I N T H E SUPR EM E C O UR T O F M I SS I SS I PPI NO. 2 0 0 6 - CA- 0 0 6 6 9 - S CT M ELI S S A ENTR ICAN
v. D O U G MI

N G, J ER EMY C A MP B EL L A N

D H MA CORPORAT

ION, I NC. d / b / a RANKI

N M EDICAL C EN T ER A MB U

L A N C E S ER V IC ESa / k / a R EMS
D A T E O F JU D G M E N T : 02/ 09/ 2006 TRI AL J UD GE: HO N. W . SW AN YER GER COURT F ROM W HI CH APP EAL ED: HI NDS COUNTY CI RCUI T COURT ATTO RN EY FO R A PP ELLAN T: ALA N D . LAN CA STER AT T OR NE Y F OR AP P E L L E E S : KI M BE RL Y NE L S ON HOWLAND NA TUR E OF THE C ASE: CI VI L - W RO NG FUL D EATH D I SPO SI T I O N : R E V E R SE D A N D R E M A N D E D - 08/ 02/ 2007 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 SM I T H , C . J. , D I C K I N SO N A N D L A M A R , JJ. S M I TH, CH I EF J UST I CE, FOR TH E COU RT: ¶ 1
. On J a n u a r y 26 , 20 0 0 , M e l i s s a Entr i c a n f i l e d s u i ta g a i n s tD o u g M i n g , J e r e my C amp bell , and R E M S ( s om et i m es r ef err ed t o her ei naf

t eras “A m bul ance Ser vi ce D e fe n d a n ts ” ), a lo n g w ith F ra n k B . B rig g s, M .D ., M a rth a D . D ick e n s, M .D ., B e v e rly M cM i l l an, M . D . , K ar l H att en, M . D . , and R i verO aks H os pi t al , al l egi ng t hatt he negl i gence
o f th e s e p a r t i e s c a u s e d o rc o n tr i b u t e d t o th e d e a th o f h e rmi n o rd a u g h t e r , Al i s h a P e a v y . By sti p u lat ion o f th e p arti es, R iver O ak s H o sp it al a n d it s e m p loy ee p h y sici an s, D r. D icke n s, D r. M c M ill a n , an d D r. H a tten , w e re d ism iss e d fro m th e su it w ith p re ju d ice
. A fte r th is d ism iss a l, onl y E ntr i can’ s c l ai m s a gai ns tthe A m bul ance Ser vi ce D ef endant s and D r . B r i ggs r emai ned.

### 2

¶2. T h e tr i al beg an o n Janu ary 17, 2006 , and atthe close of En tri ca n ’s ca se-in-c h ief,
couns el f orthe A m bul ance Ser vi ce D ef endant s m oved f

ora di r ect ed ver di cton the bas i s that the negl i gence of

R i verO aks H os pi t al , by and thr ough i t s emer gency de part m entphys i ci an, D r . D i ckens , s uper cede d any al l eged ne gl i gence of the A m bul ance Ser vi ce a nd r ender ed any
a lleg e d n e g lig e n c e o f th e A m b u lan c e S e rv ice D e fe n d a n ts o n ly a re m o te a n d n o n -a c tio n a b le
caus e of A l i s ha’ s death. ¶3. O n F ebruary 9 , 2 00 6, J udge Y er gergr ant ed the A m bul ance Ser vi ce D efendan t s’
m ot i on f ora di r ect ed ver di ct , hol di ng thatthe negl i gentom i s s i ons of D r . D i ckens i n f ai l i ng t o r ecogni ze thatA l i s ha w as i n hypovel emi c s hock, i n f ai l i ng t o adequa t el y r es us ci t at e A l i s ha by gi vi ng bl ood and i ntr avenous f l ui ds , and/ ori n f

ai l i ng t o tr ans f

erA l i s ha t o anotherm edi cal fa c ili ty , w e re n o t fo re se e a b le b y th e A m b u lan c e S e rv ic e D e fe n d a n ts w h e n th e y d e c id e d to tr ans por tA l i s ha t o R i verO aks , the near es thos pi t al
. H e f ur therconcl uded thatthe negl i gence of D r. D i cken s and/orotherR i ver O aks em ployees w as an i nterven i ng and superceding cau se of A l i s ha’ s death, and ther ef or e any ne gl i gence on the par to f the A m bul ance Ser vi ce D ef endant s w as onl y a r emot e and non- act i onabl e caus e. J udge Y er gerthen di s m i s s ed the A m bul ance Ser vi ce D ef endant s w i th pr ej udi ce. E ntr i can f i l ed a mot i on f

