IN THE SUPREME COURT OF MISSISSIPPI NO. 2014-CA-00440-SCT TABITHA PRAY

ER, FOR AND ON BEHALF OF THE ESTATE AND WRONGFUL DEATH BENEFICIARIES OF JONES TOY , DECEASED

v. GREENWOOD LEFLORE HOSPITAL

DATE OF JUDGMENT: 01/16/2014 TRIAL JUDGE: HON. W . ASHLEY HINES COURT FROM W HICH APPEALED: ATTORNEYS FOR APPELLANT: LEFLORE COUNTY CIRCUIT COURT W A LTER ANDREW

NEELY W

. ERIC STRACENER, JR. JOHN F. HAW K INS ATTORNEYS FOR APPELLEE: REX MORRIS SHANNON, III GAYE NELL LOTT CURRIE NATURE OF THE CASE: CIVIL - W RONGFUL DEATH DISPOSITION: AFFIRMED - 01/28/2016 MOTION FOR REHEARING FILED: MANDATE ISSUED:

BEFORE RANDOLPH, P.J., PIERCE AND KING, JJ. KING, JUSTICE, FOR THE COURT: ¶1. In t his wrongf

ul death action alleging m edical m alpractice as t he c a use of Jones Toy ’s brain injury and ultim ate death, the Lef lore County Circuit Court f ound f o r t h e d e f e n dant hospital af

ter a bench trial. Because substantial, credible, and reasonable evidence supports the trial court’s judgm e nt, this Court af f i rm s t he j u d g m e n t of the Lef lore County Circuit Court. FACTS AND PROCEDURAL HISTORY¶2. On Septem ber 17, 2008, f

i f ty -f our-y e a r-old Jones Toy we n t t o G r eenwood Lef lore Hospital (GLH) to have the tip of his right index f inger am putated in w hat was i ntended to be an outpatien t p r o c e d u r e. At the tim e of h is surgery , Toy had m ultiple h ealth problem s, including cardiom y opathy , a n i n ternal heart def ibrillator, end s tage renal f a ilure, and a f istula 1 t o assist with his dialy sis. “His g angrenous f inger” t hat was to b e am

putated “was consistent with his past m edical hi s t o r y o f heart disease and peripheral vascular disease.” Patients w ith t hos e t y

p e s o f illnesses of

t en “present with necrotic ulcers in their f ingers and/or their toes due to poor circulation.” Georg e “Sandy ” W eathers, a Certif ied Nurse Anesthetist (CRNA), com pleted Toy ’s pre-anesthesia report, and classif ied him as ASA 3, and his a nesthesia plan was determ ined to be Monitored A nesthesia Care (MAC), in which the patient is awake, but is given various m e dicines to m ake him l ess aware of the surgery . Bef ore 1:58 p.m ., the tim e at which Toy entered the operating room (OR), W e at h e r s g a ve him the drugs Fentany l and Versed. ¶3. Shortly af

ter W eathers took Toy to the operating r oom , C R N A J o s e p h ( “ J o d y ”) Sim cox cam e to take over Toy ’ s care, and W eathers “reported of f ” to him

. S im c ox m ade the decision to give Toy a 50 m illigram dose of Propof ol, using a roller clam

p to inf use his IV line so that he could control the rate at which the IV dripped. The orthopedic surgeon, Dr.
Daneca DiPaolo, injected local anesthesia into Toy ’s f inger. S im cox t estif

ied that at that point, T oy jerked. Thus, h e m a de the decision to give Toy a second dose of propof ol exactly

as he h a d g i v e n t h e f

irst dose. At that point, at about 2:15 p.m ., Toy ’ s b lood pressure

1 A f istu la is a l o catio n w h ere an artery a n d a v ein a re co n n ected to p ro v id e a d ialy sis access p o i n t w ith g o o d b lo o d f lo w . 2dropped, which was an expected response to the p ropof ol. In response, Sim cox a d m inistered ephedrine and atropine t o reverse t he blood pressure drop. He also changed his supplem ental
oxy gen m ask connected to a breathing m achine to a m anual bag w ith a m a sk that created a tight seal around Toy ’s m o uth and nose so that Sim cox could m anually control a n d m onitor Toy ’s breathing. From 2:15 to 2:30 p.m ., no blood pressure and no pulse oxy gen readings f or Toy were recorded in the OR record. However, carbon d ioxide exhalation was recorded during this tim e. 2 ¶4. As the s urgery concluded, W eathers entered the OR a nd n oticed that Toy had no blood
pressure reading and no pulse oxy gen reading. At that point, he tried to palpate f or a pulse and d id not f

