FOURTH D I VI SI ON

DOYLE, P. J.

, M I LLER and DI LLA RD, JJ.

N O T IC E : M otions for r e c ons i de r a tion m us t be

ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n

da y s of the da te of de c is ion to be de e m ed tim e ly file d.

http://w w w .ga a ppe a ls .us /r ule s /

Nov em ber 13, 2014



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 4 A1 15 5 . TOM E H v . BOHANNON et al

.

M I LLE R , J u d ge.

Al i k in a Bo h an n on

, i n d i vi d u al l y an d o n beh al f o f her d e c e a s e d s o n

, Xav i er

Bo h an n on

, s u ed D r. M o ham m ad To m eh

, So u th Fu lt o n M ed i cal Cen t er (“ So u th

Fu l t o n ”), an d n u m ero us o t h er m ed i cal p ro v id ers

, a l l eg i n g t h at th e h os p i tal an d i t s

s t aff co m m i tt ed m al p ract ice pri o r t o an d d u ri n g Bo h an n o n ’ s l ab o r an d d el i v e r y,

res u l ti n g i n Xav i er’ s d eat h sh o rt l y aft er h e was b o r n p rem at u rel y

. Dr. To m eh

, a

p ed iat ri ci an

, fi l ed a m o ti o n fo r s u m m ary ju d g m en t, arg u i n g t h at n o d o ct or-p at i en t

rel at i o n s h i p ex i s t ed b et ween h i m an d ei t h er Bo h an n o n o r Xav ier. Fo l l o wi n g a

h ear i n g

, t h e t ri al co u rt d en i ed Dr. To m eh ’ s m o t i o n

, an d t h i s Co u rt s u bs eq u en t l y

g ran t ed Dr. To m eh ’ s ap p l i cat i o n fo r i n t er l o c u t o ry rev i ew. On ap p eal

, Dr. To m ehco n ten d s t h at is i t un d i s p u t ed t h at n o d o ct o r-p at i en t rel at i on s h i p ex i s t ed b et ween

h i m s el f an d Bo h an n o n o r Xav ier. W e ag ree an d rev ers e. 1

[T] o p rev ai l o n a m o t i o n fo r s u m m ary ju d g m en t

, t he m o v i n g p art y

m u s t d em on s t rat e t h at t h ere i s n o g en u i n e is s u e of m at eri al fact

, so t hat

t h e p art y is en t i t l ed t o ju d g m en t as a m at ter o f law. A d efen d an t m ay d o

t h i s b y ei t h er p res en t i n g ev i d en ce n eg at i n g an es s en t ial el em en t o f th e

p l ai n t i ff’ s cl ai m s or es t ab l i s h i n g fro m t h e reco rd an ab s en ce o f ev i d en ce

t o su p po rt su ch cl ai m s

. Th u s

, t h e ru l e wi t h reg ard t o su m m ary ju d g m en t

i s t h at a defen d an t wh o wi l l n o t b ear t h e bu rd en of p ro of at t ri al n eed n o t

affi rm at iv el y d i s p ro v e t h e n o n m o vi n g p art y ’ s cas e, b u t m ay p o i nt o u t b y

referen ce t o t h e ev i d en ce i n t h e reco rd t h at t h ere i s an ab sen c e o f

ev i d en ce t o su p p ort an y es s en t i al e l e m en t o f t h e n o n m ov i n g p art y ’ s

cas e. W h ere a d efen d an t m o v i n g fo r s u m m ary ju d g m en t d is ch arg es t h i s

b u rd en

, t h e n on m o v i n g p art y can n o t res t o n i ts p l ead i n g s, b u t ra t h e r

m u s t p oi n t t o s p eci fi c ev i d en ce g i v in g ri s e t o a t ri ab le i s s ue.

