FI FTH DI VI SI ON

M CFA DDEN, P. J.

, BRA NCH and BETHEL, 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 l s .us /r ule s

October 26, 2017



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 7 A0 80 6

. KIDNEY et al

. v

. EASTSIDE M EDICAL CENTER

LLC et al

.

M C F A D D E N , Pres id i n g J u d g e.

Ti ffan y J en n i n gs -Perry d i e d fro m a v o l v u l u s

, or an ab n o rm al t wi s t i n g o f t h e

i n t es ti n e cau s i ng o b s t ru ct io n. 1 In t h e d ay s b efo re h er d eat h

, sh e t w ice h ad go n e t o t h e

em erg en cy ro o m at Eas t si d e M ed i cal Cen t er, co m p l ai n i ng o f ab d o m i n al p ai n

, b u t t h e

em erg en cy

ro o m d o ct o rs h ad d i s ch arg ed h er, fi n d in g h er co n di t i o n t o b e s t ab l e.

Gwen d o l y n Ki d n ey

, J en n i n g s -Perry ’ s m o t h er an d t he ex ecu t o r of h er es t at e,

an d Th u rn a Ray Perry

, J r

. , t h e fat h er o f J en ni n g s -Perry ’ s ch i l d, fi l ed t h is act i o n

ag ai n s t t h e h o s p i t al

, t h e two em erg en cy ro o m d o ct ors wh o s aw h er an d t h ei r

em pl o y ers , t he rad i o lo gi s t wh o read h er CT s can an d h i s em p l o y er, an d o t h ers . Th e

1 Th e Am eri can Heri t ag e M ed i cal Di ct i o n ary (2 00 7 ). Ret ri ev ed J u l y 2 6 , 2 0 1 7

fro m h t t p : / / m ed i cal -d i ct i o n ary .t h efreed i ct io n ary .co m / v o l v u l us

.t ri al co u rt g ran t ed t h e m o t i on s f o r s u m m ary j u d gm en t fi l ed by t h e h o s p i t al

, t h e

em erg en cy ro o m d o ct o rs an d t h ei r em pl o y ers

, an d t h e rad i o l o g is t an d h i s em p l o y er.

It al s o den ied t h e p l ai n t i ffs ’ m o t i on t o am en d t h e co m p l ai n t . Th e p l ai n t i ffs ap p eal

.

Th e p l ai n t i ffs arg ue t h at t h e t ri al co u rt erred b y d en y in g th ei r m o t i o n t o am en d

t h e co m p l ai nt

. Bu t t hey hav e n o t s h o wn t h at t h e t ri al co u rt m an i fes t l y ab u s ed h i s

d i s cret i o n in d en y i n g th e m o t i o n

. Th e p l ai n t i ffs arg u e t h at t he t ri al co u rt erred by

g ran t i n g t h e d efen d an t s ’ m o t i o n s fo r su m m ary j u d gm en t. W e ag ree wi t h t h e p l ai n t i ffs

t h at d i s p u t ed is s u e s o f f a ct co n t ro l wh et h er t h e h ei gh t en ed ev i d en ti ary b u rd en

i m p o s ed b y t h e e m e rg en cy m ed i cal care st at ut e, OCGA § 5 1 -1 -2 9 .5

, ap p li es t o t h e

cl ai m s ag ai n s t t hes e d efen d an t s

. So we d o n o t reach t h e d o c t o rs ’ arg u m en t t h at t h e

p l ai n t i ffs p res en ted n o ev i d en ce t h at t h ey were g ro s s l y n eg l i g en t

. Bu t w e fi n d t h at t h e

p l ai n t i ffs h av e fai l ed to po in t to an y ev i d en ce o f n eg l i g en ce on t h e p art o f t h e h o s p i t al

o r i t s em p l o y ees

. So we affi rm t h e g ran t o f th e h o s p i tal ’ s m o t i on fo r s u m m ary

ju d g m en t

. In s u m

, we affi rm t h e d en i al o f t he p l ai n ti ffs ’ m o ti o n t o am en d t h e

co m p l ai n t

, we rev ers e t h e g ran t o f sum m ary ju d g m en t to t h e em erg en cy ro o m d o ct o rs

,

t h e rad i o l o g i s t

, an d t hei r em p l o y ers

, an d we affi r m t h e g ran t o f s um m ary ju d g m en t

t o t he h o s p i t al

.

1

. Fa ct s

.

2“ W e rev i ew t h e g ran t o f su m m ary ju d g m en t d e n o vo

, v i ewi n g t he ev i d en ce in

t h e reco rd

, as wel l as al l i n feren ces th at m i g ht reas o n ab l y b e d rawn fro m t h at

ev i d en ce, i n t h e l i g h t m o s t fav o rab l e t o t h e n o n -m o v i n g p art y .” Bo n d s v. Nes b i t t

, 3 2 2

Ga. Ap p . 8 5 2 (1 ) (7 4 7 SE2 d 4 0 ) (2 0 1 3) (ci t at i o n o m it t ed ).

So v i ewed

, th e ev i d en ce s h o ws t h at earl y i n t h e m o rn i n g o f Sat u rd ay

, Ap ri l 2 8,

2 0 1 2

, J en n i n gs -P e r r y w e n t t o Eas t si d e’ s em erg en cy d ep art m en t becau s e s h e was

ex p eri en ci ng ab d om in al p ai n. J en n i n g s -Perry s aw nu rs es

, a t ech n i ci an

, an d d efen d an t

J o h n Li m eh o us e, t h e em erg en cy ro o m p hy si ci an

.

Acco rd i ng t o Li m eh o u se, J en n i n g s -Perry t o l d h i m t h at h er p ai n was m o d erat e.

Bu t sh e t o l d t h e Eas t si d e n u rs e wh o to o k her h i s to ry t h at h er p ai n l ev el was a 1 0 an d

t h en a 9 on a s cal e fro m 1 to 1 0

. L i m e h o u s e d i s co u n ted t h e rel iab i l i t y o f J en n i n g s

Perry ’ s rep o rt t o t h e n u rs es ab o u t t h e i n t en s i t y o f h er p ai n b as ed o n h i s i n t eract i o n

wi t h h er.

Li m eh o u s e was aware t h at J en n i n gs -Perry h ad h ad a Ro ux -en -Y g as tri c b y p as s

y ears befo re. Li m eh o u s e d i ag n o s ed Je nnings- Perry wi t h “ ep i g as tri c ab d o m i nal p ai n,”

o r p ai n at t h e t o p o f th e ab d o m en

, wh i ch h e ch arac t e r i z e d as a “ n on s peci fi c b ro ad

d i ag n os i s” t h at co u l d en co m pas s m o re t h an a t h o u s an d d i fferen t ai l m en t s

. B e c a u s e

J en n in g s-Perry ’ s p ai n was fai rl y m i l d

, Li m eh o u s e t es t i fi ed

, s he was g i v en v i s co u s

3l i do cai n e t o n u m b t h e es o p h ag u s a nd stom ach

, an d M y l an t a, m ed i ci n es t h at were “ ju s t

ab o ve” wh at a p ers on can g et o v er-t h e-co u n ter.

Li m eh o u s e ex pl ai n ed t hat as an em erg en cy ro o m p h y s i ci an

, h i s j o b was t o ru l e

o u t acu t el y l i fe-t h reat en i ng ev en t s an d t o get t h e p at i e n t to t h e n ex t s tep i n t h e

t reat m en t al g ori th m . Bas ed o n J en n i n gs -Perry ’ s s i g n s an d s y m pt o m s

, h e co n cl u d ed

t h at her co n di ti o n was n o t a c u t el y l i fe-t h reat en i n g an d th at s he was s t ab l e, s o h e

d i s ch arg ed h er. H e p res cri b ed Vi co d in fo r p ai n, Zo fran f o r n a u s ea, an d Pri l o s ec to

h eal t h e l i n i n g o f t h e s t o m ach

, an d i n st ru c t e d h er t o d ri n k p l en ty o f fl u i d s an d to

fo l l o w u p wi t h h er d oct o r i n t h ree d ay s

, ev en i f s h e fel t wel l.

W i t h i n t h ree h o urs

, J en n i n gs -Perry was ret u rn ed t o t h e E as t si d e e m e rg en cy

d ep art m en t b y am

b ul an ce. Eas t s i d e nur s e s r e c or de d tha t Je nning s -Perry was s u fferi n g

a 9 an d t hen a 1 0 o u t o f 1 0 o n t h e p ai n i nt en s it y s cal e.