ind one. A code was called at 2:29 p.m . 3 W eathers b egan chest com pressions

at 2:31 p.m . and Sim cox was attendi n g t o T o y ’ s airway at 2:30 p.m . and i ntubated Toy at 2:32 p.m . Toy was s uccessf ully resuscitated at 2:32 p.m . At that juncture, he was transf erred

t o the ICU and his neurological status was docum ented as “unresponsive.” Toy was unresponsive except to painf ul stim uli the entire tim e he was in the ICU, f rom Septem

ber 17, 2008, until his d e ath f

rom heart f

ailure on October 5 , 2008. It was agreed that Toy experienced som e sort of a noxic or hy poxic b rain injury , but what Pray er a n d GLH disagree on is when and how this brain injury occurred. ¶5. On Septem

ber 1 6, 2009, a notice of c l a i m l e t t e r w a s s e n t t o Greenwood Lef lore

2 T h e E K G w as also sh o w in g a n o rm al sin u s rh y th m . H o w ev e r, t h e p lain tif f alleg es th is w a s p u l seless electrical activ i ty f ro m T o y ’s in tern a l d ef

ib rillato r . 3 T h e tim e s n o t ed are th e t im es w ritten in th e C o d e 9 9 R eco rd

. T h e testim o n y w as t h at th e tim e s m ay n o t b e e x a c t , b e cau se ev ery o n e w as f o cu sed o n th e p atien t in crisis an d n o t o n m ak in g a p erf

ect reco rd

. 3Hospital, L ef lore County , the C ity of Greenwood, Dr. DiPaolo, and others involved in Toy ’s

care f rom Septem

ber 17, 2 008, t o O c tober 5, 2008. On March 19, 2010, Tabitha Pray er, Toy ’s daughter, f

i led a wrongf

ul death c o m

plaint ag ainst G LH, t he City o f Greenwood, Lef lore County , and John and J a ne Doe def endants. Pray er eventually d ism issed the claim s against Greenwood a nd Lef lore County

. In the com plaint, Pr a y e r c laim ed that CRNA Sim cox overdosed T oy with anesthesia drugs, t hat T oy “aspirated” during the Code 99 (the

com plaint seem s to alle g e t h a t this caused som e loss of neurological f unction), but that “according to a radiographic exam taken on Septem ber 18, 2008, Toy still h ad neurological f unction.” The com

plaint f urther alleged that on Septem ber 21, 2008, in the ICU, a nurse

was conducting a phy sical exam ination o f Toy when she bec a me suspicious that Toy was not being ventilated. The RN paged the phy s ici a n o n c a l l , Dr. Resik. Af

ter approxim a t e l y twenty -f ive (25) m i nutes, an ER p hy sician attende d t o M r. Toy and reintubated him

. 4 Due to t he f a i lure by the D e f endants to tim ely attend to the circum stances, T o y lost all neurol o g i c a l f unction and was lef

t in a state of

anoxic encephalopathy

. 5 ¶6. The bench trial i n the case b egan on August 26, 2013. A t t rial, the plaintif f proceeded

on the theory that T oy was overdosed by the CRN A and that he suf f ered anoxic encephalopathy in the OR because the CRNA f ailed to tim ely r e c o g n i z e and treat Toy ’s cardiac a rrest. T he plaintif f ’ s theory r elied heavily on the lack of blood p ressure and pulse
oxy gen readings in the OR record f or the nearly f

if teen m inute tim e period f rom 2:15 p.m

. until t he code was called at 2:29 p .m . The plaintif f abandoned the t heory that the b rain injury

4 T h is in cid en t is f

o u n d in th e n u rse’s n o tes.