ora ne w tr i al , w hi ch J u d g e Ye r g e rd e n i e d o n M a r c h 2 2 , 2 0 0 6 , a n d s h e n o w a p p e a l s t o th i s Co u r tf o rr e v i e w. On app eal , E ntr i can assert s the fol l ow i ng err ors: I . The Tri alC our t C om m i t t e d a Pr e j udi ci alLega l Err or by I m pr ope r l y G r ant i ng t he M ot i on f or D i r e c t e d V e r di c t of t he D ef endant on t he G round T hat t he N egl i gence of t he R i ver O aks H os pi t aland i t s E m er ge nc y Room Phys i c i an Cons t i t ut e d a Sup erc edi ng Int erve ni ng C ause of t he D eat h of

A l i s ha P eavy.

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I I . The Tri alC our t C om m i t t e d a Pr e j udi c i alLega l Err or i n G r ant i ng t he M ot i on f

or D i rec t ed V erdi ct of

D ef endants on t he G round T hat the N egli gen ce of t h e D efend an ts C on st i tuted O n l y a R em ote C au se of t he D eat h of

A l i s ha P eavy. I I I . The Tri alC our t C om m i t t e d a Pr e j udi c i alLega l Err or i n G r ant i ng t he M ot i on f

or D i rec t ed V erdi ct of

D ef endants on t he G round T hat t he N eg l i ge nc e of

t he R i ver O aks H os pi t al and i t s E m erge ncy R oom P h y sic ia n a n d th e N e g lig e n c e o f D r . B r ig g s W e r e N o t F o r e se e a b le b y the D efend an ts . I V . The Tri alC our t C om m i t t e d a Pr e j udi c i alLega l Err or i n G r ant i ng th e M o tio n fo r D ire c te d V e r d ict o f D e fe n d a n ts in T h a t in R enderi ng i t s D eci s i on, t he T ri al C ourt F ai l ed t o V i ew t he E vi dence in a L ig h t M o st F a v o r a b le t o th e P la in tiff T o g e th e r W ith A ll R e a s o n a b le I n fe r e n c e s T h a t C o u ld B e D r a w n T h e r e fr o m . ¶4
. H o w ev er, th ese issue s ha v e b ee n co m b ined an d rest ated by th e C o u rt , an d there fore
w e w i l l addr es s onl y the f ol l ow i ng i s s ue: I . W het her t he A m bul ance Servi ce D ef endants K new or Shoul d H ave K nown T hat R i ve r O ak s H os pi t alW as Not Capabl e of M ana gi ng A l i s ha’ s Condi t i on, a nd W he t he r Thei r Act i ons i n T r ans por t i ng A l i s ha t o That H os pi t alW e r e O nl y a R e m ot e C aus e of H e r D e at h. FACTS ¶ 5 . A p p e llan t M e lissa E n trica n is a n a d u lt re sid e n t citize n o f R a n k in C o u n ty , M iss iss ip p i, and i s the m otherof

A l i s ha Peavy, t he d eceased. Ap p e l l e e s Do u g M i n g a n d J e r e my C ampbel l ar e adul tresi dentci t i zens of the St at e of

M i s s i s s i ppi and emer gency medi cal t echni ci ans empl oyed by A ppel l ee R anki n M edi cal C ent erA m bul ance Ser vi ces ( her ei naf t er “R E M S”)
. A tal l re l evantt i m es , R E M S w as act i ng by and thr ough i t s emer gency medi cal

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tec h n icia n s, M in g a n d C a m p b e ll, w h o w e re ac tin g w ith in th e sc o p e o f th e ir e m p lo y m e n t w ith R E M S
. ¶6. O n J anuary 26, 1998, at appr oxi m at el y 11: 30 a. m . , A l i s ha w as i nvol ved i n a mot or vehi cl e col l i s i on w hic h occurr ed atthe i nt er s ect i on of H i ghw ay 471 and Bay Poi nt e R oad
w i thi n R anki n C ounty, M i s s i s s i ppi
. I n r es pons e t o a c al l a tRE M S f oremer gency a s s i s t ance atthe s cene of

