I N T H E C O UR T O F APPEA LS O F TH E STAT E O F M I SS I SS I PPI NO . 2 0 1 3 - CA - 0 0 3 7 2 - CO A RODNE Y W I LL I AM S , I NDI VI DUAL LY AND AS AD M I NI S T RA T OR F OR T HE E S T AT E OF M ANN I E EARL W I LLI AM S , AND ON BEHALF OF THE W RO NG FUL DEATH BENEFI CI ARI ES O F MA N N I E E A R L WI L L I A MS AP P EL LA NT

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D A T E O F JU D G M E N T : 02/ 14/2013 TRI AL J UDG E: HON . W I LL I AM A. GOW AN J R. CO UR T F RO M W HI CH AP P E AL E D: HI NDS COUNTY CI RCUI T COURT A T T O RN E Y S F O R A P P E L L A N T : W . E R IC S T R A C E N E R J R . W ALTER A ND REW NEELY ATTO RN EYS FOR A PP ELLEE: W . DA VI S F RY E BA RR Y W . F OR D ANDR E A L A’ VE RN E F OR D E DNE Y BR ADL E Y C L AYT ON MOODY NA TUR E OF THE C ASE: CI VI L - W RO NG FUL D EATH T R IA L C O U R T D IS P O S IT IO N : G R A N T E D D IR E C T E D V E R D IC T IN F A V O R O F A P P E L L E E F O R A P P E L L A N T ’S F AI LURE TO P ROVI DE E XPE RT TEST I M ON Y ESTAB LI SHI NG PROX I M ATE CA U SE D I SPO SI T I O N : A FFIRM E D - 09/ 30/ 2014 M OT I ON F OR RE HE AR I NG F I L E D: M ANDAT E I S S UE D: B E F O R E L E E , C . J. , B A R N E S, I SH E E A N D F A I R , JJ. I S HEE, J . , FOR TH E COU RT: ¶1. T hi s appeal st em s f rom a m edical -negl i gen ce act i on fi l ed b y R od ney W i l l i am s against M a n h a ttan N u rsin g & R e h ab ili tatio n C e n terL L C (M a n h a ttan ) in th e H in d s C o u n ty C irc u it

### 2

C ourt . A tthe conc l us i on of W i l l i ams’ s cas e- i n- chi ef , M anhatt an moved f

ora di r ect ed
ve r di c t . The c i r c ui tc ou rtg r a nt e d the mot i on . A gg r i e ve d, W i l l i a ms app e a l s . Fi ndi ng no e rr o r , we a f

f i rm. S TA TE M EN T OF F ACT S AND P ROCE DURAL HI S TORY ¶2. W i l l i ams f

i l ed a compl ai nt on N ovember 3, 2008, al l egi ng that M anhatt an br eac hed
a nur s i ng s t andar d of

car e w hen hi s gr andmothe r , M a nn i e Ear l W i l l i a ms ( M a nn i e ) , devel oped an ul certhatW i l l i ams c l ai m s c aus ed herde ath. T hi s c as e w entt o tr i al tw i ce. T he f i r s ttr i al ended i n June 2011 w i th a j ury ver di cti n f avorof W i l l i ams. M anhatt an then f i l ed a mot i on f ora new tr i al , w hi ch w as gr ant ed. W i l l i ams di d notap peal this deci s i on, and the s econd tr ia l w a s s e t f

o r J a n u a ry 2 2 , 2 0 1 3 . ¶3 . M anni e w as admi tt ed t o M anhatt an’s f aci l i t i es on S ept ember6, 2006, f or reh ab il it ati o n after sh e fe llat h o m e a n dfracture dh er p elvis. M an n ie w as e igh ty-six y ea rs ol d a nd ha d s i gni f

i cantmedi calpr obl ems, i ncl udi ng: end- s t age r enaldi s eas e, hypert ens i on, conges t i ve heartf