Defen d an t Kam l es h Gan d h i was t h e em erg en cy ro o m p hy s i ci an wh o s aw

J en n in g s-Perry at t hi s s eco n d v i s i t

. Gan d h i was aware t h at J en n in g s -Perry had b een

t o t h e em erg en cy ro o m earl i er an d h e rev i ewed t h e ch art o f h er earl i er v is i t

. J en n i n g s

Perry t o ld h i m

t h at t h e Vi co d i n p res cri b ed b y Li m eh o u s e h ad n o t rel i ev ed h er p ai n.

Bu t G an d h i d i s co u n t ed t h e rel i ab i l i t y o f h er rep ort o f h er p ai n b a s ed o n h i s

o b s erv at i o n : s he d i d n o t ap p ear t o b e i n t h at m u ch p ai n, s h e was n o t g ri m aci n g in

4p ai n

, s h e was no t cry in g

, sh e was t al k in g n o rm al l y o n h er cel l p h o n e, h er v it al s i gn s

were n o rm al

, an d s h e d i d n ot ex h i b i t an y s i g n s o r s y m p t o m s o f s ev ere p ai n. Gan d hi

g av e J en n i n gs -Perry Di l au d i d fo r p ai n an d Ph en erg an fo r n au s ea.

Gan d h i ord ered an u l t ras o u n d

, t h i n k i n g t h at J en ni n g s -Perry ’ s s y m p t o m s m i g ht

b e rel at ed t o h er g al l b l ad d er, an d a CT s can o f h er ab d om en wi t h IV co n t ras t “ t o ru l e

o u t an y li fe-t h reat en i n g si t u at i o n ,” s u ch as p erfo rat i o n o f t h e s t o m ach

. A t ech n i ci an

em pl o y ed b y t h e h o s p i t al p erfo rm ed th e CT s can

. Defen d an t rad i o l o g i s t Ro b ert

Ku b ek rev i ewed t h e CT s can o n h i s co m p u t er screen

, bu t he n ev er m et o r s po k e wi th

J en n in g s-Perry

. Ku b ek s aw n o t h i n g t h at req u ired su rg i cal in terv en t i o n

, ad m i s s i o n to

t h e h o s p it al

, or fu rt h er wo rk u p . Ku b ek s aw s wi rl i n g o f t h e m es en t ery 2 i n J en n i n g s

Perry ’ s CT s can

, b u t h e d i d n o t m ak e a n o tat i o n o f i t b ecau s e h e d i d no t b el i ev e t h at

i t was s i g n i fi can t

, gi ven t he cl in i cal fi n d i ng s as rel at ed b y Gan d h i ; h e b el iev ed t h at

t h e i m ag e s i m

p l y s h o wed J en n i n g s -Perry ’ s p o s t -g as t ri c b y pas s an at o m

y

. Ku b ek

ex p lai n ed t h at a rad i o l o g i s t can n o t t e l l w h e t h er a s wi rl in g of t h e m es en t ery as

d ep ict ed o n a CT s can i s acu t e o r n o nacu t e; t h e fi nd i n g s m u s t b e co rrel at ed wi t h t h e

2 Th e m es en t ery i s “ [a] n y o f s ev eral fo l d s o f t h e p eri t o neu m t h at co n n ect t h e

i n t es ti n es t o t he d ors al ab d o m i nal wal l .” T h e Am eri can H eri t ag e Med i cal Di ct i o n ary

(2 0 0 7). Ret ri ev ed J u l y 2 0 , 2 0 1 7 fro m h t t p : / / m ed i cal -d i ct i o nary .t h efreed i ct i o n ary

.

co m / m es en t ery

.

5cl i n i cal fi n di n g s as ev al u at ed b y t h e em erg en cy ro o m ph y s i ci an

. Acco rd i n g t o Ku b ek

,

a swi rl i n g o f t h e m es en t ery co u l d i n d i cat e an ab n o rm al i t y

, s u ch as i n t ern al h ern i at i o n

wi t h s t ran g u l at i o n o f t he s m al l b o wel

, i f t h e p at i en t al s o h as s ev ere ab d o m i n al p ai n

o r o t h er s y m

p t o m s

.

Ku b ek an d Gan d h i d is cu s s ed J en n i n g s -Perry ’ s cl i n i cal h i s t o ry

, i n cl ud i n g t h at

s h e was ex p eri en ci n g m i l d p ai n an d t h at h er ex am i n at i o n was b en ig n

, wi t h

, as Ku b ek

d es cri b ed i t , “ n o g u ard i ng

, n o reb o u n d [o r react i o n t o p h y s i cal t o u ch ] , n ot t en d er,”

an d t h ey d i s cu ss ed t h e res u l t s o f t h e s can

. K u b ek t ol d Gan dh i t h at t h e CT s can was

co m p l et el y n o rm al an d un rem ark ab l e. A cco rd i ng t o Gan d h i

, t hi s ru led o u t vo l v u l u s

o f t h e b o wel s

.

Bu t at t h e t i m e Ku b ek rev i ewed Jen n i ng s -Perry ’ s CT s can

, h e d i d n o t k n o w t h at

s h e had v i s i t ed t h e em erg en cy d ep art m en t h o urs b efo re an d he d i d n o t recal l Gan d hi

t el l i n g h i m h ow l o n g sh e h ad b een ex p e r i en ci n g p ai n. Gan d hi t es t i fi ed t h at h ad h e

b een i n f o r m e d o f th e s wi rl i n g o f t h e m es en t ery

, wh i ch h e co n s i d ered t o b e an

ab n orm al fi n d i n g, h e wo u l d h av e co n su l t ed wi t h a g en eral s urg eo n o r h o sp i t al i s t o r

h ad J en n i n g s -Perry ad m i t t ed to t h e h o s p i tal fo r o b s erv at i o n an d fu rt h er s t ud i es o r reev al u at i on

.

6Th at w as Ku bek ’ s an d Ga n d h i ’ s o n l y co n v ers at io n ab o u t J en n i n g s -Perry

.

Gan dh i di d n o t b el i ev e t h a t J en n i n g s -Perry was i n an i m m ed i at el y l i fe-t h reat en i n g

co n di t i o n

. He d et erm in ed t h at J en n i n g s-Perry ’ s m ed i cal co nd i t i o n was s t ab l e an d t h at

h e r p ai n h ad b een co n t ro l l ed

, s o h e d i sch arg ed h er fro m t he h os p i t al

. Gan d h i

p res cri bed Tram ad ol fo r p ai n an d in s tru ct ed h er to s e e a g a s t ro en t ero l o g i s t as s o o n

as p o s s i b l e. Gan d h i co n si d ered m o re t han a d o zen cau s es fo r J en n i n g s-Perry ’ s

ab d om i n al p ai n

, b u t h e h ad n o t reach ed a sp eci fi c d i ag n os i s wh en h e d i s ch arg ed h er.

O n M o n d ay

, Ap ri l 3 0

, 2 0 1 2, J en n i ng s -Perry was s een by g as t ro en t ero l o g i s t

San j ay Pari k h

, a d efen d an t wh o i s no t a p art y t o t h i s ap p eal

. He d et erm i n ed t h at s h e

was s i ck an d n eed ed t o b e i n t h e h o s p i t al

. He t o ld h er h e wo u ld d i rect l y ad m i t h er to

t h e h o sp i t al o r s h e co u l d g o t o t h e em erg en cy ro o m . Sh e refu s ed b ot h o pt i o n s

.

A fri en d o f J en n i n g s -Perry fo u n d her dead in h er ap art m en t t h e nex t d ay

. Th e

m ed i cal ex am i n er d et erm i n ed as t h e cau s e of d eat h “ s m al l in tes t i n al i s ch em i a 3 d u e to

v o l v u l u s o f s m al l in t es t i n e.” Sh e d et erm i n ed as an o t h er s i g n i fi can t co n di t i o n “ rem o t e

Ro u x -en -Y g as t ri c b y

p as s s u rg ery .”

3 An i s ch em i a i s “ [a] d ecreas e in t h e b l o o d s u p p ly t o a b o di l y o rg an

, t i s s u e, o r

p art cau s ed b y co n s tri ct i o n o r o bs t ru ct i o n o f t h e b l o o d v e s s e l s .” Th e Am eri can

H e r i t a g e M e d i c a l Di c t i o n a r y ( 2 0 0 7 )

. R e t r i e v e d J u l y 2 0

, 2 0 1 7 f r o m

h t t p : // m ed i cal -d ict i o n ary .t h efreed i ct i o n ary .co m /i s ch em i a.

72

. Den i a l o f p l a i n t i ff s ’ mo t i o n t o a men d

t he co mp l ai n t

.

