SECOND DI VI SI ON

M I LLER, P. J.

, HODGES and PI PKI N, 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.

https ://w w w

. ga a ppe a ls .us /r ule s

D E A D LIN E S A R E N O LO N G E R TO LLE D IN T

H I S

C O U R T. A LL FILIN G S M U ST B E S U B M I TTE D WITH IN

TH E TIM E S S E T B Y

O U R C O U R T R U LE S

.

June 16, 2021



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A2 1 A0 25 6

. EVANS et al

. v

. THE MEDICA L C ENTER OF

CENTRAL GEORGIA.

M I LLE R , Pres i d i n g J u d g e.

Bran d y Ev an s

, in d i v i d u al l y an d as t h e ad m i n is trat o r o f t h e es t at e o f Ral p h

M o s s (co l l ect i v el y

“ Ev an s ”), ap p eal s fro m

t h e t ri al co u rt ’ s o rd er g ran t i n g s u m m ary

ju d g m en t o n h er cl ai m s fo r m ed i cal m al p ract i ce ag ai n s t nu rs e Bri an a St el m ach ers an d

t h e M ed i cal Cen t er o f Cen t ral G eo rg i a (“ M CCG”). Ev an s arg u es th at th e t ri al co u rt

erred i n g ran t i n g s u m

m ary ju d g m en t b ecau s e t h e ev i den ce p res en ted a fact i s s u e as

t o wh et h er t h e d efen d an t s ’ n eg l i g en ce p ro xi m at el y cau sed Mo ss ’ s d ea t h

. W e ag ree

an d t h erefo re rev ers e t he t ri al co u rt ’ s ju d g m en t

.

Su m m ary ju d g m en t i s p ro p er wh en t here i s n o g en u i ne i s s ue o f m at eri al

fact an d th e m o v an t i s en t i t l ed t o ju d g m en t as a m at t er o f law. In

rev i ewi ng a g ran t o r d en i al o f s u m m ary ju d g m en t, we o we n o d eferen cet o t h e t ri al co u rt ’ s ru l i n g an d we rev iew d e no v o b o t h th e ev i d en ce an d

t h e t ri al co u rt ’ s l eg al co n cl u s i o n s

. Mo reo ver, we co n s t ru e t h e ev i d en ce

an d al l i n feren ces an d co n cl u s i on s ari s i n g t h erefro m m o st fav o rab l y

t o ward t h e p art y o p p o si n g t he m o t i o n

. In d oi n g s o

, we bear i n m i n d t hat

t h e p art y o p p o si n g s u m m ary ju d g m en t is n o t req u i red t o p ro d u ce

ev i d en ce d em an d i n g ju dg m en t fo r i t

, b u t i s o n ly req u i r e d t o p res en t

ev i d en ce t h at rai s es a g en u i n e i s s u e o f m at eri al fact

.

(Ci t at i o n s an d p u nct u at i on o m it t ed .) S wi n t v. Al ph o ns e

, 3 48 Ga. A p p

. 1 9 9

, 1 9 9 -2 0 0

(8 2 0 SE2 d 3 1 2 ) (2 0 1 8 ). “ To d efeat a m o t i o n fo r s u m m ary ju d gm en t t h e res p o n d en t

d o es no t h av e t o p res en t co n cl u s i v e p ro of t o reb u t t h e m o v an t ’s e v i d en ce; i f t h e

re s p o n d e n t p ro d u ces or p o i n t s t o an y s p eci fi c ev i d en ce, even s l i g h t

, i n t he reco rd

g i v i n g ri s e t o a t ri ab le i ss u e o f m at eri al fact

, t h en su m m ary ju d g m en t m

u s t b e

d en ied .” (Ci t at i o n an d p u n ct u at i o n o m i t t ed ; E m ph as i s s u p p lie d. ) P e ac h B l osso m Dev.

Co . v. Lo we El ec. S

u p p ly Co

. , 3 0 0 Ga. Ap p

. 2 6 8 , 2 6 9 (6 84 S.E.2 d 3 9 8 ) (2 0 0 9 ).

