Where an HCLA plaintiff failed to establish a breach of the applicable standard of care, the Claims Commissioner’s ruling for the State was affirmed.
In Black v. State, No. M2022-00399-COA-R3-CV (Tenn. Ct. App. July 25, 2023), plaintiff filed suit on behalf of her husband, who died after a short stay in a skilled nursing facility owned and operated by the State of Tennessee. When the husband was admitted to the facility, he was 84-years-old and suffered from Alzheimer’s disease, diabetes, and many other health complications.
Plaintiff visited her husband every day in the facility, and on December 29, 2016, she told the staff that she suspected he had a urinary tract infection. The facility staff ran a test, which was negative, and created care plans for the husband the next day. Four days later, the facility staff completed a more detailed assessment of the husband’s condition and care needs. Four days after this assessment, the husband was taken to the emergency room, where he was found to be suffering from septic shock and aspiration pneumonia. Approximately two weeks later, the husband died at the hospital.
Plaintiff filed this HCLA action, asserting that the facility had breached the acceptable standard of care in four ways: 1) failing to follow the care plan to prevent dehydration, 2) failing to prevent urinary tract infections, 3) failing to notify the physician “of a significant change in clinical status,” and 4) failing to properly assess the husband. Both plaintiff and defendant presented expert testimony, and the Claims Commissioner ultimately credited the testimony of defendant’s expert. The Claims Commissioner agreed with defendant that the husband’s decline and death was due to his age and health condition, not to any negligence by his care team, and that “[a]ny potential lack of certain documentation in the record did not contribute” to the husband’s death. On appeal, this ruling was affirmed.
In its analysis, the Court of Appeals focused on two assertions by plaintiff. First, plaintiff argued that the Claims Commissioner should have deemed documents produced by defendant during discovery to have been admissions as to the required standard of care, and that defendant should not have been allowed to put on testimony disputing that these documents outlined the official standard of care. The Court rejected this argument, noting that the request for production in response to which these documents were produced asked for documents that were provided to nursing personnel for “demonstrating, describing or instructing employees on the proper care of residents during the residency.” Based on this description, the Court wrote that “it does not follow that all responsive documents necessarily contained official [facility] policies.” Further, defendant’s stipulation that the documents were authentic and admissible did not constitute an admission that they contained official facility policy. Finally, plaintiff failed to present expert testimony supporting her argument that the procedures outlined in these documents were illustrative of the standard of care.
Plaintiff also asserted that the Claims Commissioner erred by finding that the facility staff did not breach the standard of care, but the Court of Appeals affirmed the ruling. The Court explained that plaintiff’s arguments centered on a lack of documentation in her husband’s medical record, rather than an actual lack of care. The Court stated that “the failure to comply with documentation requirements in [the husband’s] care plan and documented expectations of staff cannot establish professional negligence in the absence of expert testimony that those requirements were commensurate with the standard of care,” and that “the lack of documentary evidence cannot be held against Defendant in the absence of a properly established, objective standard establishing that such documentation is part of the standard of care.” (internal citations omitted).
Because plaintiff failed to prove a breach of the applicable standard of care, the ruling for the State was affirmed.
This case is a reminder that HCLA plaintiffs must have expert proof of the standard of care and a breach of that standard, and that cases that are decided largely on credibility are rarely overturned on appeal.
This opinion was released 5.5 months after oral arguments in this case.