Th e p l ai n t i ffs en u m erat e as erro r t h e t ri al co u rt ’ s d en ial of t h ei r m o t i o n to

a m en d t h ei r co m

p l ai n t t o ad d a cl ai m u n d er t h e Fed eral Em erg en cy M ed i c a l

Treat m en t an d Act i ve Lab o r Act

, 4 2 USC § 13 9 5 d d

, ag ai n s t Eas t si d e. W e di s ag ree.

(To t h e ex ten t t h e pl ai n t i ffs arg u e t h at t h e t r i a l co u rt erred b y d en y i n g t h ei r m o t i o n

t o ad d a cl ai m ag ai n s t L i m eh o u s e, Gan d h i, an d Ku bek fo r v i o lat i o n o f t he Act

, we

o b s erv e th at t h e reco rd co n t ai n s n o m o t io n t o ad d s u ch a cl ai m a g ai ns t t h es e

d efen d an t s ; t h e m o t i on o nl y p ro p o sed ad d i n g t h e cl ai m ag ai n s t Eas t si d e.)

Th e t ri al co u rt en t ered a ca s e m a n ag em en t o rd er t h at es t ab l i s h ed dead l i n es

i n cl u d i n g an Oct o b er 2 8, 20 1 5 d ead l i n e fo r t he fi l i n g o f al l am en d m en t s ad d i n g

co u nt s or p art i es

. In Decem b er 2 0 1 5

, t h e p art i es fi led a jo i n t m o t i on as k i n g t h e co u rt

t o ex t en d t h e d ead li n e t o May 1, 2 0 1 6

. In res p o n se, o n Decem b er 8

, 2 0 1 5

, t h e t ri al

co u rt en t ered an am en d ed cas e m an ag em en t o rd er, ex ten d i n g t h e d e a d l i n e fo r t h e

fi li n g o f am en d m en t s t o M arch 3 1

, 2 0 16

, a m o n t h earl i er t h an t he p art i es h ad

req u es t ed b u t fi v e m o n t h s l a t e r t h an t he o ri gi n al d ead l i n e. T he p lai n t i ffs fi l ed t h ei r

m o ti o n t o am en d t h ei r co m p l ai n t an d p ro p os ed am en dm en t i n Au g u st 2 0 1 6

.

Gen eral ly

, “ [a] p art y m ay am en d h i s p lead i n g as a m at t er o f co u rs e an d wi t h o ut

l eav e o f co u rt at an y ti m e b efo re t h e en t ry o f a p ret ri al o rd er.” OCGA § 9 -1 1 -1 5 (a).

8Ho wev er, t h e pl ai n t i ffs fi l ed t h ei r m o ti o n t o am en d a n d t he p ro p o s ed am en d m en t

b efo re t h e en t ry o f a p ret ri al o rd er bu t “ wel l aft er t h e [M arch 3 1

, 2 0 1 6] d ead l i n e s et

fo rt h i n t h e o rd er o f [Decem b er 2 0 1 5 ] wh ich h ad b een en t ered [i n res p o n s e] t o a [jo i nt

m o t i o n ] b et ween t h e v ari o us p art i es

. . . .” S h ed d v. G o l d smi t h Ch evr o let

, 1 7 8 Ga.

Ap p

. 5 5 4

, 5 55 (1 ) (a) (3 4 3 SE2 d 7 33 ) (1 98 6 )

. T h e cas e m an ag em en t o rd er was

effect i v el y

a p ret ri al o rd er as co n t em p l at ed b y OCGA § 9 -1 1-1 5 an d t h u s [t he

[p l ai n t iffs ] co u l d [n o t ] am en d as a m at t e r o f ri g h t

. . . . Th e o rd er b y

s et t i n g a p art icu l ar t i m e co n t ro ll ed as t o t h e ex pi rat i on d at e fo r [fi l i n g ]

am en d m en t s

. B y d o in g t h i s

, t h o u g h n o t s o l ab el ed

, i t w as i n effect a

p ret ri al o rd er as t o t h es e m at ters

. M o reo v er b y p art ici p at in g i n th e [jo i n t

m o t i o n t h e pl ai n t i ffs ] wai v ed [t h ei r] ri g h t t o rel y o n OCGA § 9 -1 1 -1 5 (a)

reg ard i n g am en d m en ts t o [ t h ei r] co m pl ai nt

. [Th ey ] ap p aren t l y s o

reco gn i zed , as [t h ey ] t h ereaft er s o u g h t l eav e o f co u rt t o am en d . . . .

S h ed d

, 1 78 Ga. Ap p

. at 5 55 (1 ) (a) (ci t at i o n o m it t ed ). See al s o Dya l s v. Dya l s

, 2 8 1

Ga. 8 94

, 89 6 (3 ) (6 4 4 SE2 d 1 3 8 ) (2 0 0 7 ) (a p art y can n o t co m p l ai n o f erro r i n d u ced by

h i s o wn co nd u ct ).

“ Un d er O CGA § 9 -1 1 -1 5 (a) []

, th e t ri al co urt i s g i v en d i s cret io n t o al l o w

am en d m en t s t o t h e p l ead i n g s aft er t h e en t ry o f a p ret ri al o rd er

. . . , an d th e ap p el l at e

co u rt m ay rev i ew s u ch a d eci s i o n o n l y fo r m an i fes t ab u s e o f di s cret i o n .” Ba b i es Ri g ht

9S t a r t v. G a

. Dep t

. o f Pu b

. Hea l t h

, 2 9 3 Ga. 5 5 3

, 5 5 6 (2 ) (b ) (7 4 8 SE2 d 4 0 4 ) ( 2 0 1 3 )

(ci t at i o n om i t t ed ). Th e p l ai n t i ffs arg u e th at b ecau s e t h e d efen d an t s d i d no t neg at e t h e

es s en t i al fact s rel at ed t o t h ei r o b l i g at i o n s u n der t h e Fed eral E m erg en cy M ed i cal

Tr e a t m e n t an d Act i v e Lab o r Act

, t he t ri al co u rt s h o u ld h av e g ran t ed th e m o t i o n to

am en d

. T h ey ad d t h at i t is u n fai r t o al l o w t he d efen d an t s to cl ai m t h e ben efi t s o f t h e

em erg en cy m ed ical care s t at u t e wh i l e p rev en t i n g t h e p l ai nt i ffs fro m p urs u i n g a cl ai m

b as ed u p o n t h e pro vi s io n o f em erg en cy m ed i ci n e. Nei t h er o f t h es e arg u m en t s

,

h o wev er, s h o ws h o w t h e t ri al co u rt ab u s ed h i s d i s cret i on i n ad heri n g t o t h e d ead l i n e

es t ab l i s h ed at t h e i n d u cem en t o f t h e p l ai n ti ffs

.

3

. Fed er a l Emer g en cy Med i ca l

Tr ea t men t a n d Act i ve La b o r Act

.

Th e p l ai n t i ffs arg ue t h at t h e t ri al co u rt erred b y g ran t i n g s u m m ary ju d g m en t to

Eas t s i d e o n t h e cl ai m u n d er t h e Fed eral Em erg en cy M ed i cal Treat m en t an d Act i v e

Lab or A ct

, 4 2 USC § 1 3 9 5d d

. Bu t as di s cu ss ed ab o v e, t h e tri al c o u r t d e n i ed t h e

p l ai n t i ffs ’ m o t i o n t o am en d t h e co m p l ai n t s o t h e cl ai m u n d er t h e fed eral act was n ot

b efo re t h e co u rt

. No r d i d E as t s i de m o v e fo r s um m ary ju d g m en t o n t h e cl ai m

. Th u s t h e

t ri al co urt d i d n o t g ran t s u m m ary ju d g m en t o n t h e cl ai m

, an d t h i s arg u m en t p res en t s

n o t h i n g fo r rev i ew.

4

. Hei g h t en ed evi d

en t i a r y b ur d en u n d er OCGA § 5 1 -1 -2 9 .5

.

10Th e p l ai n t i ffs arg u e t h at th e t ri al co u rt erred b y g ran t i n g s u m m ary ju d g m en t to

t h e defen d an t s becau s e wh et h er t h e d efen d an ts are en ti t l ed t o t h e ben efi t o f t h e

h ei g h t en ed ev i d en t i ary b u rd en of t h e em erg en cy m ed i cal care st at u t e, OCGA § 5 1 -1

-

2 9 .5

, d ep en d s o n di sp u ted i s s u es o f fact

. W e ag ree. (As d i s cu s s e d i n Di v i s i o n 5

b el o w, h owev er, Eas t s i d e is en t i t l ed t o s u m m ary ju dg m en t o n a d i fferen t g ro un d : t h at

t h e p l ai n ti ffs h av e fai led t o p o i n t t o ev i d en ce t h at an y n eg l ig en ce o f Eas t s i d e’ s n u rs es

cau s ed o r co n t ri bu t ed t o J en n i n g s -Perry ’ s d eat h .)