(Ci t at i o n s a n d p u n c t u at io n o m i t t ed .) Co wa r t v. W id en er

, 2 8 7 Ga. 6 2 2

, 6 2 3 (1 ) (a)

(6 9 7 SE2 d 7 7 9 ) (2 0 1 0 ). W e rev i ew t h e d en i al o f a m o t io n fo r su m m ary ju d g m en t d e

n o v o

, v i ewi n g t h e ev i d en ce i n t h e l i g h t m o st fav o rab l e t o t h e p art y o p p o s i n g t h e

m o ti o n fo r s u m

m ary ju d g m en t . Id . at 6 24 (1 ) (a).

1 T hi s ap p eal o n ly co n cern s Bo h an n o n ’ s cl ai m s ag ai n s t D r

. To m eh

. Acco rd in g ly

, we ex p res s n o o pi n i o n as t o h er cl ai m s ag ai ns t o t h er m ed i cal p ro v i d ers

.

2So v iewed

, t he ev i d en ce s h o ws t h at Bo h an n o n fi rs t s ou g ht p ren at al care fro m

o b s t et ri ci an Dr. Gab ri el Nas s ar wh en s h e w as ap p ro x im at el y 25 week s p reg n an t

.

Bo h an n on was o f ad v an ced m at ern al ag e an d s u f f e r ed fro m i n s ul i n -d ep en d en t

d i ab et es an d h y

p ert en s io n

. Her b ab y ’ s es t i m at ed d u e d at e was J u l y 2 5, 2 0 1 1

. On J u n e

2 2

, 2 0 1 1

, Bo h an n o n arri v ed at So u t h Fu l t on ’ s l ab or an d d el i v ery u n i t

, co m

p l ai n i n g

o f p ai n an d l eak i n g fl u i d

. Bo h an n o n un d erwen t fet al m o n i t o ri n g an d was d i s ch arg ed

a few h o u rs l at er wi t h i n s t ru ct i o n s t o res t an d d ri n k wat er.

Bo h an n o n al leg ed i n her co m p l ai n t t h at at ap p ro x im at el y m i d n i g h t o n J u n e 2 6,

2 0 1 1

, s he cal led 9 1 1 co m

p l ai n i ng o f co nt ract i o n s

, pai n an d v ag i n al b l eed i n g an d was

t ak en t o So u t h Fu lt on by am b u l an ce. Sh e arri v ed at t h e ho s p i t al at aro u n d 1 : 1 5 a.m

.

o n J u n e 2 7 an d was ex am in ed b y Dr. Nas s ar an h o u r l at er. At 3 :1 9 a.m ., Dr. Nas s ar

d el i v ered Xav i er b y

ces arean s ect i o n

.

I m m e d ia te l y aft er bi rt h

, Xav ier was b l u e an d l i m p

. M ed ical p er sonne l intuba te d

Xav ier an d at t em

p t ed to res u s ci t at e h im

, b u t h e d i ed aro u n d 3 : 4 4 a

. m

. T h e

h an dwri t t en n o t at io n s on Xav i er’ s m ed i cal reco rd s s h ow t h at a res p i rat o ry t h erap i s t

i n t u b at ed Xav ier an d n eo n at al n u rs e p ract i t i o n er Sara Po s l ey o v ers aw h i s t reat m en t

.

Nu rs e p ract i t i o ner Po sl ey was o v ers een b y D r. Bab at u n de On as a n y a. Th e

i n t rao p erat i v e reco rd

, as wel l as t h e h an d wri t t en reco rd s

, s h o w t h at Dr. Nas s ar, n u rs e

3p ract i t i o n er P o s l e y

, an an es t h es i o l o g is t

, a res p i rat o ry t h erap is t, a scru b t ech

, an d

s ev eral n u rs es were p res en t i n t he o p erat i n g ro o m d u ri n g Xav i er’ s bi rt h. Un der So u th

Fu l t o n ’ s wri t t en p o l i ci es

, a n eo n at o l o g i s t, n u rs e p ract i t i o ner, p h y s i ci an ’ s as si s t an t

, o r

res p i rat o ry

t h erap i s t i s res p on s ib l e fo r t h e i n t u b at io n o f h i g h -ri sk n ewb orn s

.

Pri o r t o d e l i v ery

, Bo h an n o n h ad n o t ch o s en a p ed i at ri ci an fo r Xav i er. Dr.