the col l i s i on, M i ng and C ampbel l arr i ved atthe s cene i n a R E M S am bul ance . U p o n a rriv a l, M in g a n d C a m p b e ll n o ted m a ss iv e d a m a g e to A lish a ’s sid e o f th e a u to m o b ile
a n d fo u n d A lish a tra p p e d in th e p a ss e n g e r se a t. T h e y a lso n o ted th a t sh e w a s a p p ro x im a tely ei ght( 8) m onths pr egnanta nd ha d a s of tabdomen w i th brui s i ng. W i th epi s odes of decr eas ed
r es pons i venes s , a s ys t ol i c bl ood pr es s ur e i n the 80 t o 90 r ange, a nd s i gns of i nt ernal bl eedi ng, A l i s ha w as cl as s i f

i ed by M i ng and C ampbel l as a C ode 2 ca s e ( i nd i cat i ng thats he w as d e ter io ra tin g ) a n d tak e n to th e R iv e r O a k s H o sp ital. ¶7. A tappr oxi m at el y 12: 40 p. m . , A l i s ha w as a dm i t t ed t o the emer gency de part m entat R i verO aks
. A f

t erthi s t i m e, M i ng and C ampbel l no l ongert ook c ar e of A l i s ha butr emai ned atR i verO aks H os pi t al i n cas e the phys i ci ans de t erm i ned thattr ans por tt o anotherhos pi t al
w as neede d af

t eri ni t i al s t abi l i zat i on. M artha D i ckens, M . D . , the phys i ci an i n R i verO aks H os pi t al ’ s emer gency de part m ent , a cce pt ed A l i s ha as a pa t i ent . D r . D i ckens , empl oyed ni ne year s as a f

ul l
- t i m e emer gency phys i ci an, t es t i f i ed attr i al thats he w as tr ai ned i n A dvance d T r auma L i f

e Suppor t , w hi ch i s a s ys t em of ge ner al l y acc ept ed pr ot ocol s f orthe tr eatm entof tr auma pat i ent s . A s an A T L S- cert i f i ed phys i ci an, D i ckens w as t r ai ned t o re cogni ze the s i gns
a n d s y m p to m s o f h y p o v o lem ic s h o c k . D r. D ick e n s a lso tes tified th a t w h e n so m e o n e is in

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h y p o v o lem ic s h o c k , the c o rre c t p ro c e d u re is to a d m in iste r flu id s to th e p a tien t, an d th e n if vi t al s i gns cont i nue t o det er i or at e, t o admi ni s t erbl ood. D r . D i ckens al s o t es t i f i ed thats he fe a re d A lish a w a s in h y p o v o lem ic sh o c k a n d p ro c e e d e d to a d m in iste r flu id s in a n a ttem p t to i m pr ove A l i s ha' s vi t al s i gns . H ow ever , the vi t al s i gns c ont i nued t o de t er i or at e, and, al though D r . D i ckens admi t t ed i n hert es t i m ony thatw hen thi s happens , i ti s a " f undament al pr i nci pl e" to th e n s ta rttr a n s fu s in g b lo o d , s h e fu rt h e r a d m itte d th a t s h e d id n o t d o th is
. ¶ 8
. A t 1 :2 5 p .m ., A lish a w a s tak e n to x -ra y fo r c e rv ica l sp in e , a n d c h e st x -ra y s b u t w h ile
s he w as w ai t i ng t o be pl ace d on the C T m achi ne, herre s pi r at i ons beca m e more l abor ed and
r api d. A l i s ha w as then r eturned t o the emer gency depart m ent , a nd on the w ay back, s he
s to p p e d b re a th in g . H e r re sp ira tio n s w e re as sis ted w ith a b a g v a lv e m a sk
. A t 2:3 5 p .m ., A l i s ha w as agai n t aken t o C T , w her e s he r emai ned unt i l 3 : 45 p . m . , atw hi ch t i m e s he w as t aken t o the hol di ng r oom ( pr eoper at i ve ar ea)
. A t3: 52 p. m . , she w as t aken t o the oper at i ng
ro o m , w h e re su rg ica l pr o c e d u re s w e re p e rfo rm e d b y D r. B rig g s a n d D r. M c M ill a n . I d. D u rin g s u rg e ry , th e d e c e d e n t’s h e a rt s to p p e d , a n d re su sc itatio n a ttem p ts w e re u n su c c e ss fu l. Id
. A lis h a w a s p ro n o u n c e d d e a d a t 5 :1 5 p .m . DI S CUS S I ON I . W het her t he A m bul ance Servi ce D ef endants knew or s houl d have kno wn t hat R i ve r O ak s H os pi t al was not c apa bl e of m ana gi ng A l i s ha’ s c ondi t i on, and w het her t hei r a c t i ons i n t r ans por t i ng Al i s ha to th a t h o s p it a l w e r e o n ly a r e m o te c a u s e o f h e r d e a th . A . St andard of R evi ew