ai l ur e, atr i al f

i br i l l at i on, a nd e nl ar gementof the heart . A f

ew year s pr i or t o b ei ng adm i tt ed to M anh att an , sh e h ad b een h ospit al i zed for r espi rat ory i nfect i on s, pneumoni a, and bronc hi t i s . D ur i ng herre s i dency w i th M anhatt an, s he w as hos pi t al i zed on
m u ltip le o c c a s io n s fo r p u lm o n a ry is s u e s . ¶4. O n February 13, 2007, M anni e devel oped a r eddene d ar ea on hercocc yx. T he ar ea b ec am e infe cted w ith fun g al d erm ati ti s, an dev en tually ad v an ce dinto a stag e-fo u r ulce r. T hi s ul cers erves as the f ocus of W i l l i ams’ s cl ai m thatM anhatt an w as ne gl i genti n c ar i ng f or M anni e and thatM anni e’ s death w as a r es ul tof M anhatt an’ s negl i gence . O n February 19, 2007, M anni e w as adm i tt ed t o S t . D om i ni c’ s H os pi t al
. F i ve days l at er , M anni e di ed. T he

### 3

death cert i f

i cat e l i s t ed the caus e of

death as car di opul m onary fa i l ur e, pneum oni a, and other
s i gni f i cantco nd i t i ons , i ncl udi ng end- s t age r enaldi s eas e and pl eur al ef f us i ons . T he f

i nal di agnos es l i s t ed on M anni e’ s di s char ge s um m ary i ncl uded: end- s t age r enaldi s eas e, conges t i ve heartf

ai l ur e, bi l at er al pl eur al ef f us i ons , bi l at er al i nf

i l tr at es , chr oni c dee p venous throm bo si s, and sepsi s. ¶5. W i l l i ams pr es ent ed N ur s e Luanna Trahantt o est abli sh thatM anh att an br eac hed a nur s i ng s t andar d of

c ar e. A ccor di ng t o Tr ahant , M anhatt an br eac hed the s t andar d of car e by f ai l i ng t o pr ovi de M anni e w i th a pl anned pr ogr am t o r educe the ri sk o f herbecomi ng compl et el y i ncont i nent . T r ahantt es t i f i ed thatM anni e s houl d have be en pl ace d on a t oi l et i ng s chedul e upon admi s s i on t o M anhatt an, w her e s he w oul d be as s i s t ed i n us i ng the bathr oom her s el f i ns t ead of

becomi ng depende nton br i ef s and di apers. T r ahantes t abl i s hed that M anni e w as compl et el y i ncont i nentand unabl e t o part i ci pat e i n a t oi l et i ng pr ogr am by D e c e m b e r 2 2 , 2 0 0 6 . T ra h a n t sta ted u n d e r o a th th a t sh e d idn o t h a v e a n y iss u e w ith M anhatt an’ s abi l i ty t o c ar e f oran i ncont i nentpat i ent . Further , s he t es t i f i ed thatM anhatt an f ol l ow ed the nur s i ng s t andar d of car e w i th r egar d t o cl eani ng M anni e, chec ki ng her , and
re p o s itio n in g h e r. ¶6. W i l l i ams then pr es ent ed the t est i m on y o f D r. K ei th M i l l er t o est abli sh m edi cal
caus at i on. A tthe f

i r s ttr i al , D r . M i l l ert es t i f i ed i n per s on butw as unavai l abl e f orthe s econd tr i al
. A s s uch, D r . M i l l er ’ s vi deot aped de pos i t i on f r om Sept ember28, 2012, w as pr es ent ed t o the j ury. A f

t e rr e vi e w i ng M a nn i e ’ s medi c a l r e c or ds , pr og r e s s no t e s , a ndthe di s c ha r ge s um m ary, i tw as D r . M i l l er ’ s opi ni on thatM anni e’ s i m m edi at e caus e of death w as s eps i s or s ever e i nf

ect i on caus ed by the i nf ect i on i n herpr es s ur e s or e and he rl ungs , m ade w or s e by

