Georgia Court of Appeals Affirms Plaintiffs’ Verdict in Gross Negligence ER Case

In the second appellate version of Southwestern Emergency Physicians, P.C. v. Quinney, the Georgia Court of Appeals affirmed a $4.5 million verdict for the plaintiffs. Plaintiffs sued Southwestern Emergency Physicians, a doctor, and the hospital where the care encounter took place. Plaintiffs alleged that the negligence of the physician and two non-party nurses caused Mr. Quinney to become a paraplegic.

On appeal, the main issues were whether the trial court erred in permitting Plaintiffs to argue both gross negligence and the “ordinary” professional malpractice standard of care in light of the previous appellate decision in the case, whether the trial court erred by instructing the jury that the gross negligence standard applied to non-parties for purposes of apportionment, and whether the trial court should have listed the hospital as a separate entity from its employee nurses for purposes of apportionment. The Court of Appeals affirmed the verdict, denying each of the grounds asserted.

In the first appellate case, the defense moved for summary judgment on the issue of “ordinary” professional malpractice because the care provided arose solely out of emergency medical care to which the gross negligence standard applies under Section 51-1-29.5. On appeal, the Court held that the gross negligence standard applied because “emergency medical services” had been rendered, but ruled there were fact disputes about whether the doctor was grossly negligent. After remand and finishing discovery, the defense moved to exclude any testimony or argument about anything other than gross negligence. The trial court denied the motion in part because two defense experts had testified since the first appeal that Mr. Quinney was stable and that the jury should hear the evidence and then decide whether to apply the gross negligence standard or the “ordinary” standard of care. The defense then stated that it intended to discuss gross negligence in opening and Plaintiffs argued they should be allowed to discuss ordinary negligence if that was the case. The trial court agreed and gave “careful” preliminary and jury instructions that were “adjusted to the evidence, apt, and a correct statement of the law” regarding gross negligence. In addition, during the charge conference, Plaintiffs withdrew charges related to “ordinary negligence” leaving only gross negligence as the issue. Accordingly, the Court of Appeals affirmed the denial of the motion to preclude any mention to ordinary negligence.

Next, the defense argued that the trial court should not have instructed the gross negligence standard as it applied to apportioning fault to non-parties, such as the individual nurses. After Plaintiffs withdrew the ordinary negligence jury charge in the charge conference, the defense argued for the charge to apply to the non-parties on the theory that apportionment only requires a finding of fault, not liability. The Court held that the duty the non-parties owed to Mr. Quinney was one of “slight care” (gross negligence) and that the defense was required to prove they did not provide such care if the jury was to apportion to them. Notably, the jury did apportion to two non-parties.

Lastly, the defense argued the hospital should have also been listed as a separate party for apportionment. The Court held that because the defense did not offer any evidence that the hospital would be liable independent of its role as employer of the two non-party nurses who were listed on the verdict form, there was no error.

Take-home: this case highlights the complicated nature of trying a case under the “gross negligence” standard and with apportionment. These cases are highly fact specific and it can be challenging to get the right jury charges for all of the scenarios that might be presented.

The case is Southwestern Emergency Physicians, P.C. v. Quinney, 2018 Ga. App. LEXIS 538

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Georgia Court of Appeals Reverses Defense Verdict Based on Assumption of the Risk

In this convoluted case, the Georgia Court of Appeals reversed the denial of a motion for new trial filed by the plaintiffs after a defense verdict for the defendant cardiologist. Mr. Berryhill was prescribed medication to control his blood pressure at a local clinic. He then went to see the defendant cardiologist, Dr. Daly, who provided him with additional medication. Dr. Daly also performed a cardiac catheterization and placed a stent. Following surgery, Dr. Daly told Mr. Berryhill not to engage in any “strenuous or risky activity, or any lifting, bending, or stooping over.” Mrs. Berryhill was present. Five days later, Mr. Berryhill went hunting with a friend. He was in a deer stand about 18 feet off the ground when he fainted and fell, suffering serious injuries.