5 A n an o x ic b rain in

j u ry is o n e in w h ich th e b rain h as b e en d ep riv ed o f o x y g en f o r a p erio d o f tim e sig n if

ican t en o u g h to cau se b rain d am ag e.

4occurred on Septem ber 21, 2 008, in the ICU. T he def endant also noted that, in preparation f or trial, the plaintif

f did not take any

depositions whatsoever. ¶7. At trial, the p l aintif f put f orth several witnesses, including a CRNA e x p e r t and an

a n e s t h esiologist. Y olanda Toy , Toy ’s wif e , and Pray er b oth testif ied that he n e v e r

com m unicated m eaningf

ully a f ter his surgery . Rex Allison, the pl a i ntif f ’s CRNA expert, testif i ed t hat giving Toy the second dose of propof ol “ would very likely cause an overdose” based on Toy ’ s m edical record and his ASA classif i cation of 3, and that what was done was

a breach of the s tandard o f c are. He also testif ied t hat he believed that Toy was in cardiac

arrest at 2:15 p.m . based upon the precipitous drop of blood pressure, and that “according to Advanced Cardiac Lif

e Support (ACLS) g u i d elines, a t that point he had no blood f low through his sy stem and CPR should have been instituted at that point.” He opined that one

reason t hat no oxy gen saturation reading was obtained during t his tim e period could be because “his b lood pressure was too low and he had no circu l a t i o n.” He noted that, according to ACLS guidelines, brain injury occurs in less t han f ive m inutes in situations like this. ¶8. D r . N o r m a n Douglas Packer, an anesthesiologist and f orm er president of

Ja c k s o n Anesthesia A ssociates, also testif ied f or the plaintif

f

. H e f irst testif i ed t h a t G L H f

ailed to appreciate Toy ’s m edical condition. Like Allison, h e testif ied that the standard of care was breached with the dosage of propof ol. Dr. Packer opined that clea r l y [ Toy ] received too m uch m edicine. His blood pressure dropped as a result o f r eceiving t oo m

uch m edicine. Of course he’s – his breathing stopped, as w e have seen f

rom the previous CRNA expert, a nd he had a cardiac arrest, and he had no ef

f ective blood pressure o r circulation f or 1 5 m inutes. A nd t hat

5ultim ately led to his death.

He f urther noted that the EKG e l e c t r i cal activity could be accounted f o r by T oy ’s internal cardiac d ef

ibrillator. He concluded that the cardiac arrest caused a lack o f oxy genated blood f low t o the brain, as shown by the f ailure of blood pressure o r pulse oxy gen to register, which caused the anoxic brain i njury

. He opined that CPR should have been adm i nistered around 2:17 p.m

. ¶9. In addition to t he t estim ony , the m edical records in e v idence contain som e indications that anoxic bra i n i n

j u r y w as suspected shortly af ter surgery . Num erous notations in the nurses’ notes a nd various patient assessm ents in the h ours a n d day s shortly af ter surgery indicate that Toy only responded to painf ul or “noxious” stim

uli, or that he was unresponsive.
Notes by o ne of the consulting phy sicians indicate that Toy had a c ardiac arrest during his

sur g e r y a n d “was thought to have sustained hy p oxic brain injury during the episode.”
Doctors ’ n o t e s a nd tests perf o rm ed f rom that tim e period also indicate the possibility that brain injury

occurred during, or im m ediately af ter, surgery

. ¶10. GLH f

irst called Dr. DiPaolo to testif y . Dr. DiP a o l o noted that Toy ’s “gangrenous f inger was consistent with his past m edical history of heart d isease and peripheral vascular disease. In [ sic] individuals with those ty pe o f illnesses are the o nes who generally present with necrotic ulcers in their f ingers and/or their toes due to poor circulation.” Dr. DiPaolo also testif ied that in this surgery , the doctor m ust dissect t he f

inger until she gets a bleeding edge “because it’s the blood s u pply that brings the oxy gen that gets the wound to heal.” She testif i ed that she did indeed dissect Toy ’s f inger until she observed bleeding. S he noted that