OCGA § 5 1 -1 -2 9 .5 p ro v i d es i n rel ev an t p art :

In an act i o n i n v ol v i n g a h eal th care l i a b i l i t y cl ai m ari si n g o u t o f th e

p ro v i s i o n o f em erg en cy m ed i cal c a r e i n a h o s p i t al em erg en cy

d ep art m en t o r ob s t et ri cal u ni t o r i n a s u rg i cal s ui t e i m m ed i at el y

fo l l o wi ng t h e ev al u at i on o r t r e a t m e n t o f a p at i en t i n a h o s p i t al

em erg en cy d ep art m en t, n o p h y s i ci an o r heal t h care p ro v id er sh al l be

h el d l i ab l e u n l es s i t i s p ro v en b y cl ear an d co n v i n ci n g ev i d en ce th at th e

p h y s i ci an o r h eal th care p ro vi d er’ s act i on s s ho wed g ro s s n eg l i g en ce.

OCGA § 5 1-1 -2 9.5 (c). Th ree co n d i t i on s m u s t be p res en t fo r t h e em erg en cy m ed i cal

care s tat u t e t o ap p l y :

([1 ] ) t h e l aws u i t m

u s t i n v o l v e a “ h eal t h care l i ab i l i t y cl ai m ”; ([2 ] ) th e

cl ai m m u st ari s e o u t o f t he p ro v i s i o n o f “ em erg en cy m ed ical care”; an d

([3 ] ) t h e care m

u st h av e b een p ro v i d ed t o t h e pat i en t “ i n a h o s p i t al

em erg en cy d ep art m en t o r o b s tet ri cal u n i t o r in a s u rg i ca l su i t e

11i m

m ed i at el y fo ll o wi ng t h e ev al u at i o n or t reat m en t o f a p at i en t i n a

h o s p i t al em erg en cy

d ep art m en t .”

Ni s b et v. Da vi s

, 32 7 Ga. Ap p. 5 5 9

, 5 6 4

- 5 6 5 (1 ) (7 6 0 SE2 d 1 7 9 ) (2 0 1 4 ) (ci t at i o n

o m it t ed ). In t h i s cas e, w h et h er al l o f t h es e co n d i t i o n s w e re p res en t d ep en d s o n

d i s p u t ed i s s u es o f fact

.

(a) Ea s t s i d e, Li meh o u se, Ga n d

h i

.

It i s u nd i s p u t ed t h at t hi s l aws u i t i n v o l v es a “ h eal th care l i ab i l i t y cl ai m ,” t h e

fi rs t co nd i t i o n

, an d i t i s cl ear t hat t he s erv i ces o f L i m eh o u s e, Gan d h i, an d Eas t s i d e’ s

em pl o y ees were p ro v i d ed t o J en n i ng s -Perry “ i n a h o sp i t al em erg en cy d ep art m e n t ,”

t h e t h i rd co n d i t i o n

. Th e q ues t i o n i s wh et h er t h es e d efen d an t s w ere p ro v i d i n g

“ em erg en cy

m ed ical care” fro m

wh i ch t h e p lai n t i ffs ’ cl ai m s aro s e.

Th e em erg en cy

m ed i cal care s t at u t e d efi n es “ em erg en cy m ed i cal care” as :

b o n a fi d e em erg en cy s erv i ces pro v i ded aft er t h e o n s et o f a m ed i cal o r

t rau m at ic co nd i t i o n m an i fes t i n g i t s el f b y acu te s y m p t om s o f s u ffi ci en t

s ev eri t y

, i n cl u di n g sev ere p ai n

, s u ch th at t h e ab sen ce o f i m m ed i at e

m ed i cal at t en t i o n co u l d reas on ab l y b e ex p ect ed t o res u l t i n pl aci n g th e

p at i en t ’ s h eal t h i n s e r i o u s jeo pard y

, s eri o us im p ai rm en t t o b o di l y

fu n ct i o n s

, o r s eri o u s d y s fu n ct i o n o f an y b o di ly o rg an o r p art

.

12OCGA § 5 1 -1 -2 9 .5 (a) (5 ). Th e p h ras e “ bo n a fi d e em erg en cy serv i ces ” as u s ed i n t h e

s t at u te “ m ean s ‘ g en u in e o r act u al em erg en cy s erv i ces .’ [T]h e s t a t u t e es t ab l i s h es an

o b ject i ve s t an d ard o n th i s is s u e; t h e heal th care p ro v i d er ’s s u b j e c t iv e b el ief ab o ut

wh at k i n d o f care h e was p ro v i d i n g t h e p at i en t o r wh at k i n d o f care t h e p at i en t n eed ed

d o es n ot d et erm i n e wh et h er ‘ b o n a fi d e em erg en cy serv i ces ’ were p ro v i ded

. ” Ng u yen

v. S o u t h wes t er n Emer

g en cy Ph ys i ci a n s

, P.C.

, 2 9 8 Ga. 7 5

, 7 9 -8 0 (2 ) (b ) (7 7 9 SE2 d

3 3 4 ) (2 0 1 5 ) (ci t at i o n s o m i t t ed ).

M o reo v er,

wh et h er t h e co n di t i o n o f t h e p at i en t m eet s th e d efi ni t i o n of “ em erg en cy

m ed i cal care” is an o b

j ect i v e, rat h er t h an s u b

ject i ve, t es t

. . . . T he

p at i en t ’ s act u al m ed i cal o r t rau m at i c co n di t i o n i s d et erm i n at i v e — b u t

o n l y as t h at co n d i t io n i s rev eal ed by t h e p at ien t ’ s s y m p t o m s

. T he

fact fi n d er m

u s t c o n s i d er t h e ev i d en ce reg ard i n g t h e s y m p t o m s th e

p at i en t p res en t ed an d d e te r m ine w h e ther t h os e s y m

p t o m s were acu t e an d

s u ffi ci en t l y s ev ere t o s h o w t h at t h e p at i en t h ad a m ed ical o r t r a u m at i c

co n d i t i o n t h at co u l d reas o nab l y b e ex p ect ed t o s eri o u sl y i m p ai r h er

h eal th i f n o t at ten d ed t o i m m ed i at el y

.

Ng u yen , 2 9 8 Ga. at 8 1 (2 ) (c) (ci t at i o n o m i t t ed ).

Th e st at u t e ex cl u d es fro m i t s d efi n i t i o n o f “ em erg en cy m ed i cal care” “ m ed i cal

care o r treat m en t t h at o ccu rs aft er t h e p at i en t i s s t ab i l ized an d i s cap ab l e o f recei v i n g

13m ed i cal t r eat m en t as a n o n em erg en cy p at i en t

. . . .” OCGA § 5 1 -1 -2 9 .5 (a) (5 ). So

m ed i cal care can ch an g e fro m em erg en cy m ed i cal care t o n o n -em erg en cy care: “ t h e

s erv i ces p ro v i d ed b y [t h e defen dan t s co u l d h av e b een ] ‘ em e r ge nc y m ed i cal care’ u n t i l

s u ch t i m e as [J en n i n gs -Perry ] was s t ab i l i zed an d t h e ab sen ce o f s u ch serv i ces wo u ld

n o t h av e p laced [h er] h eal t h i n s eri o u s jeo p ard y .” Bo n d s , 3 2 2 Ga. Ap p . at 8 5 5 (1 ).

N e ithe r D r

. L im e house no r Dr. Gan d hi b el iev ed th at J ennings- P e r r y ’ s c ondition

was l i fe-t h rea t e n i n g

. Th ey b ot h d et erm i n ed t h at h er co n d it io n was s t ab le, s o t h ey

d i s ch arg ed h er fro m th e em erg en cy ro o m . Vi ewi ng t h e ev i d en ce an d al l reas o n ab l e

i n feren ces i n t h e l i g ht m o s t f a v o r a b l e to t h e p lai n ti ffs

, w e co n cl u d e th at wh et h er

J en n in g s-Perry at s o m e p o i n t was “ st ab [l e] an d [] cap ab l e o f recei v i n g m ed i cal

t reat m en t as a n on em erg en cy p at i en t w i t h i n th e m ean i n g o f OC GA § 51 -1 -2 9 .5 (a)

(5 ) i s a q u es ti o n fo r t h e t ri er o f fact .” Bo n d s

, s up ra, at 8 5 6 (1 ) (p u n ct u at i o n o m i t t ed ).