To m eh ju s t h ap p en ed t o b e th e o n -cal l p ed i at ri ci an at So u t h Fu l t o n on Ju n e 2 7

, 2 0 1 1.

As an o n -cal l p ed i at ri ci an

, D r. To m eh t reat ed i n fan t s i n t h e n o rm al n u rs ery b u t d id

n o t t reat i n fan t s in th e n eo nat al i nt en s i v e c a r e u n i t

, an d h e d i d n o t i n t u b at e o r

res u s ci t at e i n f

an t s i m m ed i at el y fo l l o wi n g d el i v ery

. Acco rd in g t o So u t h Fu l t o n ’ s

p o li ci es

, a p ed i at ri ci an trai ned i n res u s ci t at io n an d cap ab l e o f i n t u b at io n was t o b e

p res en t

, up o n req u es t

, d uri n g ces arean s ect i o ns an d h ig h

- r i s k v a g i n al d el i v eri es

.

Xav ier’ s co m

p ut er-g en erat ed ad m i s s i o n reco rd s fro m So u t h Fu l t o n l i s t Dr. T o m eh as

X a vier’ s ad m i t t in g an d at t en d in g d o ct o r. Dr. To m eh i s al s o li s ted o n an au to m at i ca lly

g en erat ed co d i n g s u m

m ary as t h e p ro v i d er wh o i n t u b at ed Xav ier an d p erfo r m e d

res u s ci t at i o n effo rt s

.

In h i s affi d av i t i n s u p p or t o f h i s m o t i o n fo r s u m m ary ju dg m en t

, Dr. To m eh

av erred th at he n ev er co n s ul t ed wi t h n o r pro v i ded t reat m en t fo r Xav i er or Bo h an n o n.

Dr. T o m eh fu rt h er av erred t hat h e was n o t co ns u lt ed ab o ut Xav i er; h e was n o t cal l ed

4o r as k ed t o t r e a t X a v i e r at an y p o i n t ; h e di d n o t refu s e t o t reat X av i er; h e was n ot

p r e s e n t a t So u t h Fu l t o n o n J u n e 2 7

, 2 0 1 1 ; an d h e was n ot req u i red t o b e pres en t a t

t h at t i m e. Dr. T o m eh al s o av erred t h at h e h ad n ev er m et Bo h an n o n o r Xav i er, h e d id

n o t ch arg e Bo h an n o n o r her i n s u ran ce fo r an y t reat m en t

, an d h e accep t ed n o p ay m en t

fo r an y al l eg ed t reat m en t s

. Sp eci fi cal l y

, Dr. To m eh den i ed t h at h e p art i ci pat ed i n t h e

effo rt s t o i nt u b at e o r res u sci t at e Xav i er.

In h i s s o l e en um erat i o n o f erro r, Dr. To m eh co n t en d s t h at th e t ri al co u rt erred

i n d en y i n g h i s m o t i o n f

o r s u m m ary ju d g m en t b ecau s e t h ere was n o d o ct or-p at i en t

rel at i o n s h i p b et ween h im an d Xav i er o r Bo han n on . W e ag ree.

It i s w el l s et t l ed G eo rg ia l aw t h at p ro o f o f t h ree es sen t i al el em en t s i s req u i red

t o es t ab l i s h l i a b i l i t y i n a m ed i cal m al p ract i ce act i o n : “ (1 ) t h e d u ty i n h eren t i n t h e

d o ct o r-p at ien t rel at i o n s h i p ; (2 ) t h e b reach o f t h at d ut y b y f a i l i n g t o ex erci s e t h e

req u i s i t e d eg ree o f s k i l l an d care; an d (3 ) t h at t h i s fai l ure b e t h e p ro x i m at e cau s e o f

t h e i n j u ry s u s t ai n ed .” (Ci t at i o n an d p u n ct u at i o n om i t t ed .) Zwi r en v. Th o mp s o n