6if Toy had been without a pulse f or any signif

i cant period of tim e, she would n ot have been able to obtain bleeding f

r om the f inger. She also t estif

ied that the a c tual surgery took about f ive to ten m inutes. Dr. DiPaolo testif ied that T o y h ad a f

i stula in his f

orearm “which is a ty pe of blood vessel c onnection that is used f or dialy sis patients, and what it is is an artery is connected to a vein to allow f or a very easily i dentif

ied pulsation.” She stated that a f istula pulses m o re evidently than a norm al pulse, and that as she was com pleting the p rocedure, she noticed that the f

istula n o longer had a pulse. Prior to the e nd of the procedure, she had not noticed any

lack of blood f low to the f

istula. ¶11. CRNA W eathers testif ied next. He n o t e d t h a t c e r tain occurrences can prevent an
accurate blood pressure reading, f or exa mple, if the patient is m oving o r if there is a f luctuation in b l ood pressure, which m ay explain t he lack of blood pressure r eadings in the OR record. He also testif

ied that it is very com m on to get n o pulse oxy gen reading when the blood p ressure cuf

f is on the sam e arm as the pulse o xim eter, because “the tightening of the blood pressure cuf

f prevents a pulse f

rom reaching the extrem ity ,” potentially explaining the lack of pulse oxy gen readin g i n the OR record. L ast, in regard to the OR record, he noted that the f if t e e n mi n ute increm ent block on the f orm represents a block of tim e and what is recorded is just a snapshot. He did adm i t that he palpated f or a p ulse as soon as he walked into the OR and im m ediately began CPR, a n d that Toy was revived about one m inute later. ¶12. C R

N A Sim cox testif

ied next. He testif

ied that when Dr. DiPaolo stuck T o y w i t h a needle, Toy m oved, s o Sim cox t hen gave Toy the second dose of propof ol. He s t a t e d that Toy ’s breathing slowed and his blood pressure dropped, whic h w a s a n expected response.

7Because h e ex p e c t e d this response, Sim cox testif ied that he already had som e ephedrine drawn up, which he adm inistered to r a ise blood pressure. Sim cox also testif ied that at that point, h e could determ ine that Toy was breathing because of the rise and f all of his chest and the f ogging of his oxy gen m ask, but that h is b reathing did slow, so Sim cox “elected to take

m y m ask, which is connected to my b r e athing m achine, and put it on h is f ace, and it’s connected to the balloon and bag t hat y ou s ee people squeeze.” At that point, Sim cox noted that T oy had a tight seal on his m outh and nose and Sim cox had his hands on the bag, and could thus better determ ine whether Toy was breathing, and how deeply

. He f urther testif

ied that when he w as m ask a ssisting Toy , Toy was breathing on his own. He m entioned that at

one p oint when h e f

ailed to g et a blood pressure, T oy w as m oving his arm purposef ully , so he wasn’t concerned a

bout the lack of blood pressure since Toy had p urposef ul m ovem ent, an EKG tracing, carbon dioxide output, and was inhaling and exhaling. ¶13. Af ter Toy ’s heart rate f

ell, he gave Toy a dose of atropine t o i n c r e a s e h e art rate. Sim cox also gave Toy a second dose of ephedrine. Sim cox testif ied that at that point, a blood
pressure cy cle f

ailed to register, Toy ’s breath i n g changed dram atically , the surgery was f inishing up, and W e athers cam e into the OR. That was when W eathers palpated f or a pulse and f ound none, and he began chest com p ressions while Sim cox intubated Toy

. Sim cox testif i ed that af ter they stabilized Toy

and Toy b egan waking up, Toy began to grab f or the intubation tube a nd g o t a bit com bative. They t ried to calm him down and instructed him not to pull the tube out. W hen asked if he believed that Toy could understand what was being said to him , Sim cox replied “Yeah, I think so. You know, we w ere t alking to him

. He was

8clearly a gitated. A breathing tube is an of f e nsive m echanism , a n instr u me n t