See al s o Ng u y en

, 2 9 8 Ga. at 8 1 (2 ) (c)

. T h e t r i a l co u rt erred b y gran t i n g s u m m ary

ju d g m en t t o Eas t s i d e, Li m eh o u se, an d Gan d h i o n t h e i s s u e o f wh et h er t h e em erg en cy

m ed i cal care s tat u t e ap p l i es t o t h e cl ai m s ag ai n s t t h em

.

(b ) Ku bek

.

W h et h er Ku b ek i s en t i t l ed t o t h e ben efi t s o f t h e em erg en cy m ed i cal care s t at u t e

d ep en d s n o t o n l y o n t h e d i s p ut e d i s s u e o f wh et h er h i s s erv ices were em erg en cy

14m ed i cal care as d es cri b ed in Di v i s i o n 4 (a), b u t al s o o n t h e i s s u e o f w h et h er h i s

s erv i ces were p ro v i d ed i n a h o s p i t al em erg en cy d ep art m en t. “ By i t s o r d i n a r y an d

ev ery d ay m ean i n g

, care p ro v id e d ‘ i n a h os p it al em erg en cy d ep art m en t ’ i s care

p ro v id ed t o a p at i en t i n a p art i cu l ar lo cat i on i n a h o s p i t al .” Ni sb et

, 32 7 Ga. Ap p

. at

5 6 7 (1 ) (c). Sp eci fi cal l y

, “ th e [em erg en cy m ed ical care] s t at u t e ap p l i es on l y wh en t h e

m ed i cal care at i s s u e was p ro v i d ed i n a h o sp i t al em erg en cy dep art m en t or o b s t et ri cal

u n i t or i n a s u rg i cal s u i t e i m m ed i at el y fo l l owi n g t h e ev a l u a t io n o r treat m en t o f a

p at i en t i n a h o sp i tal em erg en cy d ep art m en t .” Ng uyen

, 2 9 8 Ga. at 7 8 (2 ) (a) (ci t at i o n

o m it t ed ). Al t h o ug h J en n i ng s -Perry rem ai n ed i n t h e h o s p i tal e m e r g e n cy ro o m

, t h e

reco rd d oe s not u n d is p ut ed l y s h o w wh ere K ub ek p ro vi d ed “ t h e m ed i cal care at i s s u e.”

Th e p l ai n ti ffs al l eg e t h at Ku b ek d ev iat ed fro m t h e s t an d ard o f care b y fai l i n g

t o reco g n i ze an d p ro p erl y rep o rt t h at J en n i ng s -Perry ’ s CT scan was ab n o rm al

. Th u s

,

as t o Ku b ek

, t h e “ m ed i cal care at i s s u e” i ncl u d es h i s al leg ed fai l u re t o p ro p erl y read

J en n in g s-Perry ’ s CT s can as wel l as h i s al l eg ed fai l u re t o effect i v el y rep o rt to Gan d hi

wh at he s aw i n t he s can

. Ku b ek read t h e CT scan i n “ rad i o lo g y .” He p o i n t s t o n o

ev i d en ce t h at “ rad io lo g y ” i s l o cat ed i n o n e o f t h e p art i cu l ar l o cat i o n s l i st ed i n t h e

s t at u te. He t el ep h o n e d Ga n d h i t o d i s cu s s hi s fi n d in g s

. It i s no t cl ear wh ere ei t h er

p h y s i ci an was wh en t h ey s p o ke b y t el e p h o n e. Gi v en th i s ev i d en ce, wh ere Ku b ek

15p ro v id ed t he m ed i cal care at i s s u e, wh et h er i n a h o sp i t al em erg en cy d ep a r t m e n t o r

el s ewh ere, i s n o t a m at t er o f u nd i s pu t ed fact . An d i f h e d i d n o t pro v i de t h e m ed i cal

care at i s s u e i n a h o s p i t al em erg en cy d ep art m en t

, he wo u l d n o t b e en t i t l ed t o t h e

h ei g h t en ed ev id en t i ary b u rd en o f t h e em erg en cy m ed ical care s t at u t e. OCGA §

5 1 -1 -2 9

. 5 (c).

Th e co n cu rri n g o p i n i on rai s e s t h e po s si b i l i t i es o f ci rcu m st an ces wh ere a

p h y s i ci an co n s u lt ed b y way o f t el e-m ed i ci n e t ech no l o g y m i g h t b e d eem ed t o h av e

b een v irt u al l y p res en t i n an em e r g e n c y ro o m as em erg en cy s erv ices were b ei n g

p ro v id ed o r a co m

po u n d i n g p h a r m a c i s t m i g h t b e fo u n d t o h av e b een s u b ject ed to

s o m e of t h e p res s u res o f t h e em erg en cy ro o m

. Th e q u es t i o n s ra i s e d b y s u ch

ci rcu m s t an ces wo u l d b e s ub s t an t i al

. Bu t t h ey are n o t b efo re u s t o d ay

. On t h e reco rd

b efo re u s

, a fact fi n der wo u ld b e au t h o ri zed t o in fer t hat Dr. Ku b ek rev i ewed t h e CT

s can s i n t h e rel at i v e q u i et o f h i s o ffi ce.

W e reco g ni ze t h at i n Ni s b et

, we s t at ed t h at t h e em erg en cy m ed i cal care s t at u t e

“ co v er[s ] an y p h y s i ci an p ro v i d in g em erg en cy m ed i cal care t o a p at ien t l o cat ed i n t h e

em erg en cy ro o m .” Id

. at 56 8 (1 ) (c). Bu t Ni s bet d oes n ot co n cl u s iv el y an s wer t h e

q u es ti o n o f wh et h er Ku b ek p ro v i d ed care i n a h os p it al em erg en cy d ep art m en t

.

16Fi rs t

, un d er it s p l ai n t erm s

, t h e em erg en cy m ed ica l c a r e s t a t u t e ap p l i es t o “ a

h eal t h care l i ab i l i t y cl ai m ari s i n g o u t o f t he p ro vi s i o n o f emer g en cy med i ca l ca r e in

a h o s p i t a l emer

g en cy dep a r t men t ,” OCGA § 5 1-1 -2 9

. 5 (c)

— n o t t o a h eal t h care

l i ab i l i t y cl ai m ari si n g o u t o f t h e p ro v i si o n o f em erg en cy m ed i cal care t o a p a t i en t

l o ca t ed i n a h o s p i t al em erg en cy d ep art m en t , as Ni s b et

h el d

.

Seco n d

, t h e i ns t an t cas e i s fact u al l y di s t i n gu i s hab l e fro m Ni s b et

. In Ni s b et

, i t

was n o t di s p u t ed t hat th e p h y si ci an p ro v id ed at l eas t s o m e c are i n t he em erg en cy

d ep art m e n t

. N

i s b e t

, 3 27 Ga. Ap p

. at 5 6 0 (“ Dr. Ni sb et fi rs t saw M rs

. D av i s i n t h e

em erg en cy d e p a r t m e n t at 8 : 5 1 p .m

., acco rd i n g t o m ed i cal reco rd s pro d u ced b y t h e

h o s p it al

. Dr. Ni s b et s p o ke wi t h t h e n urs es an d Dr. Bu ch an an

, ev al u at ed t h e x -ray an d

u l t ra s o u n d res u l t s

, an d sp o ke wi t h M rs

. Dav is an d h er h u s b an d ab o u t h er m ed i cal

h i s t o ry

, i ncl u d in g h er recen t s u rg ery .”)

. Here, i t i s n ot cl ear wh ere Ku b ek was l o cat ed

wh en h e p ro v i d ed care.

T hi rd

, t h e qu o t ed l an g u ag e fro m Ni sb et i s d ict a. T h e i ss u e i n t h at cas e w a s

wh et h er t h e ap p li cat i o n of t h e em erg en cy m ed i cal care s t at u t e “ was d ep en d en t o n t h e

d ep art m en t of t he p hy s ici an res p o n s i b l e f o r t h e p at i en t’ s care [o r] t h e p h y s i cal

l o cat io n o f t h e p at i en t i n t h e h o s p i t al .” Id

. at 5 6 4

. Ni s b et di d n o t ad d res s t h e si t u at i o n

p res en t ed h ere: t h e p at i en t i s p h ys i cal l y l o cat ed i n t h e em erg en cy ro o m b u t t h e

17p h y s i ci an m ay h av e p ro v i d ed s erv ices rem o t el y

. Fi n al l y

, as no t ed ab o v e, o u r Su p rem e

Co u rt

, al bei t i n d i c t a

, has s t at ed t h at “ t h e [em erg en cy m ed i cal care] s t at u t e ap p li es

o n l y w h e n t h e m ed i cal care at i ss u e was p ro v i ded i n a h o sp i t al em erg en c y

d ep art m en t ” Ng u

yen , 2 9 8 Ga. at 7 8 (2 ) (a) (ci t at i o n o m i t t ed ).