### 4

h er m alno u ri sh ed stat e. D r. M il ler w as c ri ti ca l of M an h att an in th ree se p ara te area s: pressu re
u lce rs, m a ln u triti o n , an dinf e c tio n s. A lth o u g h D r. M ill e r p ro v id e dtes tim o n y re g a rd in g h is
conce rn f orM anhatt a n’ s c on tr i bu t i ont o M a nn i e ’ s mal no ur i s hed s t at e, the j ury w as i ns truct ed th a t th is is s u e w a s n o t in d is p u te . ¶ 7 . D r. M ill e r o p in e dth a t M a n n ie ’s u lc e r w a s th e p ro d u c t o f M a n h a ttan ’s f a ilu re to adeq uatel y turn an d p osi t i on M ann i e, as w ell a s re li ev e press ure f rom her ul cer. H e al so al l eged thatM anhatt an f ai l ed t o keep M ann i e clean so a s t o pr eventthe w ound f r om b e c o m in g in fe c ted . D r. M ill e r d e c lin e dto a llo w th e lac ko f a to iletin g p lan to fa c to r in to h is opi ni ons . H e s t at ed that“[ a] t oi l et i ng [ pl an] m ay w el l have be en s om e of the r eas ons f

or i nf ect i ons , butthat ’ s notm y opi ni on. I have no opi ni on aboutthat
. . . . A t oi l et i ng pl an had nothi ng t o do w i th m y opi ni ons becaus e I don’ tknow how t o w r i t e t oi l et i ng pl ans . ” ¶ 8 . A fte r h e a rin g W ill iam s’s e x p e rt tes tim o n y , M a n h a ttan m o v e d fo r a d ire c ted v e rd ict. M anhatt an ar gued thatthe t est i m ony f ai l ed t o es t abl i s h a pr i m a f aci e ca s e f

orm edi cal negl i gence . Subse quent l y, the ci r cui tcourtent er ed a j udgm entdi r ect i ng a ver di cti n f avor of M anhatt an. A ggr i eved, W i l l i ams appe al ed. S TANDA RD O F REVI EW ¶ 9 . A m o tio n fo r a d ir e c te dv e rd ic t c h a lle n g e s th e s u ff ic ie n c y o f th e e v id e n c e . McG ee v . R i ver R egion Med. C tr. , 5 9 S o . 3 d5 7 5 , 5 7 7 (¶8 ) (M iss. 2 0 1 1 ) (cit ati o n o m itted). In
r evi ew i ng a mot i on f

ora di r ect ed ver di ct , thi s C ourtw i l l cons i der“w hetherthe evi dence , as appl i ed t o the el ement s of a party’ s cas e, i s ei thers o i ndi s put abl e, ors o def i ci ent, thatthe
nece s s i ty of

atr i erof f acthas been obvi at ed. ” I d. (c i t at i on om i tt ed)
. T he evi dence w i l l be vi ew ed i n the “l i ghtm os tf avor abl e t o the non- m ovi ng party[ , ] and .
. . thatparty [ w i l l be

### 5

gi ven] the bene f

i tof al l f avor abl e i nf

er ence s thatm ay be r eas onabl y dr aw n f r om the evi dence pr es ent ed attr i al
. ” G ri

f f i n v. N
. Miss. Med. C tr. , 66 So. 3d 670, 67 2 (¶5) (M i s s . C t . A pp. 2011) ( ci t i ng Munf

ord I nc. v . Flem i ng , 5 9 7 S o . 2 d1 2 8 2 , 1 2 8 4 (M iss. 1 9 9 2 )). I f a ques t i on of f actar i s es “f

r om w hi ch r eas onabl e mi nds c oul d di f f er , ” the mot i on f

ora di r ect ed ver di ct
s h o u ld n o t b e g ra n te d
. I d. ¶1 0 . W il li am s a rg u e s th a t th e c irc u it co u rterred in g ran ti n g M an h att an ’s m o ti o n for a di r ect ed ver di ctbecaus e the expe rtt es t i m ony es t abl i s hed a pr i m a f aci e case form edi cal negl i gence . T he M i s s i s s i ppi Supr eme has f ound: In order t o est abli sh a pri m a faci e case of m edical m al pract i ce, a plai nti ff m ust p ro v e (1 ) th e e x iste n c e o f a d u ty b y th e d e fe n d a n t t o c o n fo rm to a sp e c ific st and ard of cond uct f