### 6

¶ 9
. T h e sta n d a rd o f re v iew fo r d e ter m in in g w h e th e r a m o tio n fo r d ire c ted v e rd ict s h o u ld b e g ra n te d is d e n o v o . W in dm o n v. Ma rs h a ll , 9 2 6 S o . 2 d 8 6 7 , 8 7 2 (M iss . 2 0 0 6 ). A ll evi dence i s cons i der ed “i n t he l i ghtm os tfa vor abl e t o t he non- m ovant , gi vi ng t hatparty the benef i tof al l fa vor abl e i nf

er ence s t hatm ay be r eas onabl y dra w n fr om t he evi dence
. ” Forbes
v. GM C, 935 So. 2d 869, 872 ( ci t i ng Cousarv. State, 8 5 5 S o . 2 d 9 9 3 , 9 9 8 (M iss. 2 0 0 3 )). If th e C o u rt fin d s th a t th e e v id e n c e fa v o ra b le to th e n o n -m o v in g p a rty a n d th e re a so n a b le i nf er ence s dr aw n ther ef

r om pr es enta ques t i on f orthe j ury, the mot i on shoul d notbe gr ant ed. P a ce v . Fina n cial S ec . L if e , 6 0 8 S o . 2 d 1 1 3 5 , 1 1 3 8 (M iss .1 9 9 2 ). T h is C o u rt h a s a lso h e ld that"[ a] tr i al courts houl d s ubm i ta n i s s ue t o the j ury onl y i f the evi dence c r eat es a ques t i on of f actconcerning w hich r easona ble j urors could di sagree. " V ines v. W indham , 606 So. 2d 1 2 8 , 1 3 1 (M iss. 1 9 9 2 ).

B . R ul e 50( a) M ot i on f or a D i rec t ed V erdi ct ¶1 0
. M . R . C
. P . 50 (a) pro v ides gu idelines for gran ti n g a d ire c ted v e rd ict. C o m m e n tary fo llo w in g th e ru le s tate s: I n rul i ng on the m ot i on f ora di r ect ed ver di ct , the courts houl d pr ocee d al ong the sam e g u idelines an d stan d ard s tha t hav e g o v ern ed p ri o r pe rem p tory i ns truct i on and di r ect ed ver di ctpra ct i ce i n M i s s i s s i ppi : the courts houl d l ook s ol el y t o the tes t i m on y on behal f of the oppos i ng party; i f

s uch t es t i m ony, a lo n g w ith a ll rea so n a b le in fe re n c e s w h ich c a n b e d ra w n th e re fro m , co u ld s uppor ta ver di ctf

orthatparty, the ca s e s houl d notbe t aken f r om the j ury. See W hite v. T hom ps on , 3 1 0 S o . 2 d 9 1 4 (M iss . 1 9 7 5 ); E z el l v. Metr opolitan Ins . Co. , 228 S o . 2 d 8 9 0 (M iss . 1 9 6 9 ); Hol m es v. Sim on , 7 1 M is s . 2 4 5 , 1 5 S o . 7 0 (1 8 9 3 ).

### The e me rge ncy departm ent UMC has Leve l Itraum a c are c apa bil it y. 1 

### 7 C . D ut y and B reac h ¶11. T he el ement s of a negl i gence s ui t , w hi ch are w el l -s et t l ed i n M i s s i s s i ppi , ar e duty, b re a c h o f d u ty , c a u s a tio n , a n d in ju ry . Pa tte rs o n v. Lib e r t y As s o c s . , L. P. , 910 So. 2d 1014, 1019 ( M i s s . 2004) ( ci t i ng Mis s . D e p ’t o f T r a n s p . v. Ca r g ile, 84 7 S o. 2d 25 8, 26 2 (M i ss. 2003) )
. T he exi s t ence of a duty i s c l eara nd undi s put ed i n thi s c as e. U ndert he C entr al M i s s i s s i ppi E m er gency M edi cal S ervi ces P r ot ocol M anual (“ E M S Pr ot ocol ”) , i ti s evi dent thatM i ng, C ampbel l , and R E M S ow ed a duty t o pr ovi de care and t r eatm entt o A l i s ha. Fur therm or e, underthe s t andar d f ora Rul e 50( a) mot i on, the tr i al courtl ooked s ol el y t o the t es t i mony o n b e ha l f

of the a pp e l l a nt , a nd a s s umed , f orthe pu rpo s e s of

thi s rul i ng , tha tt he A m bul ance Ser vi ce D ef endant s bre ache d thi s duty by t aki ng A l i s ha t o R i verO aks H os pi t al instead o f U n iversity M ed ical C en ter (U M C ). 1