So v i ewed

, t he reco rd s h o ws t h at o n J u l y 2 6

, 2 01 4

, 5 7 -y ear-o l d Ral p h M o ss

was t ran s p o rt ed b y am b u l an ce t o M CCG’ s Em erg en cy Dep art m en t a f t e r h e

co m p l ai n ed o f v o m it i n g an d ch es t p ai n t h at rad i at ed t o h i s l eft arm

. M o s s arri v ed at

t h e E m erg en cy Dep art m en t at 1 2 : 2 8 p .m

., an d h e was n ot ex p eri en ci n g ch es t p ai n at

t h at t i m e. Bri an a St el m ach ers

, a n u rs e i n t h e Em erg en cy D ep art m en t

, as s es s ed M o ss

2an d

, bas ed o n s t an d i n g o rd ers

, p erfo rm ed an el ect ro card i a g r a m ( “ ECG”) 1 an d

t ro p o n i n l ev el b l o o d tes t

. M o s s ’ s ECG was i n it i al l y read as “ Bo rd erl i n e ECG

-

Prel im i n ary - M D M u s t Rev i ew STAT,” an d em erg en cy ro o m p h y s ici an Dr. Nat h an

S t o k es s u b s eq u en t ly i n t erp ret ed th e E CG as s h o wi n g “ n o i s ch em i c ch an g es .” 2 A

t ro p o n i n t es t was perfo rm ed at 1 : 2 4 p .m

., an d i t rev eal ed t h at M o ss ’ s t ro p o n i n l ev el

was el ev at ed at 0 .0 9 ng / m L, ab o v e t h e n orm al ran g e o f 0 -0 .0 8 n g / m L.

To as s u re t h at each p at i en t p res en t i n g t o t h e em erg en cy d ep art m en t wi t h ch es t

p ai n recei v es t h e p ro p er d i ag no s i s an d th at heart at t ack co re m eas u res are ad d res s ed

,

M CCG’ s i n t ern al p o l i cy req u i r e s a p h y s ici an

, n u rs e p ract i ti o n er, o r p h y s i ci an

as s i s tan t t o as s i g n p at i en t s t o o ne o f fo u r o rd er s et t rack s

. Nu rs es are t o fo l l o w o rd ers

o n t h e as s i g n ed t rack

, s o i f a p at i en t h as n o t b een as si g n ed a t rack

, t h e p o l i cy p ro v i d es

t h at t h e n u rs e s h o u ld as k t h e p h y s i ci an fo r t rack o rd ers

. Track s 1

– 3 are fo r p at i en t s

wi t h ch es t p ai n o f cert ai n or p ro b ab l e card iac o ri gi n an d req u i re, am o n g o th er t h i n g s

,

s eri al E CGs an d s eri al tro p o n i n t e s t i n g

. Track 4 i s fo r p at ien t s wi t h ch es t p ai n o f

p ro b ab l e n o n -card i ac o ri g i n an d d o es n o t req u ire s eri al t es t i ng

. St el m ach ers i n i t i al l y

1 Th ro u g h o u t t h e reco rd

, wi t n es s es refer t o t he el ect ro card i o g ram t es t as b o th

ECG an d EKG. W e refer t o t h e t es t as ECG i n t hi s o p i n i o n

.

2 A card i o l o g i s t wh o rev i ewed t h e ECG t h e s am e d ay i n t erp ret ed i t as

“ Bo rd erl i n e,” wi t h “ s i g n i fi can t ECG co n t o u r ch an g es an d T ab n orm al it i es .”

3t ri ag ed M o s s as “ Lev el III,” b u t D r

. S t o k e s d id n o t as si g n M o s s to a t rack

, an d

St el m ach ers d i d n ot ap p ro ach Dr. St o k es ab o u t p l aci n g M os s o n o n e.

Dr. St o kes ev al u at ed Mo s s at 1 : 5 0 p.m

. Mo s s t o l d D r. St o kes t h at h e h ad

recen t l y un d erg o n e a s t res s t es t an d t h e res u lt s were n eg at i v e

. B a s e d o n M o s s ’ s

p h y s i cal ex am an d h i s t o r y, D r. St o k es do cu m en t ed s ev eral ri s k fact o rs fo r h eart

at t ack

, i n cl u d i n g a h i s t o ry o f h i g h ch o l es t ero l an d COPD an d a fam i l y h i s t o ry o f

co ro n ary art ery d is eas e, hy p ert en s i o n

, an d d i ab et es

. Mo s s t o l d Dr. St o k es t h at h e h ad

n o n au s ea o r v o m i t i n g

. Al t h o u gh M o s s h ad co m pl ai n ed of t h o s e s y m

p t o m s t o EM S

an d N u rs e St el m ach ers

, Dr. St o k es co u l d n o t recal l wh et her he s aw t h e rep o rt

d o cu m en t i n g M os s ’ s co m p lai n t s o f t h o s e s y m

p t o m s b efo re h e d eci d ed t o d i s ch arg e

M o s s

.