Fo r t h es e reas o n s

, t h e t ri al co u rt erred b y g ran t i n g s um m ary ju d g m en t t o Ku b ek

o n t h e i s s u e o f wh et h e r th e em erg en cy m ed i cal care s tat u te ap pl i es t o t h e cl ai m s

ag ai n s t h i m

.

5 . Evi d en ce o f t h e n u r ses ’ n eg l i g en ce.

Th e p l ai n t i ffs arg ue t h at t h e t ri al co u rt erred b y gran t i n g s u m m ary ju d g m en t to

Eas t s i d e b ecau s e wh et her th e n u rs es were n eg l i g en t o r gro s s ly n eg li g en t an d wh et h er

an y n eg l i g en ce cau sed o r co n t ri b u t ed t o J en n i n g s -Perry ’ s d eat h d ep en d u p on g en u i n e

i s su es o f m at eri al fact

. W e fi n d t h at t h e p l a i n t i ffs h av e n o t co m e fo rward wi th

s u ffi ci en t ev i den ce t o creat e a j u ry q u es t i o n as t o wh et h er an y co n d u ct of t h e n u rs es

cau s ed o r c o n t r i b u t ed t o J en n i n g s -Perry ’ s d eat h. So t h e t ri al co urt d i d n o t err in

g ran t i n g s u m

m ary ju d gm en t t o Eas ts i d e.

Ev en wh ere t h ere i s ev i d en ce o f n eg l i g en ce,

a pl ai n ti ff can n o t reco v er fo r m ed i cal m al p ract i ce

. . . u n l es s t h e p l ai n ti ff

es t ab l i sh es by a p rep o n d eran ce o f t h e ev i d en ce t h at t h e neg l i g en ce ei t h er

18p ro x i m at el y cau s ed o r co n t ri bu t ed t o cau se p l ai n t i ff h arm . . . . In o rd er

t o es t ab li s h p ro xi m at e cau s e by a p rep o n d eran ce o f t h e e v i d en ce i n a

m ed i cal m al pract i ce act i o n

, t h e pl ai nt i ff m u s t u s e ex p e r t t es t i m o n y

b ecau s e t h e q ues t i on o f wh et h er t h e al l eg ed p ro fes s i o n al n eg l i g en ce

c a u s ed t h e p l ai nt i ff’ s i nju ry i s gen eral l y o n e fo r s p eci al i zed ex p ert

k n o wl ed g e b ey on d t h e k en o f t h e av erag e l a yp ers o n

. Us i n g th e

s p eci al i zed k no wl ed g e an d t r a i n i n g o f hi s fi el d

, t h e ex pert ’ s ro le i s t o

p res en t t o t h e ju ry a real i s t i c as ses s m en t o f t h e l i k e l i h o o d th at th e

d efen d an t ’ s al l eg ed n eg l i g en ce cau s ed t he p l ai n t i ff’ s i n ju ry

.

Zw i r e n v

. Th omp s o n

, 27 6 Ga. 4 9 8

, 5 0 0 -5 0 1 (5 7 8 SE2 d 8 6 2) (2 0 0 3 ) (ci tat i o n s an d

p u n ct u at i o n o m it t ed ).

To h o l d Eas t si d e l i ab l e, t h e p l ai n t i ff s p o i n t t o t h e co n d u ct o f th e t wo n u rs es

wh o t reat ed J en ni ng s -Perry at her t wo v i s i ts to t he em erg en cy d ep art m en t

. T h ey rel y

o n t h e affi d av i t o f t h ei r n u rs in g ex p ert

, wh o t es t i fi ed t hat t h e n u rs es dev i at ed fro m t h e

s t an d ard o f care b y fai li n g t o rep ort J en n in g s -P e r r y’s co n t i n u in g u nres o l v ed

a b d o m i n al p ai n t o th e em erg en cy d ep art m en t p h y si ci an s p ri o r to her d is ch ar g e a n d

b y al l o wi n g J en n in g s -Perry t o b e d i s ch arg ed wi t h ou t as s u ri n g t h em s el v es t h at h er

p ai n h ad b een rel i ev ed

. Th e n u rs in g ex p ert al s o t es ti fi ed i n her affi d av i t t h a t i n h er

o p i n i o n

, “ w i t h i n a reas o n ab l e d eg ree o f cert ai n t y

. . . t h e d ev i at i on s o f t h e s t an d ard

o f care

. . . cau s e[d ] o r co n t ri bu t ed t o cau se Ms

. J en n i n g s-Perry ’ s p ai n an d s u fferi n g

19an d d eat h .” Bu t t h e pl ai n t i ffs p o i n t t o n o ev i d en ce l i n k i n g t h e al l eg ed d ev i at i o n s to

J en n in g s-Perry ’ s d eat h

.

In h er d ep o s i t i o n

, t h e n u rs i n g ex p ert t es t i fi ed t hat Carl a Bray

, t h e n u rs e wh o

s aw Jen ni n g s -Perry at t h e f i r s t v i s i t

, s h o u l d h av e t ri ag ed J en n i n g s -Perry at a m o re

u rg en t l ev el

, b u t t h e ex p ert co u l d n o t s ay wh et h er t h e o u t co m e wo u l d h av e b een

d i fferen t i f Bray h ad tri ag ed Jen n i n g s -Perry at a m ore u r g e n t l e v el

. Th e ex p ert

t es t i fi ed t h at Bray d i d n o t d o cu m en t a co m pl et e ab d o m i n al as s es s m en t

, b u t s h e

ad m i t t ed t h a t D r

. Li m eh o u s e’ s d o cu m en t at i o n i n di cat ed t h at Bray d i d n o t m i s s an y

s ym p t o m s

. Sh e co u ld n o t i d en ti fy an y s p eci fi c t h i n g th at was m is sed becau s e o f a n

al l eg ed l y i m p ro p er as ses s m en t

.

Th e ex p ert tes ti fi ed th at Bray s h o u ld h av e a p p ro ach ed Li m eh o u s e reg ard i n g

J en n in g s-Perry ’ s p ai n

, reco n fi rm i n g wi t h h i m wh et h er an y t h ing e l se shoul d b e l o o k ed

at an d i n fo rm i n g h i m th at s h e was n o t co m fo rt ab l e d i s ch arg i n g J en n i n gs -Perry

, g i v en

h er p ai n l ev e l

. Bu t s h e ad m i t t ed t h at Li m eh ou s e was aware of J en n i n g s-Perry ’ s

rep o rt ed p ai n l ev el an d t h at Bray h ad n o ted o b ject i v e fi nd i n g s

— “ n o acu t e d i s t res s

,

al ert an d o ri en ted

, p at i en t am b u l at i n g w i t ho u t d i ffi cu l t y ”

— t h at s u gg es t ed t h at

Je nni ng s -Perry ’ s rep o rt ed p ai n l ev el was n o t o bject iv el y accu rat e. Th e ex p ert te stif ie d

20t h at Bray s h ou l d h av e g o n e up t h e ch ai n of co m m an d

, b u t s h e co u l d no t wi t h an y

d eg ree o f m ed ical cert ai n t y s ay t h at an y t h i n g d i fferen t wo u l d h av e h ap p en ed

.

Th e ex p ert t es t i fi ed t hat nu rs e Ni co l e Jo h ns o n

, w h o s aw Jen n i n g s -Perry at h er

s eco n d v is i t

, s h o u l d h av e i n creas ed t h e p ri o ri t y l ev e l o f t ri ag e, gi v en th at t h i s was

J en n in g s-Perry ’ s seco n d v i s it

, t h at J en n i n g s -Perry rep o rt ed h er p ai n as a 1 0 o f 1 0

, an d

t h at Jen ni n g s -Perry cam e b y am b u l an ce. Bu t t h e ex p ert ad m i t t e d t h at t he reco rd s

i n d i cat ed t h at Gan d h i i m

m ed i at el y s aw J en n i n g s -Perry : s he arri v ed at t h e em erg en cy

d ep art m en t at 9 : 3 0 a.m

. an d Gan d h i s aw h er a t 9 : 3 0 a.m

., s o t h e p l ai n t i ffs h av e n ot

p o i n t ed t o ev id en ce t h at el ev at i n g t h e p ri o ri t y l ev el o f t ri ag e wo u l d h av e ch an g ed t h e

o u t co m e.