D . P rox i m ate C au se ¶12. T o pr ove the el ement of caus at i on, both caus e i n f act and pr oxi m at e caus e m us tbe
s h o w n . P atters on , 910 So. 2d at1019 ( ci t i ng J a c ks o n v. S w in n e

y, 244 M i s s . 117, 123, 140 So. 2d 555, 557 ( 1962) )
. Pr oxi m at e caus e has be en def i ned as “ caus e w hi ch i n natur al and cont i nuous s equenc e unbr oken by any e f f i ci enti nt erveni ng caus e pr oduces the i nj ury and
w i thoutw hi ch the r es ul tw oul d nothave oc curr ed. ” P a tte rs o n , 910 So. 2d at1019 ( quot i ng D elahouss aye v. Mar

y Mahoney’s, I

nc. , 783 So. 2d 666, 671 ( M i s s . 2001) )
. Fur therm or e, to b e h e ld lia b le , a p e rso n “ n e e d n o t b e th e so le c a u se o f a n in ju ry . It i s s u ffic ien t th a t h is

### 8

negl i gence concurr i ng w i th one orm or e ef f i ci entcaus es, o t her than the pl ai nt i f f’ s , i s the pr oxi m at e ca us e of

the i nj ury. ” Foster v. B ass , 5 7 5 S o . 2 d 96 7 , 99 2 (M iss. 1 9 9 0 ) ( quot i ng Sm ith v. D illo n Ca b Co ., I n c ., 2 4 5 M iss. 1 9 8 , 2 0 5 -06 , 1 4 6 S o . 2 d
. 8 7 9 , 8 8 2 (19 6 2 )). ¶13. I n her t es t i m ony, D r . D i ckens , empl oyed nine year s as a f ul l
- t i m e emer gency r oom phys i ci an, s t at ed thats he w as t r ai ned i n A T L S. D r . D i ckens al s o t es t i f i ed thatw hen s om eone i s i n hypovol emi c s hock, the corr ectpr ocedur e i s t o admi ni s t erfl ui ds t o t he pat i ent , and then i f vi t al s i gns cont i nue t o det er i or at e, t o admi ni s t erbl ood. Sh e w ent on t o admi tthats he fe a re d A lish a w a s in h y p o v o lem ic sh o c k a n d p ro c e e d e d to a d m in iste r flu id s in a n a ttem p t to i ncr eas e A l i s ha’ s vi t al s i gns . H ow ever , the vi t al s i gns c ont i nued t o det er i or at e, and al though D r . D i ckens a dm i t t ed i n he rt es t i m ony thatw hen thi s happens , i ti s a “f undament al pr i nci pl e” t o then st arttransf

usi ng blood, s he further adm i t t ed thatshe did no tdo this
. ¶14. D r . C ar l H aus er , a s ur geon and s peci al i s t i n tr auma and cri t i cal care, al s o s t at ed on
cr os s - exami nat i on thatthe pr act i ce of gi vi ng f l ui ds and then bl ood i f vi t al s i gns do not i m pr ove i s “one of

the bas i c t enent s of A T L S ” and thatf ai l i ng t o tr ans f

us e bl ood w as “vi ol at i on of

the s t andar d” of

c ar e. T her ef

or e, i ti s cl earby D r . D i ckens ’ s ow n admi s s i on,
a lo n g w ith D r. H a u se r’s tes tim o n y , tha t D ick e n s w a s n e g lig e n t in n o t tra n s fu sin g b lo o d in thi s s i tuat i on, a s a tr ai ned A T L S phys i ci an w ho s houl d have know n and admi t t edl y di d know th a t s u c h p ro c e d u re s w e re th e a c c e p te d s ta n d a rd in th e m e d ic a l c o m m u n ity
. ¶1 5. Fur the r mor e , Dr . Haus e r ’ s t e s t i mony made i tc l eart hatbr eac hi ng t he gener al l yacc ept ed medi cal s t andar d f orthe tr eatm entof