M o s s w a s d i s ch arg ed fro m t h e Em erg en cy D ep art m en t at 2 : 4 2 p .m

, h av i n g

recei v ed a s i n g le E C G an d s i n g l e t ro p o n i n t es t

. Dr. St o k es en t ered t h e d i s ch arg e

i n s t ru ct i o n s an d St el m ac h e r s w e n t o v er t h em wi t h M o s s

. T h e di s ch arg e p ap erwo rk

ad v is ed M o s s th at

, bas ed o n h i s ex am

, t he ex act cau s e o f h is ch es t p ai n was u n k n o wn

b u t h i s co nd i t i o n d i d n o t ap pear t o b e s e r i o u s an d t h e p ai n d i d n ot ap p ear t o b e

co m i n g fro m h i s h eart . M o s s d i ed t h e n ex t d ay

, at h i s ho m e, o f an acu t e m y o card i al

i n farct i o n

.

4M o s s’ s wi d o w b ro u g h t t h e i n s t an t m ed i cal m al p ract i ce act i on ag ai n s t Drs

.

St o k es an d Kal am

b ur Pan ch ap ak es an

, Nu rs e St el m ach ers

, an d M CCG, al l eg i n g t h at

t h ey fai l ed t o fo l l o w p ro p er p ro t o co l s wh en M o s s vi s i t ed th e Em erg en cy Dep art m en t

wi t h ch es t p ai n

, w h i ch led t o M o s s b ei n g p rem at u rel y d i s ch arg ed an d cau s ed h i s

d eat h

. M rs

. M os s vo l u n t ari ly di s m is s ed h er cl ai m s ag ai n s t Dr. Pan ch ap ak es an

. Aft er

M rs

. M o ss d i ed d u ri n g l i t i g at io n

, t h e M os s es ’ d au g h t er, Ev an s

, was s u b s t i t u t ed as t h e

p l ai n t i ff. Ev an s reach ed a s et t l em en t wi t h Dr. St o kes

, l e a v in g o n l y t h e cl ai m s

reg ard i n g Nu rs e St el m ach ers p en d i n g

.

Nu rs e St el m ach ers an d MCCG m o v ed fo r s u m m ary ju d g m en t

, an d t h e t ri al

co u rt g ran t ed th ei r m o t i on

, co n cl u d i n g t h at an y al l eg ed n eg l i g en ce by St el m ach ers

w a s n o t t h e p ro x i m at e cau s e o f Mo s s ’ s prem at ure d i s ch arg e b ecau se t h ere was

u n d i s p u t ed ev i d en ce t h at Dr. St oke s w ould h a ve d i sch arg ed M o s s ev en i f St el m ach ers

h ad q u es t i o n ed h i s d eci si o n. Th i s ap p eal fo l l o wed

.

In h er s ol e en u m erat i o n o f erro r, Ev an s arg u es t hat t h e t ri al co u rt erred wh en

i t g ran t ed s u m

m ary ju dg m en t t o M CCG becau s e t h e t o t al i t y o f th e ev i d en ce

s u rro u n d i n g M o s s ’ s d i s ch a r ge c r e a te d a f a ct i s s u e as t o wh et h er St el m ach ers ’ s al l eg ed

n eg li g en ce p ro x i m at el y

cau s ed M o s s ’ s d eat h

. W e ag ree.

5To reco v er i n a m ed i cal m al p ract i ce cas e, a p l ai n t i ff m u s t s h o w n ot o n l y

a v i o l at io n o f t h e ap p l icab l e m ed i cal s tan d ard o f care b ut al s o t h at th e

p u rp o rt ed v i o l at io n o r d ev i at i o n fro m t he p ro p er s t an d ard o f care i s th e

p ro x i m at e cau s e o f t h e i n

ju ry s u s t ai ned

. In o t h er wo rd s

, a p l ai n t i ff m u s t

p ro v e t h at t h e d efen d an t s ’ n eg l i g en ce was bo t h t h e cau se i n fact an d th e

p ro x i m at e cau s e o f h i s i nju ry

.

(Ci t at i o n o m it t ed .) Kn i

g h t v. Ro b er t

s

, 3 1 6 Ga. A p p

. 5 9 9

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

(2 0 1 2).

Cau s at i o n i n a m ed i cal m al p ract ice act i o n m u s t be es t ab l i s h ed t h ro u g h

ex p ert t es t i m o n y b ecau s e t h e q u es t i o n o f w h e t h er t h e al l eg ed

p ro fes s io nal neg l i g en ce cau s ed t h e p lai n t i ff’ s i n ju ry i s g en eral l y o n e fo r

s p eci al i zed ex p ert kn owl ed g e b ey o n d t h e ken o f t h e av erag e l ay p ers o n

.