The Berryhills sued the cardiologist, a pharmacy, and the manufacturer of the deer stand. Against the cardiologist, plaintiffs alleged Dr. Daly prescribed too much blood pressure medication, which caused him to faint. The pharmacy and manufacturer were dismissed before trial. Dr. Daly’s motions in limine included a motion to exclude the testimony of an expert pharmacist and to have the claims against the manufacturer admitted into evidence as admissions. The Court instructed the jury on assumption of the risk and avoidance of the consequences.

Dr. Daly won and plaintiffs moved for a new trial including as grounds that the charge on assumption of the risk was not appropriate. The trial court denied the motion and the Court of Appeals reversed.

The Court of Appeals held that a jury instruction for assumption of the risk is authorized only when the plaintiff assumes a known risk arising from a defendant’s conduct or failure to act. In so holding, the Court wrote “[t]he knowledge requirement does not refer to a plaintiff’s comprehension of general, non-specific risks that might associated . . . but rather is based in part on the reasoning that the plaintiff, in advance, has given his consent to relieve the defendant of an obligation of conduct towards him, and to take his chances of injury from a known risk arising from what the defendant is to do or leave undone.” The Court went on to write “[h]ere, climbing in to a deer stand was not a risk associated with Dr. Daly’s duty to Berryhill” and “it would be incorrect to identify this risk . . as justifying the instruction.” However, it was the risk of syncope (fainting) as a side effect that was the “particular risk in question.”  While the evidence showed Dr. Daly advised Mr. Berryhill not to engage in strenuous activity, the evidence did not establish that Mr. Berryhill knew he risked losing consciousness if he chose not to comply. Accordingly, the trial court should not have charged on assumption of the risk. The Court then concluded that the error may have been harmful because it could have led the jury into believing that any risk Mr. Berryhill assumed would support a finding of no liability.

The take-home is not that Dr. Daly had a duty to inform Mr. Berryhill of the specific risks of fainting or syncope. Rather, the Court only ruled that the jury charge should not have been given. The Court did not discuss whether a more narrowly tailored charge would have been appropriate.

The case is Berryhill v. Daly, 2018 Ga. App. LEXIS 526.

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Georgia Court of Appeals Affirms Summary Judgment on Causation

The Georgia Court of Appeals affirmed the trial court’s grant of summary judgment to a defendant hospital. In Edokpolor v. Grady Memorial, the plaintiff claimed her husband died after aspirating Golytely. The doctor’s orders were to administer the medication through a nasogastric tube. The nurse, however, administered it orally.

In support of the complaint, the plaintiff filed an expert affidavit. The expert testified that the nurses were obligated to follow the doctor’s orders and that the administration of the medication by mouth caused aspiration and caused his death. The hospital moved for summary judgment, pointing out there was no evidence the patient aspirated during administration of the Golytely orally, that the patient may have aspirated after ingesting the medication by vomiting, and that administering the medication through a nasogastric tube does not eliminate the possibility of aspiration. Plaintiff did not submit any opposing evidence. The trial court granted the motion and the Court of Appeals affirmed, holding that the affiant’s bare and conclusory allegations about causation did not create a genuine issue of material fact.

The case is Edokpolor v. Grady Memorial, 2018 Ga.LEXIS 507.

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Georgia Court of Appeals Affirms Exclusion of Hidden Affidavit

The Georgia Court of Appeals has affirmed exclusion of an affidavit of a key witness in a medical malpractice case. Plaintiff worked for a physician office. She suffered a back injury and was referred to the defendant anesthesiologist for pain management. During the second injection by the Defendant, Plaintiff contends she complained of pain shooting down her leg and additional problems.

The issue at trial was when the Defendant learned about the new complaints. The anesthesiologist testified that she did not learn about the complaints for several days until it was too late to do anything. Plaintiff testified that she told Defendant about her complaints much earlier.

During discovery, Defendant sent interrogatories regarding witnesses generally, witnesses who had expressed opinions about Defendant’s care, and requesting documents. Plaintiff’s interrogatory responses identified her employer generally, but not as someone who would opine about Defendant’s care specifically. Later, Plaintiff’s employer executed an affidavit in which he testified he had a phone call with Defendant very early on about the new complaints. Plaintiff did not disclose the affidavit to Defendant in discovery.