. I have no

reason to believe he didn’t understand us at that point.” Sim c ox t estif ied that Toy did not go
ten m inutes without breathing, and that the end-tidal carbon dioxide m easurem e nts f rom 2:15 to 2:30 were proof of

exhalation. ¶14. Regardi n g t h e i n c o n s i s t e n c i e s i n the anesthesia record, Sim cox testif ied that he

com pleted som e of the a nesthesia record af t er Toy had been transported to the ICU, because he was having to use two h a nds t o care f o r Toy du r i n g t h e latter portion of the procedure,

r a t h e r t h a n being able to w rite on a docum ent. He “conceded that the docum entation o f
p a p erwork perhaps w as neglected. That p atient Mr. Toy and his conditio n w a s n o t neglected.” ¶15. Dr. Claude Br u n s o n , a n a n e s t h e s i o l o g i s t , f orm er chairm an of the U niversity of Mississippi Medical C e n ter D epartm ent of Anesthesiology , and a board m em ber of the
Am erican Society of Anesthesiology , as w e ll as the president of the Mississippi State Medical Association, testif ied as an expe r t f

o r G L H. Dr. Brunson noted that, p rior to the
surgery , T oy had cardiom y o pathy , an illness of t he heart, a nd a num ber of other “signif

icant” illnesses. H e f

i r st testif ied that the dosage of propof ol given t o Toy w as acceptable, particularly pointing out t hat propof ol is a short-acting drug. W ith regard to the lack of pulse
oxy gen reading, Dr. Brunson opined that if any thing, it keeps the blood f r o m f l owing up here or i f y o u g e t cold or vasoconstricted or if y ou have p eripheral vascular disease it’s hard f or the blood to get out there in the f irst place, and so y ou’ll lose the r e a d i n g o n t h e pulse oxim eter. T he other thing that would c a u se that f rom happening is because this was a s hared a rm , the surgeon was operating on one a r m , and so they had t o put the blood pressure cuf f o n the s am e arm as the pulse oxim eter.

9So every tim e the blood p ressure cuf f goes u p it takes the pressure and squeeze the arm and stop the blood f low, and so y o u’re gonna have interm ittent t im es when the pulse oxim eter is not going to p ick up whenever the cuf f is going up. Dr. Brunson c onsequently testif ied that sim

ply because t h e p u l se oxim eter d oes not get a reading does not m ean that the patient has no o xy genation in his blood. He also opined that it w as m ore im

portant f or S im cox to turn his attention to Toy due to his condition, rather than

to r e c o r d blood pressure readings. Dr. Brunson noted the presence o f end-tidal carbon dioxide m easurem ents. He def ined it as [ e]nd-tidal CO2 is we breathe in o xy gen a n d we blow out carbon dioxide, and so w e actually look a t the end-tidal C O2 as one of t he m ore im portant m onitors. B ecause we can g et y ou saturated b ut w e ’ v e g ot to get the oxy genated b lood around t o the im p ortant organ sy stem s in the body , a nd the way we k now that is if y ou then return CO2 back a nd y ou bre a t h e i t o u t , we know that the entire cy cle is working then.
He testif ied that the recorded C O 2 l e v e l s in the OR record indicate that Toy ’s “com plete respiratory cy cle w as present” also noting that “[ y ]ou cannot have expired CO2 if y ou’re not circulating.” ¶16. Dr. Brunson testif ied that if Toy was pulseless with no blood pressure “f or 10 or 15

m inutes, it’s phy siologically unsustainable f or lif e.” He f urther t estif

ied that the resuscitative ef f orts used were appropriate. He noted that the r ecord indicated neurological activity in Toy af ter the surgery , which is im portant because “[ i]f y ou g et an a noxic b rain i njury f rom lack of oxy gen, it’s usually a global hy poxic event f

o r the w hole brain, and y ou will generally not

see neurological activity f ollowing that.” He opined that perhaps t he incident in the ICU in which Toy ’s tube w as extubated caused the brain injury

. He concluded that no anoxic brain injury occurred in the OR.

