"The first 18 days of DJ's life were the only normal days he would have for the rest of his life."
With those words, attorney Neal Pope let a Clayton County jury know the magnitude of the lawsuit they will be considering over the next several days in State Court as they decide who's liable and what damages, if any, should be awarded.
DJ, 4, suffered a botched circumcision at a Riverdale clinic on October 21, 2013. The procedure amputated the tip of his penis, leaving him disfigured, with medical bills that have run into the tens of thousands of dollars, and in a repeated cycle of healing after five major surgeries to date, relegated to removing scabbing to do the simplest of things, like urinate, Pope told the jury in opening statements.
The jury of seven women, five men includes parents and grandparents – and at least two of them had tears in their eyes at the end of Pope's open.
DJ's mother, Stacie Willis, is suing Life Cycle OB/GYN, as well as Certified Nurse Midwife Melissa Jones, who did the procedure; supervising physician Dr. Brian Register; the boy's pediatrician, Dr. Abigail Kamishlian; Anne Sigouin, the clinic owner; and the businesses Life Cycle Pediatrics and Daffodil Pediatric.
The circumcision was performed with a hinged metal instrument called a Mogen clamp, which Pope showed the jurors. He says despite heavy bleeding, no one told the boy's mother that part of the penis had been cut off. Register told Jones to stop the bleeding, and called clinic owner Anne Sigouin to consult with her. Sigouin advised them to call the pediatrician.
Jones contacted DJ's pediatrician, Dr. Kamishlian, telling her that the tip of the glans--the rounded tip of the penis--had been cut off. The pediatrician advised her to have Willis take her son home for the night and to report to the emergency room if there was any sign of continued bleeding -- but otherwise, to come to see Kamishlian the next day.
"When she said that to Melissa Jones, it stopped the show," said Pope. The lawsuit contends two acts of major negligence: the severing of the tissue itself, and failing to save the tissue so that it could be reattached within 6-12 hours, when it was still viable.
"It began to die the moment it was severed," he said.
Willis took her son to Children's Healthcare of Atlanta that night because of continued bleeding; and was referred to a pediatric urologist the following day. Subsequently, the complaint says, the mother was alerted about the amputation.
As Pope began to tell jurors about the ramifications of the amputation, he held up a flexible medical school model of an adult penis in front of the jury box.
"The male penis...is a marvelous thing," said Pope. "It is a gift from God. It governs much of who we are and what we do."
He detailed DJ's "severed pee hole" and said the little boy has seen doctors in six states since 2013. The day after the tip was severed, he said, no one wanted to disturb the gauze on the boy's pelvis; because Willis had not been told what had happened the afternoon she heard her baby scream, no one could visualize the injury, and no one knew how bad it was.
The jurors were shown a series of easel-sized color photos of the boy's pelvis, including how it looked as recently as last month.
Willis wept as Pope described the physical and psychological difficulty the child would face as he grows up around his three brothers, into adolescence and adulthood, "thinking about young ladies, marriage and family."
As Pope wound down his opening statement, Willis walked out of the courtroom and came back with her young son, with bright, curious eyes, holding her hand. She walked him to the front of the courtroom, where he stood then holding Pope's hand. The lawyer asked DJ if he could say hello to those nice people.
DJ turned and waved, saying, "Hello."
The jurors leaned forward and waved back, smiling at him as a chorus of "Hellos" came back to the handsome little boy.
"He's in your hands. His future life is in your hands," Pope said. He said DJ's mother would probably face criticism at trial, but says she has already weathered a lot for the young man.
"You've met him. He is worth fighting for," Pope told them.
As lawyers for the several groups of defendants took their turns, the attorneys tried to impress upon the jury that their clients should not be found liable because they have business relationships with Jones or Life Cycle.
"No way I can compete with how cute and adorable he is," said Terrell "Chip" Benton, who represents Life Cycle Pediatrics, the doctor, and the nurse. "I've got a tough act to follow.
"Everyone agrees he is a cute and adorable four-year-old. Everyone agrees there was an injury...everyone is regretful and sorry, including Brian Register and Melissa Jones," said Benton.