, 2 7 6

Ga. 4 9 8

, 4 9 9 (5 7 8 SE2 d 8 6 2 ) (2 0 0 3 ); s ee al s o OCGA § 51 -1 -2 7. Ad d it i o n al l y

,

“ [d ] o ct o r-p at i en t p ri v i ty

i s [an es sen t i al el em en t ] b ecau s e i t i s t h i s rel at i o n wh i ch i s

a res u l t o f a co ns en s u al t ran s a c t i o n t h a t es t ab l i s h es th e l eg al d u t y t o co n fo rm t o a

s t an d ard o f co n d u ct

. Th e rel a t i o n sh i p is co n s i d ered co n s en s u al wh ere t he p at i en t

5k n o wi n g l y s eek s t h e as s i s t an ce o f t he p h y s i ci an an d t he p h y s i ci an k n o wi n g l y accep t s

h i m as a p at ien t.” An d

er s on v. Ho u s er

, 2 4 0 Ga. Ap p

. 6 1 3

, 6 1 5 (1 ) (5 2 3 SE2 d 3 4 2 )

(1 9 9 9); s ee al s o Her ri n gt on v. Ga u l d en

, 2 9 4 Ga. 2 85

, 2 8 6 (7 5 1 SE2 d 8 1 3 ) (2 0 1 3 )

( p l ai nt i ff i n m ed i cal m al p ract i ce cas e m u st u s u al l y pro v e t h e ex i s t en ce o f a d o c t o r

p at i en t rel at io n s h i p ).

(a) Th e ev i d en ce d o es n o t s h o w t h e ex i s t en ce o f a do ct o r-p at i en t rel at i o n s h ip

b et ween Dr. To m eh an d Bo h an n o n o r Xav i er.

Dr. To m eh

, b y h i s affi d av i t

, p res en ted a p l et h o ra of ev i den ce t h a t h e d i d n ot

t reat Bo h an n o n or Xav i er. M o reo v er, t h e d i rect or o f m ed i cal reco rd s at So ut h Fu l t o n

i n h er affi d av i t av erred t h at w h en a b ab y i s b o rn al i v e at t h e h o s p i t al

, a m ed i cal ch art

i s creat ed an d an ad m it t i n g an d at t en d i n g ph y s i ci an m u s t b e as s i g n ed t o t h e b ab y

.

W h er e

, as h ere, t h e p aren t has n o t s el ect ed a ped i at ri ci an fo r t h e ch i l d

, t h e

p ed iat ri ci an wh o i s o n cal l at t h e t i m e o f t h e bab y ’ s b i rt h i s as s i g n ed au t o m at i cal l y as

t h e ad m i t t i n g an d at t en d i n g p h y s i ci an i n th e ch i l d ’ s ch art

. Th e d i rect o r o f m ed i cal

reco rd s sp eci fi cal l y av erred

, “ If t h e b ab y d i es i n t h e o p erat in g ro om an d pri o r t o t h e

t ran s fer t o t h e n u rs ery

, t h e o n -cal l p ed i at ri ci an wi l l s t i l l b e l i s t ed as t h e ad m i t t i n g an d

a t t en d i n g p h y si ci an i n t h e b ab y ’ s m ed i cal reco rd s

, ev en i f t h e p ed i at ri ci an n ev er

t reat ed t h e b ab y .”

6Th e d i rect o r o f m ed i cal re co rd s al so av erred t h at So ut h Fu l t o n ’ s p at i en t

s o ft ware s y s t em au t o m at i cal ly creat es a co d in g su m m ary

, wh i ch l i s t s t h e n a m e o f

each p at i en t ’ s at t en di n g p h y s i ci an i n co n ju n ct i o n wi th al l t h e t reat m en t ren d ered t o

t h e p a t i e n t

, reg ard les s of wh et h er t he at t en d i n g p h y s i ci an act u al l y p erfo rm ed t h e

t reat m en t

. T h e co di n g s u m m ary i s n o t a b i ll i ng do cu m en t an d d o es n ot n eces s ari l y

refl ect t h e s erv i ces b i l l ed b y t h e ho s pi t al

. Acco rd i n g l y

, ev en t h o u g h t he m ed i cal

reco rd s l i s t ed Dr. T o m eh as Xav i er’ s p ed i at ri ci an an d t h e co di n g s u m m ary i n d i cat ed

t h at Dr. To m eh p ro v i d ed cert ai n treat m en t s t o Xav i e r

, t h o s e reco rd s d o n ot

n eces s ari l y es t ab l i sh t h at Dr. To m eh t reat ed Xav i er. Acco rd i n g ly