B ut Geo rg i a cas e l aw req u i res o n ly t h at an ex p ert s t at e an o p i n i o n

reg ard i n g p ro x i m at e cau s at i o n i n t erm s st ro n g er t h an th at o f m ed i cal

p o s s i b i l i t y

, i

. e

., reas o n ab l e m ed i cal p ro b ab i li t y o r reas o n ab l e m ed i cal

cert ai n t y

. An d cau s at i o n m ay b e es t ab l i sh ed by l i n k in g th e t es t i m on y o f

s ev eral d i f

f e ren t ex p ert s an d m

u s t b e d et erm i ned i n l i gh t o f th e

ev i d en t i ary reco rd as a w h o l e. Fu rt h erm o re, i t i s we l l es t ab l i s h ed t hat

q u es t i o n s reg ard i ng cau s at i o n are p ecu l iarl y q u es t i o n s fo r t h e ju ry

ex cep t i n cl ear, p lai n , p al p ab l e an d u n d i s p ut ed cas es

.

(Pu n ct u at i on an d ci t at i o n s o m i t t ed ). Cen tr a l Ga

. W o m en ’s Hea l t h Cen ter

, LLC v.

Dea n

, 3 4 2 Ga. Ap p

. 1 2 7

, 1 3 4 (1 ) (b ) (8 0 0 S.E.2 d 5 9 4 ) (2 0 1 7 ). See a l s o Mo o re v.

S i n g h , 3 2 6 Ga. Ap p . 8 05 , 8 0 9 (1 ) (7 5 5 SE2 d 3 19 ) (2 0 1 4 ) (s am e).

6In h i s d e po s it i o n

, Dr. St o kes t es ti fi ed t h at he deci d ed t o d i s ch arg e M o ss

b ecau s e M o s s was as y m

p t o m at i c wh il e at t h e h o s p i tal

, h ad recen tl y had a n eg at i v e

s t res s t es t

, h ad an u n rem ark ab l e ECG, an d h ad u n rem ark ab le v it al s i g n s wh i l e at t h e

h o s p it al

. A l t h o u g h Mo s s ’ s t ro p on i n lev el was s l i g h tly e le va te d, D r

. S tokes co n s i d ered

t h at t o b e cl i n i cal l y u n rem ark ab l e. As t o t h e o r d e r t rack s, Dr. St o kes s t at ed t h at

, in

p ract i ce, i n i t iat i n g a fo rm al track i s o p t i o n al ; p h y s i ci an s us e o r o m it co m p o n en t s fro m

v ari o u s t rack s as th ey s ee fi t

. If Dr. St o k es wo ul d h av e a s s i g n ed M o s s to a fo rm al

t rack

, i t wo u l d h av e b een Track 4 fo r p ro b ab l e n o n -card i ac ori g i n ch es t p ai n

, wh i ch

,

as n o t ed ab o v e, d o es n o t req u i re s u bs eq u en t E C G s o r t ro p o n i n t es t i n g. Dr. St o k es

s t at ed t h at i f St el m ach ers h ad ap p ro ach ed h i m an d q u es t i o n ed h i s d eci s i o n to

d i s c h a r ge M o ss, h e s t il l wo u l d h av e d i s ch arg ed M o s s un l es s St el m ach ers sh ared s o m e

ad d it i o n al i n fo rm at i o n wi t h h i m

. He fu rt h er s tat ed t h at

, ev en k n o wi n g ev ery t h i n g in

t h e reco rd

, h e was n o t aware o f an y fact s t h at s h o u l d hav e rai s ed a co n cern p ri o r t o

d i s ch arg e.

Ev an s pres en t ed ex p ert wi t nes s t es t i m o n y fro m Sep t em b er Lee Ev an s , R. N.,

w h o t e s ti fi ed t h at

, bas ed o n M o s s ’ s h i s t o ry an d co m p l ai nt s wh en h e arri v ed at t h e

Em erg en cy Dep art m en t

, St el m ach ers s h ou l d h av e t ri ag ed hi m as th e m o re u rg en t

7Lev el II rat h er t h an L ev el III. Acco rd i n g to Nu rs e E v an s

, St el m ach ers f u r t h er

b r e a c h e d t h e s t an d ard o f care b y fai l i n g to co m p l et e t h e req u ired t ri ag e fo rm

, a n d

Nu r s e E v a n s ex p l ai n ed t h at a co m p l et ed fo rm refl ect in g al l o f Mo s s ’ s s y m p t o m s

m i g h t h av e cau s ed Dr. St o k es t o o r d e r s eri al ECG o r t ro p on i n t es t s

. In ad d i t i o n,

St el m ach ers fai l ed t o ad vo cat e fo r Dr. St o k es t o p l ace M o s s o n a fo rm al t rack o rd er,

o r at l eas t t o co n d u ct m o re t es t i n g s u ch as a s eri al ECG an d s eri al tro p o ni n t es t

, an d

t h i s lack o f ad v o cac y was a b reach o f t h e s t an d ard o f care i n l i g h t o f M o s s ’ s

b o rd erl i ne E CG an d el ev at ed t ro p o n i n l ev el

. Nu rs e Ev an s n o t ed th at i f Dr. St o k es was

n o t recep t i ve, a n u rs e can g o u p t h e ch ai n o f co m m an d t o ad v o cat e fo r h er p at i en t

.