1 0¶17. T h e trial court entered judgm ent in f avor of GLH. In i t s F i n d i n g s o f F a c t a n d Conclusions o f Law (FOFCOL), it f ound Toy “was having a g aseous exchange required to circulate oxy gen through the bodily sy stem .” It specif ically noted that the end-tidal carbon dioxide m onitor recorded a positive reading during the surgery . I t also s pecif i cally noted that “[ t]he Court f

ound D r. D ipaolo to be a credible witness whose testim ony was given in a calm prof essional, m atter-of

-f act, m anner. The Co u

r t a c c e p t s D r . D i p a o l o ’s testim ony as truthf ul.”
It concluded that Toy was revived within less than one m inute af ter his cardiac a rrest and that “[ a]t no tim e f

r o m the p oint prior to t he p rocedure, when Mr. T oy was p laced on supplem ental oxy gen, through the tim e o f his a rrest was Mr. Toy ever deprived of oxy gen.” The trial court f

urther f o und that “[ n]o eviden c e w a s p resented i n regard to the care and

treatm ent rendered to Mr. Toy af ter 3:00 p.m . on Septem

ber 17, 2008.” The tria l c o urt applied its f

indings to t he elem ents of negligence in a m edical m alpractice lawsuit. W hile the court f ound t hat a duty d id exist, it f ound that Toy ’s cardiac arrest occurred in the absence of any negligence. I t f

o u nd that Toy was not overm edicated and that the drugs given h im

were adm inistered w ithin the standard of care. It f urther f ound that Pray er f

a iled t o establish that W eathers or S im cox breached the standard of c are or t hat a n y such breach proxim ately caused Toy ’s injury o r death. Indeed, it f ound that “Mr. W eathers a n d M r. S im cox m et or exceeded the applicable standard of care in their c a re and treatm ent of Jones Toy at all tim es and in all respects. The Court f urther f inds that n othing Mr. W eathers or Mr. Sim cox did or f ailed to do proxim ately caused or contributed t o any injury to Mr. Toy or Mr. Toy ’s death.” ¶18. Pray er appeals to this Court. The s ole i s s u e s h e r a i s e s o n a p peal is that the trial

1 1court’s FOFCOL is not supported by substantial, credible, and reasonable evidence. ANALYSIS ¶19. In a m edical m alpractice c ase, th is Court reviews the trial court’s f indings f or m anif est

or clear e r

ror. Univ. Med. Ctr. v

. Martin , 9 9 4 S o . 2d 7 40, 7 46 (Miss. 2008). The trial court’s “f indings m ust be supported by substantial, c r edible, and reasonable evidence.” Id.
Its f indings are accorded def

erential treatm ent, such that “[ f ]indings of f

act b y a trial judge af ter a bench trial are subject only to a lim ited s cope of review if the trial judge applied the appropriate legal standard.” Id. If the record contains s ubstantial supporting evidence, “this Court w i l l not reverse a trial court’s f indings, even if this Court d isagrees with those f indings.” I

d. a t 747. In determ i ning whether the tria l court’s f indings are supported by substan t i a l , c r e d i b l e , a

n d r easonable evidence, this Court “ m ust exam ine the entire r ecord and

m ust accept[ ] that evidence which supports or reasonably tends to s upport the f indings of f

act

m ade b e l o w , together with all reasonable inf erences w hich m ay be drawn theref rom and which f a vor the lower court’s f

indings of f

act.” Id. (internal quotations om i tted). Moreover, conf licting testim ony is t o be resolved by the trier of f act, the judge in a bench trial. Id. at 746. The trial judge in a bench trial m ust a l so determ ine questions of weight and credibility of testim ony , including that of experts. Id. at 747. ¶20. Pray er a rgues that the trial court’s f inding that T oy did not suf f er a brain injury

while in the surgical s uite is n ot suppor t e d by credible evidence. She f urther argues that the credible evidence shows that Toy did suf f e r a brain injury

during surgery . She also claim s that the court should not rely o n t estim ony f rom Sim cox, as h is testim ony was inconsistent,