, Dr. To m eh

p res en t ed ev i d en ce neg at i n g an es s en t ial el e m e nt of B oha nnon’ s cl ai m

– t h e ex i s t en ce

o f a d o ct or-p at i en t rel at i o n s h i p

– a n d t h e b urd en t h en s h i ft ed t o Bo h an n o n t o p o i nt

t o s p eci fi c ev i d en ce g i v in g ri s e t o a t ri ab l e i s s u e. Co wa rt , s u p ra, 2 8 7 Ga. at 6 2 3 (1 )

(a). Bo h an n o n fai l ed t o do s o

.

No t ab l y

, i n res p o n s e t o Dr. To m eh ’ s m o t i o n fo r s u m m ary j u d gm en t

, Bo h an n o n

d i d n ot ad d res s Dr. To m eh ’ s affi d av i t

, n or t h at o f t h e d i r e c t o r o f m ed i cal reco rd s

.

Bo h an n on al s o d id n o t ad d res s t h e h a n d w r i t t en h o s p i t al reco rd s s h owi n g t h at Dr.

To m eh was n o t p res en t i n th e o p erat in g ro o m at Xav i er’ s b i rt h an d d id no t p art i ci p at e

i n t h e effo rt s t o s av e Xav i e r

. I n s t e ad

, i n o p p o s i ti o n t o Dr. To m eh ’ s m o t i o n fo r

7s u m

m ary ju d g m e n t a n d o n ap p eal

, Bo han n o n rel i es s o lel y o n t h e co d i n g s u m m ary

fro m So u t h Fu l t o n an d o n t h e fact th at Dr. T o m e h i s l i s t ed o n Xav i er’ s co m p u terg en erat ed m ed i cal reco rd s as h i s at t en d i n g an d ad m i t t i n g p h y s i ci an

.

Befo re ci rcu m s t a n t i al ev i d en ce can h av e an y p ro bat i ve v al u e t o

reb u t or co n trad i ct d i rect an d p o si t iv e t es t i m o n y o f an u n i m p each ed

wi t n es s o f t h e al l eg ed fact s i n q u es t i o n

, s u ch ev id e n c e m u s t p oi n t at

l eas t m o re s t ro n gl y t o a c o n c l u s i o n o p po s it e t o t h e d i rect t es t i m o ny

. It

i s n o t s uffi ci e n t t h at s uch ci rcu m s t an t i al ev i d en ce p o in ts eq u al ly o ne

way o r t h e o t h er.

(Ci t at i o n o m i t t e d .) Ro s al es v. Da vi s

, 2 6 0 Ga. Ap p

. 7 0 9

, 7 1 2 (2 ) (5 8 0 SE2 d 6 2 2 )

(2 0 0 3). Here, t h e ci rcu m s t a n ti al ev i d en ce, s u ch as t h e co di n g s u m m ary an d t h e

co m p u t er-g en erat ed m ed i cal reco rd s

, wh i ch were s h o w n t o s o m et i m es b e i n accu rat e,

can n ot reb u t Dr. To m eh ’ s d irect t es t i m o n y t h at h e d i d n o t t reat Xav i er or Bo h an n o n.

Si n ce t h e b u rd en s h i ft ed t o Bo h an n o n an d s h e fai l ed t o p o i n t to an y s p eci fi c ev i d en ce

g i v i n g ri s e t o a t ri ab l e is s u e, t h e t ri al co u rt erred i n d en y i n g Dr. To m eh ’ s m o t i o n fo r

s u m m ary ju d g m en t

.