Sh e al s o n o t ed th at a l t h o u g h St el m ach ers was aware t h at M o s s h ad co m p l ai n ed o f

v o m i t i n g

, Dr. St o kes ap p aren t ly was n o t aware o f t h at s y m p t o m

. Th u s

, Nu rs e Ev an s

co n cl u d ed t h at Nu rs e St el m ach ers ’ s b reach es of t he s t an d ard of care, “ t o a reas o n ab l e

d eg ree of m ed i cal cert ai nt y

, cau s ed an d / o r co nt ri b u ted t o M r. M os s ex p eri en ci n g an

u n m o n i t o red an d u n t reat ed det eri o rat i o n i n h i s co n d i t i o n

, a d el ay i n m ed i cal care an d

t reat m en t

, an d an o u t o f h o sp i tal card i ac arres t wh i ch cau s ed an d co n tri b ut ed t o M r.

M o s s ’ [s ] d eat h .”

An o th er ex p ert wi t n es s

, Dr. Ro b ert At t aran

, M

. D. tes t i fi ed t h at

, i n h i s m ed i cal

o p i n i o n

, M o s s ’ s p rem at u re d i s ch arg e “ al m o st cert ai n l y l ed to h is d eat h .” He t es t i fi ed

8t h at t h e s ig n s an d sy m p to m s o f ac ute c o ro nary sy n d ro m e i n cl u de ch es t d is co m fo rt an d

n au sea. He al s o t es t i fi ed t hat “ [a] n acu t e t ro p on i n el ev at i o n i s m y o card i al in farct i o n

u n t i l p ro v en o t h erwi s e.” A s Dr

. At t aran ex p l ai n ed

, o n e t es t al o n e wo u l d n o t g i v e a

d efi n i t i v e an s wer as t o wh et h er a p at ien t ’ s hi g h tro p o ni n l ev el i s p art o f a wo rri s o m e

u p ward t ren d, so t ro p o n in l ev el s s h o u l d b e m eas u red ev ery few h o u r s t o d et erm i n e

i f t h ey are tren d i n g up ward

. Dr. At t aran n o t ed t h at al t h o u gh t h e ul t i m at e d eci s i o n to

d i s ch arg e a pat i e n t i s m a d e b y t h e p h y s i ci an

, t h ere are “ ch eck s an d b al an ces i n t h e

p ro t o co l t o en s u re t h at th e p h y s i ci an d o es n ’ t m i s s s o m et h i ng [.] ” Th os e p ro t o co l s

i n cl u d e v ari o u s t rack o rd er s et s t o treat p at i en t s wh o pres en t wi t h ch es t pai n

, an d t h e

t rack s et sy s t em was no t fo l l o wed i n t h is cas e. Dr. A t t aran o p i n ed t h at

, i f St el m ach ers

h ad ex p res s ed co ncern ab o ut M o s s ’s el ev at ed t ro po n i n l ev el an d ri s k fact o rs

, Dr.

St o k es m i g h t h av e reco n s id ered h i s d eci s i o n t o d i s ch arg e M o ss

.

W e co n cl ud e fro m t h i s reco rd t h at t h ere is a g e n u i n e fact is s u e as t o wh et h er

Nu rs e St el m ach ers ’ s act i o n s were a p ro x im at e cau se of M o s s ’ s d eat h

. W e fi rs t n o t e

t h at

, i n t hi s cas e, Ev an s pres en ted ex pert t es ti m o n y t h at M o s s ’ s p rem at u re d i s ch arg e

“ al m o s t cert ai n l y l ed t o h i s d eat h .” An d al t h o u g h it was Dr. St o k es wh o m ad e t h e

d eci s i o n to d i s ch arg e M os s

, t h at d o es n o t ab so l v e Nu rs e St el m ach ers fro m l i ab i l i t y

.

See, e.g

., Kn i

g h t v. Ro b er t

s

, 3 16 Ga

. A p p

. 5 9 9

, 6 0 9 (1 ) (b ) (7 3 0 S.E.2 d 7 8 ) (2 0 1 2 )

9(“ In li g h t o f ev i d en ce t h at [t h e fi rs t d o ct o r ] ’ s n eg l i g en ce was ‘ a l i n k i n th e ch ai n o f

i n co rrect d eci si o n s m ad e wi t h reg ard t o [t h e p lai n t i ff’ s ] t reat m en t[,] ’ a ju ry q u es t i o n

o f p ro x i m at e cau s e ex is t ed .”).