At trial, Plaintiff’s employer did not recall his alleged conversation with Defendant. Plaintiff’s counsel then sought to use the affidavit to refresh his memory and to admit it into evidence. Defendant objected because the affidavit had not been disclosed, which Plaintiff admitted, but contended it was work product. The trial court excluded the use of the affidavit.

Plaintiff appealed. The Court of Appeals reversed, but the Georgia Supreme Court vacated the case and remanded the case back to the Court of Appeals for further consideration in light of the 2017 decision of Resurgens, P.C. v. Elliott. The Court of Appeals held the trial court did not abuse its discretion, ruling that Plaintiff’s interrogatory responses required supplementation regarding the employer’s testimony. When Plaintiff did not supplement the discovery after obtaining the affidavit, the initial interrogatory response became misleading, thereby justifying the sanction.

Take-home message: there is tension between Section 9-11-26(e)(2)(B), which does not require supplementation when the response was “complete when made” unless the respondent later learns the original response is no longer true, and Section 9-11-37, which requires supplementation of prior responses that are incomplete, ambiguous, or no longer complete accurate.

The case is Anglin v. Smith, 2018 Ga.App. LEXIS 405 (June 21, 2018).

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Georgia Court of Appeals Holds that Doctor’s Interest in Outcome is Fair Game on Cross-Exam

The Georgia Court of Appeals has held that a doctor’s lien is fertile ground for cross-examination. In the case of Stephens v. Castano-Castano, the plaintiff sued for injuries arising out of a motor vehicle accident. The evidence showed that her attorney referred her to a treating physician who, in turn, treated her under the terms of a lien based on her recovery. Attempts at presuit settlement ultimately resulted in no settlement (and part of the decision deals with offers and acceptance), so a lawsuit was filed.

At trial, the defense sought to cross-examine the treating physician on the fact the attorney referred the plaintiff to him and his lien. Plaintiff moved to exclude the evidence, which was granted.

The Court of Appeals reversed, holding that the trial court should have permitted the defense to cross-examine the doctor based on the financial interest. The Court wrote:

“Dr. Chappius’ financial interest in the outcome of the case is highly relevant to the issue of his credibility and potential bias, as Dr. Chappuis has become an investor of sorts in the lawsuit. If Castano receives a large verdict amount, then Dr. Chappuis has a near certain chance of fully and quickly recovering the costs of the treatment provided to Castano at no initial cost. On the other hand, if Castano does not recover at trial, Dr. Chappuis’ chances of being fully reimbursed are more doubtful. Thus, the expert witness has a financial motivation to testify favorably for Castano, and the probative value of this testimony outweighs its prejudicial effect.”

The Court rejected the notion that the attorney’s referral was fair game, however. In so ruling, the Court wrote that “[a]t most, there is a suggestion of unseemliness which creates a danger of unfair prejudice and confusion of the issues before the jury.”

The case is Stephens v. Castano-Castano, 2018 Ga. App. LEXIS 307.

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Georgia Supreme Court Reverses Trial Court for Wrongly Giving an Ordinary Negligence Charge in a Medical Malpractice Case

On March 5, 2018, the Georgia Supreme Court reversed a $22 million verdict in a medical malpractice case, finding that the trial court had erroneously charged the jury on ordinary negligence.  On March 5, 2018, the Georgia Supreme Court reversed a $22 million verdict in a medical malpractice case, finding that the trial court had erroneously charged the jury on ordinary negligence.

On September 16, 2008, patient Ms. Brown had an epidural steroid injection administered by an anesthesiologist at a surgery center.  Ms. Brown was given the sedative Propofol prior to the procedure.  Her blood oxygen level was 100 percent when the procedure began.

Shortly after the procedure began, a pulse oximeter used to monitor the patient’s blood oxygen level sounded an alarm, indicating a drop in Ms. Brown’s oxygen in her blood.  Technicians and nurses in the room made efforts to increase the oxygen level.   The anesthesiologist stated that the machine was malfunctioning and that Ms. Brown’s true oxygen saturation level and breathing was fine.