hypovol emi c s hock, thi s act i on beca m e a

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pr oxi m at e ca us e of

A l i s ha’ s death. D r . H aus ers t at ed that“the arr es tw oul d nothave
occurr ed .
. . had the pat i entbeen e l ect i vel y i ntubat ed and gi ven bl ood. H e al s o s t at ed that if b lo o d h a d b e e n g iv e n , A lish a w o u ld h a v e to ler a ted th e tra n sfe r to U M C fo r su rg e ry if R i verO aks had dec i ded thats uch a tr ans f erw as needed. Fur therm or e, D r . H aus ers t at ed that i f A l i s ha h a d be e n tr a ns po r t e d t o U M C, s he “ w ou l d ha ve s urvi ve d w i th a v e r y hi gh lik e lih o o d , g re a te r t h a n n in e ty p e rc e n t . . . d e p e n d in g u p o n e x a c t tim in g a n d s o fo rt h .” ¶ 1 6
. D r. V e rn o n H e n d e rs o n , a n o th e r e x p e rt w itn e s s o ff e re d b y th e p lain tiff-a p p e llan t,
re itera ted D r. H a u se r’s sta tem e n ts re g a rd in g D r. D ick e n s’s a n d R iv e r O a k ’s n e g lig e n c e in thei rtr eatm entof

A l i s ha. A s a gene r al s ur geon w i th a s peci al i nt er es ti n tr auma sur gery, H ender s on s t at ed thatbe f or e A l i s ha arr es t ed, s he had a ni nety- f i ve per centorbett erchanc e of s ur vi vi ng. T aken a l ong w i th D r . H ause r ’ s t es t i m on y – t hat but f orthe f ai l ur e t o gi ve b l o o d , Al i s h a wou l d no tha ve a rr e s t e d – i ti s c l e a rth a tth i s f a i l u r e t o f

o l l o w pr o p e rATLS pr ocedur es w as a pr oxi m at e ca us e of A l i s ha’ s death. Fur therm or e, even i f s he had a rr es t ed
an d su rge ry w as p erfo rm ed in a tim ely fa sh ion , H en d erso n stat ed that “h er c h an ce s w ere b e tter th a n e ig h ty p e rc e n t” f o r su rv iv a l. ¶17. T he A m bul ance Ser vi ce D ef endant s ar gue that , even as s um i ng they w er e negl i gent i n tr ans por t i ng A l i sha t o R i verO aks , they es cape l i abi l i ty beca us e they coul d nothave f or es een thatD r . D i ckens w oul d ha ve devi at ed f r om the s t andar d of

car e. H ow ever , E ntr i can
a ss e rts th a t R iv e r O a k s w a s n o t ca p a b le o f h a n d lin g A lish a ’s c o n d iti o n a n d th a t ev e ry o n e in

### 10

the medi cal comm uni ty w as w el l aw ar e of thatf act . T heref

ore, E ntr i can a l l eges thatany
n e g lig e n c e o n th e p a rto f R iv e r O a k s o r i ts p h y s ic ia n s w a s fo re s e e a b le
. ¶1 8
. S ev era l w itn esse s for E n tr ican test if ied th at R iv e r O a k s d id n o t h av e trau m a ca re
c a p a b ility a n d th a t th is w a s c o m m o n k n o w le d g e in th e J a c k s o n a re a . S te v e n E s k ri d g e , a par amedi c and expertqua l i f i ed i n the f

i el d of e m er gency m edi cal s ervi ces , s t at ed thatR i ver O ak s d id n o t hav e the p erso n n el on h a n d to im m ed iat ely tak e c are o f trau m a p ati en ts. D r. R egi nal d M art i n, a gene r al surgeon , te s t i f i ed thatR i verO aks w as “ce r t ai nl y notthe i deal pl ace f ora mul t i
- s ys t em t r auma pat i ent . . . . T her e i s onl y one pl ace i n thi s ar ea w her e A l i s ha Pe a vy be l on gs , a nd tha t ’ s a tthe U ni ve r s i ty o f M i s s i s s i pp i M e di c a l Cent e r . The r ef or e, E n tr i c a n a r g u e s t h a tb e c a u s e th e Am b u l a n c e S e r v i c e De f e n d a n t s k n e w o rs h o u l d h a v e k n o wn thatR i verO aks w as notcapabl e of handl i ng the types of

i nj ur i es thatA l i s ha s us t ai ned, negl i gence on t he partof R i verO aks ’ s phys i ci ans w hen att empt i ng t o tr eatheri nj ur i es w as f or es eeabl e and c oncurr entw i th the A m bul ance Ser vi ce D ef endant s ’ negl i gence i n caus i ng A lis h a ’s d e a th
. ¶ 1 9
. In re sp o n se , the A m b u lan c e S e rv ice D e fe n d a n ts a ss e rt th a t w h e n d e liv e rin g A lish a to R i verO aks , they w er e pl aci ng heri n the ca r e of a hos pi t al w i th a tw enty- f ourhour
em ergency dep artm ent and a A T L S -trai ned em ergency departm entphysi ci an in D r. D i cken s. D r . D i ckens had been cert i f i ed thr ee di f