Ev an s ’ s ex p ert wi t n es s es t es t i fie d tha t S te lm a ch ers ’ s b reach es i n th e ap p l i cab l e

s t an d ard o f care

– i n cl ud i n g her fai l u re t o en s u re a t rack o rd er set h ad b een as s i g n ed

b y t h e d o ct o r, fai l u re t o co m m u n i cat e wi t h Dr. St o k es ab o u t M o s s ’ s el ev at ed t ro p o n in

l ev el

, fai l u re t o ad v o cat e fo r ad d i t i o nal tes t in g

, an d fai l ure t o co m p l et e t h e req u i red

t ri ag e fo rm

– cau s ed o r co n t ri b u t ed t o M o ss ’ s p rem at u re d i sch arg e. In h er affi d av i t

,

Nu rs e E v an s cl ari fi ed t h at s h e b el i ev ed

, “ t o a reas o n ab l e d eg ree o f m ed i cal cert ai n t y ,”

t h at Nu rs e St el m ach ers ’ s b reach es o f t h e s t an d ard o f care c a u s e d o r co n t ri b u t ed to

M o s s ’s p r e m at u re d i s ch arg e. 3 Al s o

, D r. At t aran t es t i fi ed t h at h os p it al p ro t o co l

3 T h e ap p el l ees co n t en d t h at Nu rs e E v an s w a s n o t q u al i fi ed t o t es t i fy as to

cau s at i o n i n t h i s cas e b ecau se t h at i s s u e fal ls wi t h i n th e p u rv i ew o f a m ed ical d o ct o r.

Bu t t h e i ss u e h ere co n cern s t h e i d en t i fi cat i o n o f s i g n s an d s y m p t o m s rat h er t h an a

m e d i cal di ag n os i s, an d wh et her St el m ach ers ’ s fai l u re t o i den t i fy Mo s s ’ s s i g n s an d

s y m p to m s an d co m

m u n i cat e t h em t o Dr. St ok es l ed t o M os s ’ s p rem at u re d is ch arg e.

See Fr eema n v. LTC Hea l th ca r e o f S t at es b o r o

, In c.

, 3 2 9 Ga. Ap p

. 7 6 3

, 7 6 6 (7 6 6

SE2 d 1 2 3) (2 01 4 ) (“ Geo rg i a law d o es n o t m an d at e t hat o n ly m ed i cal d o ct o rs b e

p erm i t t ed t o t es t ify reg ard i n g m ed i cal i s s u e s ; o t h ers wi th cert ai n trai n i n g an d

ex p eri en ce m ay tes ti fy o n i s su es wi t hi n t h e p aram et ers o f t h ei r ex p ert i se.

. . Th i s ru l e

ex t en d s t o a l i cen sed reg i s t ered n u rs e t es ti fy i n g as an ex p ert wi t h i n t he areas o f h er

ex p ert i s e.”) (ci t at i o n s an d p u nct u at i o n o m it t ed ). Here, Dr. At taran t es t i fi e d t h at

M o s s ’ s prem at u re d i s ch arg e l ed t o h i s deat h

, an d Nu rs e Ev an s

, a fo rm er em erg en cy

ro o m nu rs e an d cl i n ical n u rs e t eam l ead er, t es t i fi ed t hat St el m ach ers ’ s b reach es i n t h e

10i n cl u d es “ ch ec k s a n d b al an ces ” t o m ak e s ure th at t h e ph y s i ci an do es n o t m i ss

an y t h i n g

, an d h e an d Nu rs e Ev an s t es t i fi ed th at M o ss m ay n o t h av e b een d i s ch arg ed

i f Nu rs e St el m ach ers h ad cal l ed at t en t i o n t o h i s el ev at ed t ro p o n in l ev el or ot h er ri s k

fact ors

. Th ere was al s o e v i d e n c e th at

, ev en i f Dr. St o k es had n o t been recep t i v e to

St el m ach ers ’ s ad vo cacy

, s h e co u l d h av e reach ed o u t to a ch arg e n u rs e o r o t h er

p h y s i ci an

. Th i s t es t i m o n y creat es a q u es ti o n fo r t h e j u r y a s t o wh et h er Nu rs e

St el m ach ers ’ s b r e a c h e s i n t h e s t an d ard o f care were a p ro x i m at e cau s e o f M o s s ’ s

p rem at u re d i s ch arg e, wh i ch l ed t o h i s d eath. S e e C e n t r a l Ga