Ms. Brown failed to resuscitate following the procedure, and EMTs responded to the practice’s 911 call for help.  The anesthesiologist told Ms. Brown’s daughter-in-law and the physician who admitted her to the hospital that the procedure had gone fine and Ms. Brown was simply having complications coming out of the anesthesia.  The anesthesiologist gave no indication that Ms. Brown might have experienced respiratory complications during the procedure.

Plaintiff’s counsel asserted both medical malpractice and ordinary negligence claims, including that the anesthesiologist improperly administered Propofol without positioning another anesthetist at the head of the table, failed to respond appropriately when the patient experienced respiratory distress and failed to contact emergency medical services promptly.

The trial judge charged the jury on both ordinary negligence and medical malpractice.

The Court of Appeals had concluded that the trial court charged correctly on ordinary negligence because a lay person would not need expert testimony to understand the meaning of data provided by pulse oximeters and blood pressure monitors and how best to respond to that information in the midst of a medical procedure.

The Georgia Supreme Court accepted certiorari and framed the issues as:  1) whether the trial court’s instruction on ordinary negligence was proper, and 2) if not, whether that error was harmful to the defendants.  The Supreme Court concluded that the ordinary negligence charge was improper and harmful to the defendants, ordering a retrial.    The Supreme Court disagreed with the Court of Appeals’ finding that responding to medical data from medical devices did not require medical judgment.

The case is Southeastern Pain Specialists, P.C. v. Brown, et al., Georgia Supreme Court No. S17G0733, decided March 5, 2018.

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Eleventh Circuit Court of Appeals Permits Introduction of Evidence of Litigation Funding

In a much anticipated decision, the 11th Circuit, in Houston v. Publix Super Markets, Inc., 2018 U.S. App. LEXIS 2935 (11th Cir. Feb. 7, 2018), held that a district court did not err in admitting evidence at trial concerning payments made by a litigation funding company to the plaintiff’s treating doctors because the evidence was relevant to show bias on the part of the doctors who testified in the case.

Plaintiff Robin Houston sued Publix Super Markets after she slipped and fell in one of its stores.  She subsequently underwent treatment for her injuries from a number of providers, which treatment was largely funded my ML Healthcare, a “’litigation investment’ company that contracts with doctors to provide medical care for injured people with viable tort claims who lack medical insurance.”  Houston, 2018 U.S. App. LEXIS 2935, at *2.  During the litigation, Publix conducted discovery regarding the relationship between Plaintiff, her treating doctors, and third-party ML Healthcare.  Publix learned that, pursuant to its contracts, ML Healthcare purchases at a discounted rate from these physicians the medical debt that the putative plaintiffs incur during their treatment.  The contracts also grant ML Healthcare the right to later recover the full cost of the medical care provided out of any subsequent tort settlement or judgment the treated individuals receive.

Publix sought to introduce at trial evidence of these contractual relationships to show that Plaintiff’s treatment providers were biased in their testimony and that Plaintiff’s claimed medical expenses were unreasonable.  Plaintiff sought to exclude this evidence, arguing, primarily, that it was barred by Georgia’s collateral source rule.  That rule generally gives a plaintiff the right to recover damages undiminished by collateral benefits, the rationale being that a defendant should not benefit from a plaintiff’s mitigation of her losses.  Polito v. Holland, 258 Ga. 54, 55 (1988).  The collateral source rule usually serves to render evidence of litigation funding, for instance, inadmissible when it’s offered in an effort to reduce damages.  Id. at 56.  In Houston, however, Publix argued that the arrangement between Plaintiff, ML Healthcare, and non-party providers created a risk of bias on the part of the doctors, who receive referrals from ML Healthcare and who subsequently testify on behalf of the plaintiffs they have treated pursuant to those referrals.  If a doctor did not provide a favorable causation opinion – necessary to win the case – ML Healthcare likely would find other doctors who would.  Houston, 2018 U.S. App. LEXIS 2935, at *15.  Finding that such proffer, i.e. establishing bias, was distinctly non-substantive in nature, the Court held that, procedurally, an evidentiary purpose was served by the admission of the evidence, such that the collateral source rule would not prohibit the jury from hearing of ML Healthcare’s role in the litigation.