f er entt i m es i n A T L S t r ai ni ng and t es t i f i ed thatdur i ng hert i m e as an emer gency de part m entphys i ci an, she has see n m any pat i ent s i n shock. T he De f e n d a n t s a r g u e th a tb e c a u s e AT L S p r o c e d u r e s a r e g e n e r a l l y a c c e p t e d a n d we l l
- k n o wn

### 11

thr oughoutthe medi cal c om m uni ty a nd be caus e of the tr ai ni ng and yea r s of exper i ence that D r. D ick e n s h a d w ith sh o c k p a tie n ts, it w a s u n fo re se e a b le th a t D r. D ick e n s w o u ld fa il t o admi ni s t erthe pr opertr eatm entof gi ving fl ui ds and then bl ood i n r es pons e t o A l i s ha deter i orat i ng vit al si gn s. ¶20. E M S Pr ot ocol i ncl udes a s ect i on ent i t l ed “C hoos i ng a H ospit al D es t i nat i on” w hi ch ai ds par amedi cs i n m aki ng a det erm i nati on as t o w hi ch hos pi t al a pat i ents houl d be tr a n s p o r t e d
. Th e P r o t o c o l s t a t e s th a ts e v e r e o rmu l t i s y s t e m t r a u ma p a t i e n t s wi th a tr a u ma
s cor e of t en orl es s s houl d be tr ans por t ed di r ect l y t o a hos pi t al w i th the equi val entof L evel I orII traum a centercapab i l i t i es. T his paragraph als o st at es that the m ort al i ty rat e f or these p ati en ts i n cre ase s d ram ati ca ll y if there is a d elay in rea ch ing the trau m a c en ter. H o w ev er, i ti s undi s put ed thatA l i s ha’ s tr auma s cor e neverr eac hed t en or bel ow w hi l e en r out e t o the h o sp ital. R a th e r, A lis h a ’s in iti a l sc o re w a s th irtee n a t th e a c c id e n t sc e n e a n d d ro p p e d to tw e lv e w h ile in th e a m b u lan c e . T h e re fo re , A m b u lan c e S e rv ice D e fe n d a n ts a rg u e th a t th is
r equi r ementdi d notappl y t o thei r det ermina t i on of the pr operhos pi t al des t i nat i on. M i ng t es t i f i ed thatdue t o the s er i ous ness of A l i s ha’ s condi t i on, U M C w as cons i der ed w hen the ambul ance i ni t i al l y l ef

tthe acci dents cene . H ow ever , A l i s ha’ s det er i or at i ng condi t i on, as
w el l as tr af

f i c f l ow pr obl ems betw een R i verO aks D r i ve atL akel and D r i ve and U M C atnoon
on a w eekda y, w ei ghed aga i ns tthe cont i nu i ng tr ans por tt o U M C
. M i ng t es t i f i ed thathe not i ced thati n a s hor tperi od of t i m e A l i s ha’ s m ent al s t atus and vi t al s i gns change d, i ncr eas i ng herneed of

emer gency tr eatm entby a physi ci an. T her ef or e, they tr ans por t ed

### 12

A l i s ha t o the cl os es tf

aci l i ty thatcoul d s t abi l i ze he r , w hi ch w as R i verO aks
. M i ng t es t i f i ed th a t in m a k in g th is d e c isio n , h e k n e w th a t R iv e r O a k s c o u ld d o m o re fo r h e r th a n h e c o u ld d o , a s R iv e r O a k s w o u ld b e a b le to g iv e b lo o d p ro d u c ts a n d s ta b iliz e h e r v ita l s ig n s . ¶ 2 1
. D r. R ick C a rlto n , M e d ica l D ire c to r fo r th e C e n tra l M iss iss ip p i E M S D istric t, w h o is
r espon si bl e f