Th e ex p ert al so cri t i ci zed J o h n s o n fo r d eferri n g to th e d o ct o r’ s as s es s m en t an d

ju d g m en t reg ard in g J en n i n g s -Perry ’ s p ai n an d fo r fai li n g t o g o u p t h e ch ai n o f

co m m an d

. Bu t t h e ex p ert co u ld n o t s ay t h at an y t h i n g d ifferen t wo ul d h av e h ap p en ed

h ad J oh n s o n d o n e t h i s

.

Th e p l ai n t i ffs h av e p oi n t ed t o n o ev id en ce t h at t h e n u rs es ’ al l eg ed n eg l i g en ce

“ ei t h er p ro x i m at el y cau s ed or co n tri b u t ed to cau s e [J en n i n gs -Perry ’ s ] h arm .” Zwi r en

,

2 7 6 Ga. at 50 0 (ci t at i o n an d p u nct u at i o n o m i t t ed ). Acco rd i n g l y

, t h e t ri al co u rt d i d n ot

21err in g ra nting E a stsid e s um m ary ju d g m en t

. Co m p are Ever s o n v. Ph o eb e S

u mt er Med

.

Cen ter

, 3 4 1 Ga. Ap p . 1 8 2

, 1 91 (5 ) (b ) (7 9 8 SE2 d 6 6 7 ) (2 0 1 7 ) .

6

. Gr o s s n eg l i

g en ce.

Th e p lai nt i ffs arg u e t h at t h e t ri al co u rt erred in g ran t i n g s u m m ary ju d g m en t to

Li m eh o u s e

, G a n d h i

, an d Ku b ek b ecau s e w h et h er t h ey w ere n eg l i g en t o r g ro s s l y

n eg li g en t d ep en d s u p o n g en u i n e i s s ues o f m at eri al fact

. Th e d efe n d a n t s arg u e o n l y

t h at t h ere are no is s u es o f m at eri al fact as t o wh et h er t h ey w e r e g ro s s l y neg l i g en t ;

t h ey d o n ot co u n ter t h e p l ai n t i ffs ’ arg u m en t t h at wh et h er t h ey were n eg li g en t d ep en d s

u p o n g en u i n e i s su es o f m at eri al fact

.

At t h i s ju nct u re we can n o t s ay wh et h er t h e h ei g h t en ed ev i d en t i ary b u rd en o f

t h e em erg en cy m ed i cal care s t at u te wi ll ap pl y

. Th erefo re, t h e i s s ue o f wh et h er t h e

p l ai n t i ffs h av e co m e fo rward wi t h s u ffi ci en t ev id en ce o f g ro s s n eg li g en ce t o creat e

a q u es t io n fo r t h e fact fi n d er “ m ay wel l t u rn ou t to b e m o ot

. Un der t h es e

ci rcu m s t an ces

, i s s u in g an o pi n i o n [o n t h i s is su e] wo u l d b e, i n es s en ce, ren d eri n g an

ad v is o r y o p i n i o n

. Ho w ev er, Geo rg i a ap p el l at e co urt s are n o t au t ho ri zed t o ren d er

ad v is o ry o p i n io ns as t o p o ten t i al erro r. Acco rd i n g l y

, w e d o n o t r e a c h t h is i s s u e.”

W el l s t a r Hea l th S

ys t em v. S

u tt o n

, 3 1 8 Ga. Ap p

. 8 02

, 8 0 5 (3 ) (7 3 4 SE2 d 7 64 ) (2 0 1 2 )

22(ci t at i o n s an d p u n ct u at io n o m i tt ed ). See al s o Demp s ey v. Gwi n n et t Ho s p

. S ys t em

, 3 3 0

Ga. Ap p . 4 6 9 , 4 7 5 (3 ) (7 6 5 SE2 d 5 2 5 ) (2 0 1 4 ).

Ju d g men t a f f i r med i n pa r t

, r ever s ed i n pa r t. Br an ch a n d Be t h e l

, J J

. , co n cu r

f u l l y i n Di vi s io n s 1 , 2 , 3 , 5 a nd 6 , a nd s p eci a l l y i n Di vi s i o n 4

.

23A1 7 A0 80 6

. KIDNEY et al

. v

. EASTSIDE M EDICAL CENTER

LLC et al

.

B E T H E L , J u d g e, co n cu rri n g s p eci al l y

.

I c o ncu r i n t h e ju d g m en t o f t h e co urt

, an d I co n cu r fu l l y in Di vi s i o n s 1

, 2

, 3

,

5

, an d 6. Ho wev er, wh i l e I reach t h e s am e co n cl u s i o n i n Di v i s i o n 4

, I d o n o t ag ree

wi t h si g ni fi can t p o rt i o n s o f t h e an al y s i s fo u n d in t h at p o rt io n o f t h e Pres i d i ng J u d g e’ s

o p i n i o n . Acco rd i n g ly , I co n cu r s p eci al l y t o Di v i si o n 4

.

Th e reco rd co nt ai n s ev i d en ce t h at wo ul d au t ho ri ze a f a ct -fi n d er t o co n cl u d e

t h at T i ffan y J en n i n g s -Perry d ied o n Tu es d ay

, Ap ri l 3 1

, 2 0 1 2

, as a res u l t of a co n d i t i o n

s h e was s u fferi n g fro m w h e n s h e v i s i ted t h e em erg en cy d ep art m en t o n Sat u rd ay

,

Ap ri l 2 8

, 2 0 1 2

. T h e ev i den ce i n t h e reco rd creat es g en u i n e i s s u es o f m a t e r i al fact

co n cern in g wh et h er al l o f t h e car e s h e r ecei v ed fro m t h e em erg en cy d ep art m en t

p h y s i ci an s an d t h e rad i o lo g i s t 1 co n s t i t u ted b o n a fi d e em erg en cy s erv i ce an d wh et h er

h er co n di t i o n at t h e t i m e o f t reat m en t i n t h e e m e rg en cy d ep art m en t was fo r a

1 Th e i d en t i fi cat i on o f g en u i n e i s s u es o f m at eri al fact co n cern i n g t h e d el i v ery

o f b o n a fi d e em e r g e n c y s erv ices an d t h e p res en ce o f a g en u i n e o r act ual em erg en t

co n di t i o n ap p l y

eq u al l y t o Dr. Ku b ek

.co n di t i o n th at req u i red i m m ed i at e m ed i cal at t en t i on

. 2 Th u s

, a fact -fi n d er wi l l b e

req u i red t o d e c i d e t h e fact s t h at wi l l

, i n tu rn

, d et erm i ne t he ap p l i cab l e s t an d ard o f

p r o o f

. I n a s m u ch as Di vi s io n 4 (a) ex p res s es t h i s vi ew o f t he reco rd an d t h e l aw, I

ag ree.

Bu t I d o n o t ag ree wi t h t h e a n al y s is in Di vi s i o n 4 (a) t o t h e ex t en t it s u g g es t s

t h e rel ev an ce of t h e p h y s i ci an ’ s as s es s m en t o f t h e s t ab i l i t y o f t he p at i en t o n t h i s

r e c o rd

. As th e Pres i d i n g J u d g e n o t es

, J en n i n g s -Perry was di s ch arg ed u p o n a

d et erm i n at i o n o f h er s t ab i l i ty

. I s ee n o ev i d en ce in t h e reco rd t h at s h e recei v ed

t reat m en t o r care fro m t h e d efen d an t s f o l l o wi ng t h e det erm i n at io n t h at s h e was s t ab l e.

Ab s en t s u ch ev i d en ce, wh et h er t h e care p ro vi d ed t o h er b y t he d efen d an t s p reced i n g

h er d i s ch arg e qu al i fi es as “ em erg en cy m ed i cal care” u n der OCGA § 5 1-1 -2 9 .5 (a) (5 )

i s a q u es t i o n o f fact f

o r t h e j u r y t h at s h o u l d no t be i n fo rm ed ei t h er way b y a

p h y s i ci an ’ s as ses s m en t o f s t ab il i t y at t h e ti m e o f d is ch arg e. A p h y s i ci an ’ s as s es s m en t

2 Ob v i o u s ly

, t h e v o l v u lu s i n q u es t i o n was a l i fe t h reat en in g c o n d i t i o n

. Th i s

reco rd

, h o wev er, d o es n ot p ro v i d e co n cl u s i ve ev i d en ce o f w h en t h e fai l u re t o t reat i t

p l aced J en n in g s -Perry ’ s l i fe, b o d i l y f u nct i o n s

, o r o rg an s i n s eri o u s j eo p ard y

. Th i s

q u es ti o n wi l l b e res erv ed fo r a ju ry

.

