Articles Posted in Medical Negligence

Where the only notification a hospital provided to a patient that a radiologist was not an agent of the hospital was buried in fine print in admission forms and not highlighted in any way, the trial court’s finding that the hospital was vicariously liable for any fault assigned to the radiologist was affirmed.

In Beard v. Branson, No. M2014-01770-COA-R3-CV (Tenn. Ct. App. Nov. 8, 2017), the patient in question had colon surgery at defendant hospital and developed complications. The surgeon ordered a CT scan, which was performed at the hospital and read by Dr. Anderson, “a private radiologist whose practice group was under contract with [the hospital.]” The radiologist reported that the scan showed the “possibility of a mechanical bowel obstruction,” a finding with which the surgeon disagreed. The patient’s condition worsened, and she was eventually flown to another hospital where she died in emergency surgery. Plaintiff filed this HCLA/ wrongful death case against the hospital and surgeon, alleging that the patient “died because of delay in treatment of a bowel perforation she developed as a complication of colon surgery.”

In July 2005, plaintiff’s attorney requested a copy of the CT scan, and the hospital responded that it could not be located. Plaintiff attempted to get the CT scan from the surgeon, the radiology group under contract with the hospital, and the hospital at which the patient ultimately died, but was not provided a copy until three years later. The CT scan revealed that Dr. Anderson “failed to note and report evidence of free air in [patient’s] abdomen, indicative of a bowel perforation.” By the time the CT scan was provided, it was too late to add Dr. Anderson, the radiologist, as a defendant.

In Commercial Bank & Trust Co. v. Children’s Anesthesiologists, P.C., No. E2016-01747-COA-R3-CV (Tenn. Ct. App. Oct. 25, 2017), plaintiffs were the legal guardian of a minor who, after a shunt revision, was no longer able to walk. Plaintiffs filed an HLCA suit, and after trial, the jury returned a verdict for defendants. Plaintiffs appealed, raising four issues.

First, plaintiffs asserted that “the Trial Court erred in allowing testimony that implied that [the minor’s] parents came to this country as refugees.” Because plaintiffs did not object to this line of questioning at trial, though, this issue was deemed waived.

Second, plaintiffs alleged that it was error to not allow a certain exhibit to be taken into the jury room. During cross examination of one of the defendant doctors, plaintiffs’ counsel used a piece of paper on which “standard of care” was handwritten, and the following words were typed: “The practice that protects the patient from unnecessary risk of serious harm.” After defendant doctor said she agreed with that statement, plaintiffs’ counsel attempted to file the paper as an exhibit. The trial court marked it for identification purposes only, then later refused to let it be taken to the jury deliberation room. The Court of Appeals held that this was not error, pointing out first that plaintiffs’ counsel failed to object at trial, and further that the alleged exhibit was “needless presentation of cumulative evidence, since the statement contained in [the exhibit] was read to [defendant doctor] at trial, and she testified that she agreed with the statement.” (internal quotation omitted). In addition, the Court noted that because the statement was so general, it would have likely “resulted in confusion by giving this written statement undue weight over the oral testimony on that issue.”

In a health care liability action, a plaintiff must show not only that the defendant breached the standard of care, but that such breach proximately caused the injury in question. Further, that causation testimony cannot come from a nurse.

In Estate of Sample v. Life Care Centers of America, Inc., No. E2017-00687-COA-R3-CV (Tenn. Ct. App. Oct. 11, 2017), plaintiff filed an HCLA claim after decedent died while in the care of defendant nursing home. The complaint alleged that “per medical orders, Deceased was not to be left lying flat in bed,” and that “on the day of her death, Deceased had been lying flat in bed causing her to suffocate or aspirate and die.”

Defendant filed a motion for summary judgment supported in part by the affidavit of Bethany Dragnett, a registered nurse who was one of decedent’s care takers at the home, and plaintiff’s responses to requests for admission. In the discovery responses, plaintiff “admitted that Deceased’s death certificate expressly identifies [arteriosclerotic cardiovascular disease] as the sole cause of Evelyn Sample’s death,” that decedent suffered from this cardiovascular disease and from congestive heart failure prior to her death, that the “death certificate does not mention the word “aspiration,” and that no autopsy was requested after the death. In addition, the nurse stated in an affidavit that in her opinion “none of the nurses or certified nursing assistants at Life Care breached the standard of care with regard to the care provided to Deceased.” The nurse further stated that “she never found Deceased lying flat in bed with the feeding tube on” and that when she was called into the room on the day of death, decedent was “sitting in a wheelchair not breathing.”