1 2controverted, and self

- s erving. ¶21. It is certainly true t hat the record contains credible e v idence tending to show that Toy suf f e red a brain injury

during surgery

. The OR record contains no blood pressure or pulse
oxy gen readings f

or nearly f

if teen m i nutes, the ICU records contain m u ltiple notations that indicate t hat Toy was unresponsive af ter surgery and never regained any ability to respond, the ICU records indicate t hat doctors suspected brain injury , o n e d o c t o r ’ s note contains a written suspicion t hat brain injury occurred d uring surgery , and Pray er’s experts opined that Toy was overdosed and that Sim cox f ailed to tim ely and appropriately respond when Toy crashed, and thus deprived him of oxy gen f or ten to f if teen m inutes. ¶22. Conversely , the record also contains credible evidence t ending to show that Toy did

n o t suf f er a brain injury during surgery , that he did not s uf f er any lack of oxy gen d u r i n g

sur g e r y , a n d that no standards of care were breached. Sim cox testif ied that Toy was breathing until the cardiac arrest event at the end of the surgery . Dr. DiPaolo testif ied that Toy ’s f i stula pum

ping blood was noticeable to her and that she did not notice i t stop pum ping blood until t he end of the surgery , at which point resuscitative e f f o r t s b e gan im m ediately

. She also testif

ied that she was a

ble to o btain b l e e ding in the f inger toward the end of the
surgery , which would not have occurred had T oy stopped circulating oxy gen. The OR record contains carbon dioxide exhalation m easurem ents f or the entire surgery , which Dr. Brunson opined w ould not have occurred h ad Toy ceased circulating oxy gen. D r. Brunson testif ied

as t o h is o pinion that Toy was not overm edicated and that h e d id not s uf f er a brain injury in the OR, noting t h a t h a d Toy b een without oxy g en f or ten or f

if teen m i nutes, resuscitation

1 3would have been im possible. The m edical record indicated that som e n eurological signs

were present af

ter s urgery , and Dr. Brunson testif ied that these neurological signs would be unlikely t o be present h ad T oy suf f ered a hy poxic event i n the OR. Dr. Brunson opined that the extubation event on Septem b e r 2 1, 2008, in t he ICU was m ore likely to have caused Toy ’s brain injury

. ¶23. This is a case in which, as m any d o, the record c o ntains conf licting credible evidence, with evidence supporting each party ’s theories. In this case, the trial court was t asked with d e t e r m ining the weight and credibility o f the evidence and resolving the conf licting ev i d e n c e . The trial court speci f

ically f ound Dr. DiPaolo t o be v ery credible, and her testim ony lent credence t o GLH’s theory that the brain injury did not o cc u r d u r ing surgery . It u ltim ately resolved the conf

licting evidence in f

avor of GLH. I n reviewing the entire record, t his Court
“m ust accept[ ] that evidence which supports or reasonably tends to support the f

indings of f act m ade below, t ogether with a ll reasonable inf erences w hich m ay b e drawn theref rom and which f avor t he lower court’s f indings of f

act.” Martin , 994 So. 2 d at 747 (internal quotations om itted). I n accepting all the evidence which reasonably tends to support the trial court’s f indings of f

acts, as well as the reasonable inf erences which m ay b e drawn theref rom , it i s c lear that the trial court did n ot m a nif estly err in this c ase. W hile enough evidence exists in t he record such that r easonable m inds m ay disagree, substantial, credible, and r easonable evidence exists to support the trial court’s f indings in f

avor of GLH. CONCLUSION ¶24. Conf

licting credible e v i d e n c e e x i s t s i n t h e r e c o rd supporting both sides of the

1 4argum ent as to whether Toy suf f ered a brain injury

in the OR. The trial court resolved the conf licting evidence in f

avor of GLH. Because s ubstantial, credible, and r easonable evidence e xists t o support the trial court’s j udgm ent, the t rial court d id n ot com m it m anif est

error by e ntering judgm ent in f a vor of GLH, and this Court theref ore af f i rm s the j udgm ent of the Lef lore County

Circuit Court. ¶25. AFFIRMED WALLER, C.J., DICKINSON AN D R A N D O L P H , P . J J . , L A M A R , KITCHENS, PIERCE, COLEMAN AND MAX WELL, JJ., CONCUR.

1 5