. W

o m en ’s Hea l th Cen t er

,

LLC

, s u p ra, 34 2 Ga. Ap p

. at 1 3 4 (1 ) (b ) (q u es ti on o f pro x i m at e cau s e i s fo r t h e ju ry

ex cep t i n “ cl ear, p l ai n, p al p ab l e an d u n d i s p ut ed cas es ”); Mo o r e

, 3 2 6 Ga. Ap p

. at 8 0 9

(1 ) (s am e); Pea ch Bl o s s o m Dev. Co

. , s u p ra, 30 0 Ga. Ap p

. at 2 69 (s u m m ary ju d g m en t

i s i m p r o p e r i f o p p o s in g p art y p ro d u ces ev en s l i g ht ev i d en ce g i vi n g ri s e t o a t ri ab l e

i s su e o f m at eri al fact ).

M CCG’ s rel i an ce o n o u r d eci s i o n s i n S wi nt v. Ma e

, 3 4 0 Ga. Ap p

. 4 8 0 (7 9 8

SE2 d 2 3) (2 01 7 ) an d Reeves v. Ma h a t h r e

, 3 2 8 Ga. Ap p

. 5 4 6 (7 5 9 SE2 d 9 26 ) (2 0 1 4 )

( p h y si cal p reced en t o n l y ), i s m i s p l aced b ecau se t h o s e cas es are d i s t i n g u i s ha b l e

. I n

n u rs i n g s t an d ard o f care, i n cl u d i n g h er fai l u re to i d en t i f y M o s s ’s s y m

p t o m s

,

co n tri b u t ed t o t hat p rem at u re d i s ch arg e

. Th u s

, we co n cl u d e t h at Nu rs e Ev an s ’ s

t es t i m o ny fal l s wi t h i n t h e s co p e o f h er ex p ert i s e.

11S

wi nt

, t h e p at i en t ’ s s h o u l d er was i n ju red wh i le he was u n d erg o i n g a p ro s t at ect o m y

.

S wi nt

, s u p ra, 3 4 0 Ga. Ap p

. at 4 8 1

. Du ri n g t h e s u r g e r y, h e was i n a Tren d el en b u rg

p o s i t i on wi t h h i s arm s t u ck ed t o h i s s i d es . Id . at 4 81 . Th e ex pert wi t n es s es t es t i fi ed

t h at t h ey were u n cert ai n wh at l ed t o t h e p at i en t ’ s i n ju ry ; it co ul d h av e res u l t ed ei t h er

fro m t h e i n i t i al po s i t io n i n g

, th e l en g t h o f t h e s u rg ery

, o r b o t h

. Id

. at 4 8 2

. Th e ex p ert

wi t n es s es al s o ack n o wl ed g ed t hat

, p ri o r t o t h e p at i en t ’ s s urg ery i n 2 0 1 0, t h ere was n o

m ed i cal li t erat u re o r s t at i s t i cal d at a ad v o cat i ng t h at a p at i en t u n d erg o i n g th i s t y p e o f

s u rg ery b e rep o s i t i o n ed si m p l y b ecau s e o f t he l en g t h o f t h e su rg ery

. Id

. at 4 83

. Th u s

,

i t w as n o t cl ear wh et her t h e p at i en t ’ s i n i t i al p o s it i on i n g o r t h e l ack o f rep o s i t i o n i n g

cau s ed h i s i nju ry an d t h erefo re, ev en i f t h e d efen d an t s had p rev en t ed t h e l ack o f

rep o s i t i o ni n g

, t h e p at i en t s t i l l m ay h av e b een i n ju red

. Id

. at 4 8 4 (1 ). Here, h o wev er,

t h ere i s ev i d en ce i n t h e reco rd es t a b l i s h i n g t h at it was t h e p rem at u re d i s ch arg e t h at

cau s ed M o s s ’ s i n

ju ry

. An d

, a s disc usse d a

b o v e, t h ere w as ev i d en ce t h at St el m ach ers ’ s

b reach es i n t h e s t an d ard o f care co n t ri b u t ed t o t h at p rem at ure d is ch arg e.

In Reeves

, a p at i en t wen t t o t h e em erg en cy ro o m w i th co m p l ai n t s o f n au s ea an d

s ev ere p ai n i n h er ab do m en an d ri g h t fl an k. R eeves

, s u p ra, 32 8 G a. Ap p. at 5 4 7

. Th e

em erg en cy ro o m p h y s i ci an d i s ch arg ed t h e pat i en t wi t h in st ru ct i o n s t o fo l l o w u p wi th

h er p ri m ary -care p h y s i ci an

. Id

. Th e n ex t m o rn in g

, a CT s can rev eal ed t h at t h e p at i en t

12h ad a k i d n ey s t o n e

. I d

. T h e p at i en t u l ti m at el y d i ed of s ep s i s

, an d

, in t h e res u l t i n g

wro ng fu l -d eat h l aws u it

, t h e p lai n t i ffs arg u e d t h at t h e em erg en cy ro o m d o ct o r was