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When relying on vicarious liability in an HCLA (formerly known as medical malpractice or medical negligence) case, a plaintiff must identify the standard of care for a specific agent of the defendant and how that agent deviated from the standard of care.

In Miller v. Vanderbilt University, No. M2015-02223-COA-R3-CV (Tenn. Ct. App. Sept. 29, 2017), plaintiff was in a motorcycle accident and sustained several serious injuries. He was taken to defendant hospital for treatment, where he had three surgeries, the last being a surgery on his right knee and left foot on November 2, 2010. Plaintiff was discharged from the hospital on November 5^th, but two days later he came to the ER with “fever, nausea, blurred vision, and severe pain in his right leg.” His right knee incision had become infected, and his leg was eventually amputated above the knee.

Plaintiff filed this HCLA case for compensatory and punitive damages. Plaintiff alleged that defendant “failed to recognize and investigate the signs of infection that [plaintiff] exhibited before his discharge,” and that “he was negligently and recklessly discharged from the hospital.” At the close of plaintiff’s proof at trial, defendant moved for a directed verdict, which the trial court first granted as to punitive damages and then granted as to all claims. The trial court found that “plaintiff failed to establish, through expert medical testimony, the standard of care applicable to a specific agent of Vanderbilt, how that agent had deviated from the standard of are, and that deviation had caused an injury that otherwise would not have occurred, as required by Tennessee Code Annotated § 29-26-115.” On appeal, the directed verdict was affirmed.

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A claim that a patient who burned himself should not have been left alone with a hot cup of coffee was determined to fall under the Tennessee HCLA.

In Youngblood ex rel. Estate of Vaughn v. River Park Hospital, LLC, No. M2016-02311-COA-R3-CV (Tenn. Ct. App. Sept. 28, 2017), an 86-year-old patient had hip surgery at defendant hospital. Either the same day or the day after surgery, a nurse brought the patient a cup of coffee and sat it on his bedside table in his ICU room. The patient then spilled the coffee on himself and was burned.

The patient later died of apparently unrelated causes, and his estate filed this action. Plaintiff’s claim was essentially that the patient “was an 86 year old man; who was in ICU following a major surgery; was on pain medication; had visible tremors in his hand; and had an O2 monitor on his index finder. [Patient] should not have been left alone to manage an extremely hot beverage.” Plaintiff did not give pre-suit notice or file a certificate of good faith with her complaint, as she asserted that this claim was not subject to the HCLA. The trial court dismissed the action, finding that it did fall under the HCLA, and the Court of Appeals affirmed.

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Where a doctor had time to confer with her colleagues twice, even shortly, before determining a course of action for her patient, the Tennessee trial court erred by giving the jury an instruction on the sudden emergency doctrine. The jury verdict for defendants was accordingly vacated, and the case was remanded for a new trial.

In Vandyke v. Foulk, No. E2016-00584-COA-R3-CV (Tenn. Ct. App. Sept. 18, 2017), plaintiff filed an HCLA suit related to the death of her newborn son shortly after his birth. Plaintiff was 24 weeks pregnant with twins when she was transferred to defendant hospital for pre-term labor. Once it became apparent that delivery was imminent, plaintiff was moved to the operating room, where her delivery team consisted of Dr. Foulk, the attending physician, and two fourth year residents, Goodwin and Hobbs. Baby A was born vaginally, after which time Baby B “settled into a transverse or sideways position.” Dr. Foulk rotated Baby B to a head-down position, and Baby B suffered a drop in heart rate necessitating a quick delivery. Dr. Foulk had a more senior attending physician, Dr. Herrell, paged, and Dr. Foulk and the two residents discussed what should be done. When Dr. Herrell arrived, he and Dr. Foulk assessed the situation and determined that they would attempt a delivery by forceps. Dr. Herrell tried to place a second forcep two times and “met resistance.” Baby B was then delivered by c-section, and he had a “skull fracture a scalp avulsion, meaning that his scalp was no longer attached…” Baby B was transferred to the NICU and died a few hours later.