Much like the recent state court decision in WellStar Kennestone Hospital v. Roman, 2018 Ga. App. LEXIS 34 (Ga. App. Jan. 30, 2018), the 11th Circuit has now limited plaintiffs’ use of the collateral source rule to hide the interplay of non-parties’ financial gambling in litigation.  However, the Houston Court has taken it a step further than the Roman decision did.  Not only is evidence of litigation funding discoverable, it may also be admissible if an evidentiary purpose is served by its introduction.  The significance of this ruling cannot be overstated.  The Houston Court did decline to consider whether evidence of ML Healthcare’s contract rates could be used to attack the reasonableness of Plaintiff’s claimed damages, but the path has certainly been paved for the defense bar to make this argument in the future.  The Houston case discusses Alabama’s comparable collateral source rule and, in a footnote, mentions that recent legislative changes in Alabama now permit the introduction of evidence that a plaintiff’s medical bills have or will be paid.  Perhaps Georgia will one day follow suit.  I attended a seminar recently where we were encouraged to keep attacking these issues at the trial court level with the hope that eventually the Georgia legislature will come around.  If nothing else, perhaps decisions like Houston and Roman will discourage the ever rampant medico-legal loop driving personal injury litigation.

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Tennessee Supreme Court Holds That Full and Undiscounted Medical Bills may be Submitted as Proof of Reasonable Medical Expenses

The Tennessee Supreme Court has issued its long-awaited decision in the Dedmon v. Steelman case. This case has direct and significant consequences to personal injury litigation in Tennessee. In short, defendants may not argue that the amount actually received by a medical provider is the reasonable amount of a plaintiff’s medical bills.  Plaintiffs may submit undiscounted medical bills in full as proof of reasonable expenses.

The Tennessee Supreme Court granted an appeal in Dedmon to address whether its ruling in West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014) applies in personal injury cases. In West, the court held that a hospital’s reasonable charges under Tennessee’s hospital lien statute are the amount the hospital accepts from the patient’s private insurer, not the full amount of the medical bills sent to the patient.

The Supreme Court released its decision on November 17, 2017.  The court held that the collateral source rule applies to personal injury claims in which the collateral benefit at issue is private insurance. Consequently, plaintiffs may submit evidence of the injured party’s full, undiscounted medical bills as proof of reasonable expenses. Furthermore, defendants are precluded from submitting evidence of discounted rates accepted by medical providers from an insurer in order to rebut the plaintiff’s proof that the full, undiscounted charges are reasonable.

The court reasoned that to allow defendants to submit discounted rates would conflict with the collateral source rule. However, defendants remain free to submit any other competent evidence to rebut a plaintiff’s proof on the reasonableness of medical expenses, so long as that evidence does not conflict with the collateral source rule.

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Georgia Court of Appeals Affirms Exclusion of Doctor’s Substance Abuse

In a lengthy ruling covering many issues related to a trial, the Georgia Court of Appeals affirmed the exclusion of a doctor’s past substance abuse issues on the grounds of relevance. In the case of Doherty v. Brown, et al., issued on November 18, 2016, the Court addressed numerous issues arising out of a $22 million verdict against a pain physician and his practice group. The Plaintiff claimed that the doctor’s past substance abuse issues went to the question of “patient safety.” The doctor moved in limine and the trial court granted the motion. When Plaintiff attempted to bring it up at trial, the doctor objected and the trial court sustained the objection. On appeal, Plaintiff claimed the evidence should have been admitted. The Court disagreed, holding that the trial court properly exercised its discretion to exclude the evidence because there was no proof the doctor was impaired at the time of the surgery at issue.

The take-home is that the appellate courts have repeatedly held that evidence of a physician’s past substance use or abuse is not relevant to the issue of malpractice unless there is proof of impairment at the time of the incident.

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Welcome to our Health Law & Regulation Update Blog!

Welcome to our blog! Through this blog, the members of the Health Care practice group at Carlock Copeland & Stair will share legislative, case law, regulatory, and administrative law updates and trends. We plan to cover topics such as medical malpractice, tort reform, HIPAA and medical privacy compliance, EMTALA compliance, and overpayment reviews, audits, and fraud matters. We hope you will check with us often to get the latest updates.

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