o r the p rot ect i on of others agai nstan u nreasonab l e ri sk o f i njury; (2) a fai l ure t o con form t o the requi red s t and ard; and (3) an inju ry t o the pl ai nti f

f pr oxi m at el y caus ed by the br eac h of s uch duty by the d e fe n d a n t. C lev e la n d

v . H a m il , 11 9 S o. 3d 10 20 , 10 23 ( ¶10 ) (M i ss. 201 3) ( ci t at i on s om i tt ed). In a cas e for m ed ical ne g li g en ce , ex p ert t esti m o n y m u st be p rov ided to e stab li sh the se co n dan dthir d p ro n g s . Id
. at( ¶11)
. “N ur s es cannot t est i fy as t o m edi calcaus at i on. ” V au gh n v. Miss. B ap t ist Med. C tr. , 2 0 S o . 3 d6 4 5 , 6 5 2 (¶ 2 0 ) ( M is s . 2 0 0 9 ). ¶11 . W i l l i am s ci t es McC om b N urs i ng & R ehabi l i tat i on C enterLLCv. Lee , 99 So. 3d 776 ( M i s s . C t . A pp. 2012) , i n s upportof hi s ar gum ent . I n Lee , M as um i L ee br oughts ui ton b e h a l f o f Rob e rtLe e , a p a t i e n twi th th e de f e n d a n t , M c Comb N u r s i n g a n dReh ab i l i t a t i o n LLC (M c C o m b ). I

d. at777 ( ¶2)
. D ur i ng hi s r es i dency w i th M cC om b, L ee f el l f r om hi s bed and b ro k e h is h ip
. Id
. M as um i al l eged thatM cC om b w as negl i genti n car i ng for L ee an d that h is h ip in ju ry w a s a re s u lt o f th is n e g lig e n c e . I d. A t th e c o n clus ion o f th e testi m o n y , the ju ry

### 6

re tu rn e da v e rd ic t in fa v o r o f M a s u m i. Id
. at778 ( ¶6)
. M cC om b m oved f ora di r ect ed
v erd icto n the b asis that M asu m i f ail ed to es tablish tha t any all eg ed b rea ch in the stan d ard
o f c a re p ro x im a te ly c a u s e dL e e ’s in ju ri e s . I d. Th e mo t i o n wa s d e n i e d , a n dM c Co mb appea l ed. Id
. ¶12. A ttr i al , M as um i ’ s nur s i ng e xpert , Susa n L of t on, t es t i f

i ed thatM cC om b f

ai l ed t o gi ve L e e a fa ll-riska ss e ss m e n t, faile dto d e term in e th a t h e w a s a t a h ig h risk fo r fa lls , f a ile dto
m i ni m i ze the r i s k of

f al l i ng, f ai l ed t o es t abl i s h a pr ocedur e t o pr eventL ee f r om m ovi ng on h is o w n o r s ittin g fo r lo n g p e ri o d s , a n dfa ile dto c h e c ko n L e e . I d. at(¶ 3)
. L of

t on al s o s t at ed th a t M c C o m b fa ile dto m e e t th e s ta n d a rd o f c a re in th e p o s t- fa ll a s s e s s m e n t. I d. at (¶4 ). M as um i ’ s m edi calexpertw as D r . W i l l i am M eeks , w ho t es t i f i ed thatLee s uf

f er ed a f al l and
s u s ta in e da fr a c tu re dh ip
. Id
. a t( ¶ 5 )
. Dr . M e e k s s t a t e d th a the di dn o tb e l i e v e M c Co mb br eac hed the appl i cabl e s t andard o f car e, butl at eradmi tt ed thatthe nur s i ng- r el at ed i s s ues
w e re o u ts id e o f h is s c o p e o f e x p e rt is e . I d. ¶13. I n r evi ew i ng the deni al of M cC om b’ s mot i on f

oradi r ect ed ver di ct , thi s C ourt quot ed the tr i al court , w hi ch st at ed “thatthe t es t i m ony and i nf er ence s fl ow i ng f