(b ) M o reo v er, t h e m ere fact th at Dr. To m eh was t h e o n -cal l p ed i at ri ci an at t h e

t i m e o f Xav i er’ s b i rt h d o es n ot es t ab l i s h a d oct o r-p at i en t rel at i on s hi p

.

8“ Al t h ou g h a do ct o r wh o h as ag reed t o b e on -cal l m ak es h im sel f av ai l ab l e t o b e

co n su l t ed reg ard i n g a p at i en t ’ s co n d i ti o n

, t h at fact al on e d o es n o t i n d i cat e t h at t h e

d o ct o r h as ag reed to es t ab li s h a d o ct o r-p at i en t rel a t i o ns h i p wi t h an y p at ien t wh o

p res en t s h ers el f t o t he h o sp i t al fo r d i ag n o s i s an d treat m en t .” An d er s o n

, s up ra, 2 4 0 G a.

Ap p . at 6 1 9 (1 ).

Here, al t h o u gh Dr. To m eh was t h e o n-cal l p ed i at ri ci an at t he ti m e o f Xav i er’ s

b i rt h

, he p res en t ed affi d av i t ev i d en ce s h owi n g t h at h e di d n o t d i ag n o s e o r t reat

Xa v i e r

, co n s ul t o n h is care, o r ev en m eet h i m

. A d o ct o r wh o is m erel y o n cal l

, b ut

wh o ren d ers n o treat m en t n o r c a r e t o a p at i en t d oes n o t h av e a d o ct or-p at i en t

rel at i o n s h i p

. See An d

er s o n

, s u p ra, 2 4 0 G a. Ap p

. at 6 1 5 -6 1 9 (1 ) (n o d o ct or-p at i en t

rel at i o n s h i p ex i s t ed wh ere o n -cal l d o ct o r d i d n o t co n s u l t wi t h o r t reat p at i en t );

Mi n st er v. Po h l

, 2 0 6 Ga. Ap p

. 6 1 7

, 6 2 0 (1 ) (4 2 6 SE2 d 2 0 4 ) (1 9 9 2 ) (n o d o ct or-p at i en t

rel at i o n s h i p ex i s t ed wh ere o n -cal l d o ct o r m erel y rev iewed p at i en t ’ s x -ray at n u rs e’ s

req u es t ); co m

p are Ri n d s b er g v. Nea cs u

, 3 1 7 Ga. Ap p

. 2 6 9, 2 7 4 (7 3 0 SE2 d 5 2 5 )

(2 0 1 2) (q u es t i o n o f fact rem ai n ed as t o wh et h er d o c t o r

- p a t i en t rel at i o n s h i p ex i s t ed

wh ere o n -cal l d o ct o r as k ed n u rs e ab ou t p at i en t ’ s s t at u s

, s p o k e t o p at i en t ’ s fam i l y

, an d

refu sed fam i l y ’ s req u es t t o ex am i n e p at i en t ).

9A pl ai nt iff h as to s h o w m o re t h an t h at a d o ct o r was t h e o n -cal l p h y s i ci an at t h e

t i m e o f t h e p at i en t’ s i nju ry

. Geo rg i a l aw req u ires s o m e ev i d en ce o f an act u al d o ct o rp at i en t r e l a t i o n s h i p

. In t h i s cas e, t h at Dr. T o m eh was t h e o n -cal l p ed i at ri ci an at t h e

t i m e o f X av i er’ s b i rt h al o n e can n o t g iv e ri s e t o an y l i ab i li t y fo r m al p ract i ce, an d s i nce

Bo h an n on h as fai l ed t o co m e fo rward wi t h an y ev i d en ce t o co n t rad i ct Dr. To m eh ’ s

s wo rn s t at em en t t h at he di d no t t reat h er o r X av i er, t he t ri al co u rt erred i n d en y i n g Dr.

To m eh ’ s m o t i on fo r s u m

m ary ju d gm en t.

Ju d g men t r ever sed . Do yl e, P. J., a nd

Di l l a rd , J., co ncu r

.

10