l i ab l e fo r m ed i cal m al pract i ce fo r fai l i n g t o o rd er a CT s can o r d i ag n o s e t h e k i d n ey

s t on e b efo re d i s ch arg i ng t h e p at i en t . Id . at 5 4 8 . Bu t t h e ev i d en ce s h owed t h at i f t h e

d o ct o r h ad d i ag no s ed t h e p at i en t wi t h a k i d n ey s t o ne, h e wo u l d hav e co n s ul t ed wi th

a u ro l o g i s t . Id

. at 5 4 9

. An d t h e u ro l og i st wh o u lt i m at el y t reat ed t he p at i en t t es t i fi ed

t h at i f t h e em erg en cy ro o m d o ct o r h ad co n s u l t ed h i m

, h e w o u l d h av e ad v i s ed t h e

d o ct o r t o d o ex act l y wh at h e d i d : sen d t h e p at i en t h om e t o s ee i f s h e w o u ld p as s t h e

s t on e i n dep en d en t l y

. Id

. at 5 4 9 -5 5 0

. In ad d it i on

, a cau sat i o n ex p ert t es ti fi ed t h at t h e

p at i en t h ad n o o b vi ou s s i g n s o f a u ri n ary i n fect i o n wh en s h e w en t t o th e em erg en cy

ro o m

, an d h e s t at ed t h at h e h ad n o op i ni o n o n wh et h er t h e em erg en cy ro o m d o ct o r

cau s ed o r co n t ri bu t ed t o t he p at i en t ’ s d eat h. Id

. at 5 5 0 . In l i gh t o f t h is ev i d en ce, we

co n cl u d ed t h at th e d efen d an t s were en t it l ed t o s u m m ary ju d g m en t d u e to a l ack o f

ev i d en ce as t o cau s at i o n

. Id . at 5 5 0 -5 5 1.

Here, u n l i k e i n Reeves

, t h ere i s ev i d en ce s u g ges t i n g t h at t h e p at ien t warran t ed

care h i s treat i n g p hy s ici an d i d n o t p ro vi d e t o h i m

. Ex p ert s tes t ifi ed t h at M o s s s h o u ld

h av e b een p l aced o n t h e L ev el II t rack o rd er an d t h at h i s t ro p o n i n l ev el s sh o u l d h av e

b een m o ni t o red o v er s ev eral ho u rs b efo re h e was d i s ch arg ed

. Fu rt h er, a card i o l o g i s t

13wh o rev i ewed M o s s ’ s E CG t es t i fi ed t h at i t h ad s i g n i fi can t ab no rm al i t i es

, i n co n t ras t

t o D r. St o k es ’ s i n terp ret at io n o f t h e t es t as un rem ark ab l e. To t h e e x t en t Nu rs e

St el m ach ers fai l ed t o perfo rm act i o n s

– s u ch as cal l i n g Dr. St o k es ’ s at ten t i o n to

M o s s ’ s tro u b l i n g sy m

pt o m s

, i ncl u d i n g h i s n au s ea an d v o m i t i n g

, o r ad v o cat i n g fo r

M o s s t o b e p l aced o n a t reat m en t o rd er t rack

– t hat wo u ld h av e m ad e i t m o re l i k el y

fo r M os s t o b e p ro v i d ed wi t h t h e care t h at was warran t e d

, t h i s s i t u at i o n i s

d i s t i n gu i sh ab l e fro m th at i n Reeves

, wh ere t h e m i s s ed d i ag n o s i s wo u l d h av e t ri g g ered

a co n s u l t wi t h a u ro l o g i s t b u t wo u l d n o t h av e res u lt ed i n an y ch an ge i n t h e p at i en t ’ s

t reat m en t

. Co n s eq u en t ly

, we d o n o t fi n d Reeves t o b e co nt ro l l i n g, an d

, fo r t h e reas on s

s t at ed ab o v e, we co n cl u d e t h at g en u i ne i s s u es of m at eri al fact rem ai n as t o wh et h er

St el m ach ers ’ s n eg l i g en ce p ro x i m at el y cau sed M o s s’ s deat h a n d t hat t h e t ri al co u rt

t h erefo re erred b y

g ran t i n g s u m

m ary ju d g m en t

.

Acco rd i ng l y

, we rev ers e t h e t ri al co u rt ’ s g ran t o f s u m m ary ju d g m en t t o M CCG

an d St el m ach ers

.

Ju d g men t r ever sed . Ho d g es a n d Pi p ki n , JJ., co n cu r

.

14