r om thatt es t i m ony ar e s uf f i ci entto have m etthe bur den of pr oof
. ” Id
. Further , thi s C ourtconcluded that “Loft on’ s t es t i m ony i n c onj unct i on w i th D r . M eeks ’ s t es t i m ony i s s uf f i ci entt o es t abl i s h the
nece s s ary el ement s of

pr oxi m at e caus e f

orm edi calnegl i gence . ” I d. a t 7 8 0 (¶ 1 2 ). ¶14. I n the i ns t antcas e, the ci r cui tcourtpr ovi ded the fol l ow i ng reas oni ng f or gr ant i ng M a n h a ttan ’s m o tio n fo r a d ire c ted v e rd ict in its fin a l ju d g m e n t: T h is co u rtca n n o t al low an y log ical l ea p to b e m a d e c o n n ec ti n g D r. M il ler’s c a u s a t i o n t e s t i mo n y t o T r a h a n t ’ s s t a n d a r do f c a r e /b r e a c h t e s t i mo n y . T h e two m u st co n n ec t f

o r th e p lai n ti ff t o su rviv e [a] d ir ec ted v erd ictan dthey d o n o t.

### 7

T he onl y br eac h compl ai ned of by T rahanti s M anhatt an’ s f ai l ur e t o pl ace [ M anni e] on a t oi l et i ng pr ogr am i n the f i r s tappr ox i m at e tw o m onths of her s t ay[ ; ] notonl y does D r . M i l l er ’ s t es t i m on y no tl i nk thi s br eac h t o caus at i on of i nj ury ( s acr al ul cerand dea th) [ , ] h e speci f i cal l y s t at es he di d notcons i der the br eac h i n f

orm i ng hi s caus at i on opi ni on. A l though Tr ahanta cknow l edged a br eac h i n the s t andar d of car e f orM anhatt an t o devel op a toi l et i ng s chedul e, T r ahants t at ed thatM anni e w as compl et el y i ncont i nentby D ece m ber 22, 2006, and i ncapabl e of part i ci pat i ng i n a t oi l et i ng p l an af t erthatdat e. Speci f

i cal l y, T ra h a n t tes tified th a t, at th e tim e M a n n ie d e v e lo p e dth e e x c o ria tio n o f h e r c o c c y x , M a n n ie
w as no l ong e rabl e t o p a rt i c i pa t e i n at oi l e t i ng pl a n. Furthe r , D r . M i l l e rc on c l ud e d that M ann i e’s death w as caused b y sepsi s due to a com binat i on o f her m edical problem s, i ncl udi ng notonl y herul cer , butthe i nf ect i on i n herl ungs , as w el l as herm al nour i s hed s t at e. ¶15. A f

t era r evi ew of

the r ecord, w e can no tfi nd thatthe t es t i m ony pr ovi ded a nexus b etw ee n the b rea ch o f a stan d ard o f ca re b y M an h att an an dth e p rox im ate ca u se o f M an n ie’s death. Speci f

i cal l y, the expe rtt es t i m ony f ai l ed t o es t abl i s h thatM anni e’ s ul cerw as the pr oxi m at e caus e of

he rde ath due t o M anhatt an’ s f ai l ur e t o pr ovi de an ef

f ect i ve t oi l et i ng pl an. A s s uch, thi s i s s ue i s w i thoutm er i t , and the j udgm entof the ci r cui tcourti s af

f i rm ed. ¶ 1 6 . T H E JU D G M E N T O F T H E H IN D S C O U N T Y C IR C U IT C O U R T IS AF F I R ME D . A L L C OS T S O F T HI S A P P E A L A R E A S S E S S E D T O T HE APP ELLANT. LE E, C. J . , I RVI NG , P. J . , BARNES, RO BERTS , CAR LTON, M AXW EL L A ND FAI R, J J . , CO NCU R. GR I FF I S , P. J . , CO NCU RS I N PART AND I N THE R ES ULT W I THOUT S EP ARAT E W RI TT EN OP I NI ON. J AM ES , J . , DI S S EN TS W I THOUT S E P A R A T E W R I T T E N O P I N I O N .