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Where the expert causation testimony in aT ennessee HCLA (medical malpractice) case was deemed too speculative, summary judgment was affirmed.

In Franklin-Mansuo v. AMISUB (SFH), Inc. D/B/A Saint Francis Hopsital, No. W2016-01623-COA-R3-CV (Tenn. Ct. App. Sept. 6, 2017), plaintiff filed an HCLA action based on the death of his mother. Mother had arrived at defendant hospital’s ER with difficulty breathing and swallowing, and was treated by a physician’s assistant (PA). The PA ordered a CT scan, and then consulted by phone with an ear, nose and throat physician (ENT). The ENT stated that the mother needed to be admitted to the ICU. The PA, however, thought that the ENT was coming to the hospital to oversee the admission. Almost three hours passed, at which point another doctor at the hospital admitted the mother to the ICU. At some point during her transfer or shortly after her ICU admission, the mother lost her airway and suffered brain damage. She eventually died ten days later, though her death certificate listed the cause of death as a stroke.

Plaintiff brought suit against several defendants, but by the time relevant to this appeal the only remaining defendant was the doctor who was the PA’s supervising physician on the day of the incident. The doctor filed for summary judgment, asserting that plaintiff’s experts were not qualified to testify as to the applicable standard of care and that the causation testimony they offered was too speculative. The trial court agreed, granting the motion for summary judgment, and the Court of Appeals affirmed.

HIPAA-compliant authorization forms continue to cause trouble for medical malpractice (now called “health care liability action” or ‘HCLA”) plaintiffs in Tennessee, with a recent plaintiff having his case dismissed due to his failure to fill in the portion of the form that lists who was authorized to make disclosures thereunder.

In Lawson v. Knoxville Dermatology Group, P.C., No. E2017-00077-COA-R3-CV (Tenn. Ct. App. Aug. 1, 2017), plaintiff filed suit against “a dermatology practice and a certified physician’s assistant employed by the practice.” The underlying injury occurred when plaintiff fell off an allegedly improperly secured examination table. Defendants filed motions to dismiss, asserting that plaintiff had failed to substantially comply with Tenn. Code Ann. § 29-26-121(a)(2)(E), the HCLA provision that requires that pre-suit notice include a HIPAA-compliant authorization. Specifically, defendants pointed out that plaintiff’s “authorization form did not list which individual(s) or organization(s) were authorized to make disclosures of the specified medical records.”

The trial court granted the motions to dismiss and entered an order dismissing all of plaintiff’s claims without prejudice. Plaintiff appealed the dismissal only as to the dermatology group, which the Court of Appeals affirmed.

On appeal, defendant pointed out that “the name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure” is listed as a “core element of the authorization” by the Code of Federal Regulations. (citation omitted). Defendant asserted that because this “core element” was left blank, plaintiff did not substantially comply with the HCLA requirements and dismissal was appropriate. According to defendant, “the medical authorization provided by [plaintiff] was insufficient to allow [defendant] to access relevant medical records to mount a defense.”

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Plaintiffs preparing a Tennessee health care liablity (formerly called “medical malpractice”) must pay special attention to their standard of care expert witness, especially if they plan to argue that a specific procedure was required to meet the standard of care.

In Hopps v. Stinnes, No. W2016-01982-COA-R3-CV (Tenn. Ct. App. August 1, 2017), the Court of Appeals affirmed a trial court’s decision to grant partial directed verdict and to refuse to let the jury consider a certain causation issue. Plaintiff was struck in the eye by an object while weed eating, and he went to the emergency room. There, he was treated by defendant nurse practitioner. Defendant obtained a history from plaintiff and “examined his eye with an ophthalmoscope and a Wood’s lamp.” She ultimately prescribed him antibiotic eye drops and discharged him with instructions 1) to come back to the ER if his condition worsened, and 2) to see his doctor within two days. Four days later, plaintiff went to a different hospital with additional symptoms, and he eventually lost his eye due to infection.

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