But Benton urged jurors not to let their sympathy sway their verdict, and to "fight the urge to find them guilty by association."
Bob Monyak told the jury that they will be trying three cases side by side. He is defending the pediatrician, Dr. Kamishlian, whom he says, "undisputedly had nothing to do with it."
Monyak says Kamishlian wasn't in the building or even in the same town. She got a phone call, he says, and "that phone call is why she will spend the next two weeks defending herself."
He contends nothing in the phone call from Jones made Kamishlian believe that emergency reattachment surgery was needed, and listed for the jury the phrases she says she was given about the size of the severed tissue.
"'A tiny sliver' is what she was told," said Monyak. "'Very, very small. A little small piece of tissue. As thin as two to three sheets of paper.'" He says other pediatricians will tell the jury that the doctor did not commit medical malpractice.
A note Kamishlian scribbled from the phone call refers to a severed piece of glans.
The lawsuit seeks millions of dollars in damages.
Penis tissue was kept for 'months'
The first witness in the lawsuit trial was Debbie Person, a medical assistant who helped prep DJ for his circumcision. She says she was concerned about the amount of bleeding DJ suffered, and that Melissa Jones was, too.
The severed tissue was placed in a biohazard bag, then refrigerated, said Person.
"Did you ever hear someone say to Ms. Willis, 'Ma'am, we cut off a small piece of your baby's penis?'" asked plaintiff's attorney M. J. Blakely.
"No," she said. She said that while boys always cry and are comforted after their circumcisions, DJ was different.
"He cried more," said Person. "It was difficult to console him."
The incident left her so shaken, Person said, she did not want to hold babies for the procedures any longer.
Afterward, no one thought to examine the Mogen clamp or remove it from the supply that Life Cycle had, she says. It was cleaned and put back into service as was customary.
Person also testified that all the other circumcisions she had seen Certified Nurse Midwife Jones do were good ones.
At some point, months later, the severed penis tissue was discarded. The lawsuit says it was done after the clinic knew that legal action was forthcoming.
The judge has already agreed that it was deliberate.
Clayton County State Court Judge Shalonda Jones-Parker ruled in June that destroying the tissue and returning the clamp to service deprived the boy's mother of evidence vital to her suit.
Those defendants are already liable in the case, so the jury will simply have to decide how much to award in damages.
'She threatened me'
Melissa Jones' videotaped deposition was played for the jury on Wednesday morning. In it, she details how she performed the circumcision on the 18-day-old DJ in 2013. At that point, she had been doing circumcisions for about three years, starting months after she began working at Life Cycle, and had trained exclusively on the Mogen clamp.
She said she did not have a distinct reason why the glans was cut, and repeatedly referred to the piece as "a very small piece of tissue."
Jones said when she called in Dr. Register, he told her to stem the bleeding, and declared that the tissue was "too small to do anything with." She considered the tissue "too small to run a stitch through," she said.
As Jones was being asked on the video about the penis tissue being discarded, DJ's mother, who had been quietly crying in the darkened courtroom, got up from the table and walked out. Tears streaked her face.
Jones said on the video that she gave Willis aftercare instructions, but implied that later she was not sure they were followed because the mother was "in a violent state" that day.
"She was very combative at the time. She threatened me, she told me I was going to pay for this, and she was going to the ER no matter what I said," said Jones. Jones said it probably took her 10 minutes of applying direct pressure to the boy's penis, along with several sticks of silver nitrate, to stop the bleeding.
She says she told Willis that part of her son's penis had been cut off, and contended that Willis "knew" because "she was there when it came off. It was laying right there on the table."
The video was used as a direct examination of sorts, and Jones then was called to the stand for cross-examination. She testified that she thought the only emergency that day was the bleeding DJ was suffering, and that was her priority.
She says while the severed piece was kept in a refrigerator in case Willis did go to the Emergency Room and there was a call looking for the tissue, she did not believe the tissue, which she described as "no thicker than a credit card," was large enough for reattachment.
"I'm not a pediatrician, but I would think two millimeters, three millimeters, or four millimeters," she said. "But I wouldn't think that a piece of tissue that if you tried to make a stitch that it would just pull through and dissolve."