died. Araneta's opinion supports plaintiff's lawyer Mark Lanier's contention that Ernst suffered a heart attack that killed him too fast to leave evidence of heart damage. He also has drawn jurors' attention to Merck's medical manual used by doctors across the country, which says arrhythmia in some form occurs in more than 90 percent of heart attack patients.

However, Araneta was not identified by name as a witness by the pretrial deadline, so Merck's team balked at what they called her surprise appearance. State District Judge Ben Hardin allowed both sides to question Araneta privately on Tuesday, and scheduled a hearing later Thursday to address whether she will testify. If the judge rules Araneta can testify, Lanier will decide whether to put her on the stand or have jurors watch her videotaped deposition. Testimony Thursday came from Dr. David Egilman, a physician and professor at Brown University, who said Merck's multiple Vioxx studies conducted before the drug was approved in 1999 were unreliable because they were too short and involved too few patients to produce solid data. Merck's lawyers had yet to question him. Lanier's legal team flew Araneta to Texas from Abu Dhabi, United Arab Emirates, over the weekend to testify in the first of more than 4,200 lawsuits across the country to go before a jury.

At the time of Ernst's death, Araneta was an assistant coroner for the Johnson County Medical Examiner's office who performed autopsies at Walls Regional Hospital in Cleburne near Fort Worth. She told Merck lawyer Joseph Piorkowski she didn't see evidence of a heart attack, which isn't unusual in sudden deaths. She also told Piorkowski she didn't get his e-mail sent before she traveled to Texas asking whether she had spoken to Lanier and if she would be a witness. "My only conclusion is that it must have gone into my spam box," she said.