2o f s t ab i l it y wo ul d o nl y b e rel ev an t wh ere th ere was ev i d en ce of ad d i t i on al t reat m en t

fo l l o w i n g t h e as ses s m en t o f s t ab i l i t y

. 3

I fu rt h er d is ag ree wi t h t h e an al y s i s i n Di v i s i o n 4 (b ). I s i m p l y can n o t ag ree wi th

t h e Pres i di n g J u d g e’ s an al y s i s th at wo ul d h av e t h e l o cat i o n o f t h e p h y s i ci an (o r o t h er

care pro vi d er) d et erm i ne th e ap p l i cab il i ty o f OCGA § 51 -1 -2 9.5 (c). Th e l an g u ag e o f

t h i s s t at u t o ry

s ect i o n p ro v i des t h at

[i ] n an act i o n i n v o lv in g a h eal t h care l i a b i l it y cl ai m a ri si n g o u t o f th e

p r o vi s i o n o

f em er g en cy med i ca l ca r e i n a h o s p it a l emer

g en cy

d ep a r t m en t

. . . , n o p h y s i ci an o r h eal t h care p ro v i d er s hal l b e h el d l i ab l e

u n l es s i t i s p ro v en b y cl ear an d co n v i n ci n g ev i d en ce t h at th e p h y s i ci an

o r h eal t h care p ro v id er’ s act i o n s s h o wed g ro ss n eg l i g en ce.

OCGA § 5 1 -1 -2 9 .5 (c) (em p h as i s s u p p l i ed ). Th e Pres i d in g J u dg e read s “ t h e p ro v i s i o n

o f em erg en cy m ed i cal care i n a h o s p i t a l e m e r g e n cy d ep art m en t ” i n th i s s t at u te to

m ean t h e p ro vi s i o n o f em erg en cy m ed i cal care by a p h ys ici a n wh o i s a l

so l o ca t ed in

a h o s p i t al em erg en cy dep art m en t

. Bu t t h e s t at u t e co n t ai ns no s u c h res t ri ct i o n

, an d

t h erefo re I b el i ev e t h e Pres i d i ng J u d g e’ s i n terp ret at i o n t o b e erro neo u s.

3 I fu l l y ag ree wi t h t h e Pres i d i n g J u d g e t h at J en n i n g s -Perry h as p ro v i d ed

ev i d en ce s u ffi ci en t t o creat e a g en u i n e i s s u e of m at eri al fact co ncern i n g wh et h er at

s o m e p o i n t d u ri n g h er care d u ri n g b o t h v i s i t s t o t h e Em erg en cy Dep art m en t s h e was

s t ab l e an d cap ab l e o f recei v i n g m ed i cal t reat m en t as a n o n -em erg en cy p at i en t

.

3I n c o n s t ru i n g OCGA § 5 1 -1 -2 9 .5 (c), “ we ap p l y t he fu n d am en t al ru l es o f

s t at u to ry co n s t ru ct i o n t h at req ui re u s t o co n s tru e t h e s t at u t e acco rd i ng t o i t s t erm s

, to

g i v e wo rd s t h ei r p lai n an d o rd i n ary m ean i n g, an d t o av o i d a co ns t ru ct i o n t h at m ak es

s o m e l an g u ag e m ere s u rp l u sag e.” L a k e vi ew Beh avi o r a l Hea l t h S ys

., LLC v. UHS

Pea ch f or d

, LP

, 3 21 Ga. A pp

. 8 2 0

, 8 2 2 (1 ) (7 4 3 SE2 d 4 92 ) (2 0 1 3 ) (ci t at i o n o m i t t ed ).

“ Th u s

, a s t at u t e s h o u l d be read acco rd i n g t o i t s n at u ral an d m o s t o b v io u s i m p o rt o f

t h e l an g u ag e wi t h ou t res o rt i n g t o s u bt l e an d fo rced co n st ru ct i o n s fo r t h e p u rp o s e o f

ei t h er l i m i t i n g o r ex t en d i n g i t s o p erat io n

. ” Id

. (ci t at i o n an d p u n ct u at i on o m i t t ed ).

Here, OCGA § 5 1 -1 -2 9 .5 (c) ap p l i es “ t o an act i o n in v ol v i n g a h e a l t h care

l i ab i l i t y cl ai m ari s i n g o u t o f t h e p ro v i s i o n o f e m erg en cy m ed ical care i n a h o s p i t al

em erg en cy d ep art m en t [.] ” Th is s t at u t ory l an g u ag e i s v ery b ro a d

, 4 an d s h o u l d b e

i n t erp ret ed acco rd i n g t o i ts t erm s wi th o ut r e s o r t i n g t o a read i n g t h at fo rces a

l i m i tat i on n o t ap p eari ng o n t h e face o f t h e s t at ut e. Th u s

, e v e n i f t h e l an g u ag e in

Ni s b et p ro v i d i n g t h at th e pro vi s i o n ap p l ies to “ an y p h y s i ci an p ro v i d i n g e m e r g en cy

4 “ W e h av e p rev io u s l y

co n s t ru ed ‘ ari si n g o u t o f’ t o m ean ‘ h ad it s o ri g i n s i n ,’

‘ grew o u t of,’ o r ‘ fl o w ed fro m .’ M o reo v er, we h av e al s o h el d th at t h e t erm ‘ ari s i n g

o u t o f’ d o es n o t m ean p ro x i m at e cau s e i n t h e st ri ct l eg al s en s e

. . . . Al m o st an y cau s al

co n nect io n o r rel at i o n s h i p wi l l d o .” Ha r ri s o n v. McAf ee

, 3 3 8 Ga. Ap p

. 3 9 3

, 3 9 8 (2 )

(b ) (7 88 SE2 d 8 72 ) (2 0 1 6 ) (ci t at i o n s o m i t t ed ).

4m ed i cal care t o a p at i en t lo cat ed i n t h e em erg en cy ro o m ” 5 i s d i ct a

, it i s n ev ert h el es s

co rrect

. J en n i ng s -Perry recei v ed al l o f h er care rel ev an t t o t hi s l i t i g at i o n i n t h e

em erg en cy d ep art m en t

. Th at s at i s fi es t h e req ui rem en t o f t he s tat u t e t h at t he care m u s t

h av e b een p ro vi ded i n a h o s p i t a l emer g en cy d ep a r t men t

.

W h en a pat i en t p res en t s i n t h e em erg en cy dep art m en t wi t h a h ead trau m a an d

t h e p h y s i ci an (o r o t h er m em b er o f th e em erg en cy d ep art m en t p ro v i d er t eam ) cal l s a

l o cal n eu ro s u rg eo n at h er o ffi ce fo r u rg en t co n s u l t

, t h at n eu ro su rg eo n i s t reat i n g t h e

p at i en t i n t h e em erg en cy d ep art m en t

. W h en an em erg en cy d ep art m en t n urs e cal l s t h e

h o s p i tal p h arm acy u rg en t l y cal l i n g fo r m ed i ci n e n o t p res en t in t h e em erg en cy

d ep art m en t

, t h e p h arm aci s t o r t ech n i ci an co u n t i n g

, m e as u ri n g

, o r co m p o u n d i n g i s

ren d eri n g care t o t he pat i en t i n t h e e m e r g e n c y d ep art m en t. W h en t h e em erg en cy

d ep art m en t i n a h o s p i t al in ru ra l G eo rg i a u ses t el e-m ed ici n e tech n o lo g y t o co n s u l t

wi t h p h y s i ci an s at a l arg e h o s p i t al i n At l an t a o r el s ewh ere, t h e ph y s i ci an o n t h e o t h er

en d of t he co nn ect i on i s p r o v i d i n g care i n t h at em erg en cy d ep art m en t

. Fu rt h er,

s u p p os e i n t h e i n s t an t cas e t h at Dr. Gan d h i h ad l eft t h e em erg en cy d ep art m en t to

ret ri ev e an i t em fro m a v eh i cl e o r h ad l eft t he em erg en cy d ep art m en t t o fi n d an

av ai l ab l e res t ro o m w h en D r. Ku b ek cal l ed t o d i s cu s s th e CT s can res ul ts

. Are we to

5 Ni s b et v. Da vi s , 3 2 7 Ga. Ap p. 5 5 9, 5 6 8 (1 ) (c) (7 6 0 SE2 d 1 7 0 ) (2 0 1 4 ).

5b el i ev e th at D r. Gan d h i wo u l d t hen no t b e p ro v i d i ng care t o a p at ien t i n t h e

e m e r g e n c y d ep art m en t ? No

. Su ch a read i n g o f t he s t at u t e b el ies i t s cl ear an d p l a i n

m ean i n g

.

A p at i en t i s recei v i n g t reat m en t , i f at al l , wh ere h e o r s h e i s l ocat ed

.

I am au t h o ri zed t o s t at e t h at Bran ch , J . jo in s i n t h i s s p eci al co n cu rren ce.

6