orw r i t i ng the pr ot ocol s , t es t i f i ed thatas A l i s ha’ s tr auma sc or e neve rr eac hed t e n wh i l e e n r o u t e t o th e ho s p i t a l , t h e r e q u i r e me n tt o tr a n s p o r th e rt o a l e v e l I o rI I tr a u ma cent erdi d notappl y. R ather , D r . C ar l t on t es t i f i ed thatthe Sect i on o f t he pr ot ocol on “Em er genci es ” w a s a pp l i c a bl e , w hi c h s t a t e s tha t“ [ e ] mer ge nc y pa t i ent s s houl d be tr ans por t ed d ir ec tl y to the n ea rest ho sp ital cap ab le of m an ag ing their em erg en cy co n d it ion
. H o w ev er, th e p a tien t’s (a n d fa m ily ’s) h o sp ital p re fe re n c e m u st b e c o n sid e re d w h e n m a k in g th is deci s i on. ” D r . C ar l t on f ur thert es t i f

i ed thata f

t err evi ew i ng the evi dence i n thi s cas e, i tw as hi s opi ni on thatthe A m bul ance Servi ce D ef endant s metthe s t andar d of car e r equi r ed of

them in th is s itu a tio n . D r. C a rlto n a lso tes tified th a t th e tra u m a sy ste m in 1 9 9 8 w a s d ra m a tica lly di f f er entf r om the s ys t em w hi ch i s i n pl ace t od ay. H e tes t i f i ed that , atthe t i m e of the i nci dent , ther e w as no or gani zed s ys t em foracc es s i ng hos pi t al s w i th the pr opercapabi l i t i es f orthe ca r e of

tr auma pat i ent s . D r . C ar l t on st at ed, att he t i m e of A l i s ha’ s acci dentther e w as
no w ay t o know thata gi ven hos pi t al w oul d have a pr obl em t r eat i ng a cer t ai n cat egory of pat i ent . D r. C ar l t on al s o t es t i f i ed that , atthe t i m e of

thi s i nci dent , nei therR i verO aks nor anyone a s s oci at ed w i th R i verO aks had made a r eques tt o the EM S of f i ce oronl i ne M edi cal C o n tr o l r e g a rd in g n o t b ri n g in g tr a u m a o f a n y k in d to R iv e r O a k s .

### 13

¶22. H ow ever , i n M i ng’ s s t at ement , w hi ch w as w r i t t en a coupl e of hour s af t er A l i s ha w as t aken t o R i verO aks , M i ng s t at ed thatD r . D i ckens advi s ed hi m thatR i verO aks coul d not h an d le this typ e of traum a and that the su rgeon (D r. B ri gg s) w as on ca l l
. M i ng t old D r. D icke n s th a t th e p ati en t’ s g u ard ian re q u ested the fa cil ity an d b ec au se o f A li sh a’s det er i or at i ng co nd i t i on, R i verO aks w as the cl os es tf aci l i ty t o s t abi l i ze he r . M i ng f ur ther
s t at ed thathe thoughtR i verO aks had the capabi l i ty t o s t abi l i ze the pat i ent . W hen D r . B r i ggs
arr i ved, he aske d w hi ch am bul ance broughtA l i s ha t o t he hospi t al and w hy i tdi d so. M i ng
re sp o n d e d a s h e h a d to D r. D ick e n s. D r. B rig g s to ld M in g th a t R iv e r O a k s c o u ld n o t h a n d le this ty p e o f tr au m a an d tha t he s h o u ld h av e tran sp o rt ed A li sh a to U M C , as th ey h ad the s taff to tr ea t th is ty p e o f pa ti en t. D r. B ri g g s furthe r st ated that M ing “p rob ab ly d id m o re h arm than good f

orthe pat i ent . ” D r . B r i ggs advi s ed M i ng t o explai n t o t he f ami l y thatA l i s ha
s houl d have gone t o U M C w i th thi s type of t r auma. A ddi t i onal l y, the EM S pr ot ocol s t at es thatw hen maki ng a hos pi t al des t i nat i on deci si on , a par amedi c s houl d “cont actm edi cal
c o n tr o l i f

th e r e i s a n y d o u b ta s t o whi c h h o s p i t a l a p a t i e n ts h o u l d b e tr a n s p o r t e d t o . ” On
cross -exa m i nat i on, M i ng s t at ed thathe di d notcal l M edi cal C ontr ol pr i ort o tr ans por t i ng A lis h a to R iv e r O a k s to s e e k th e irin p u t a s to w h ic h h o s p ita l s h e n e e d e d to g o to . ¶2 3. A ddi t i onal l y, t e s t i mony s ho w e d tha t w hi l e M i ng w a s pr i mar i l y r e s po ns i bl e f ort he d e c isio n to tra n sp o rt A lish a to R iv e r O a k s, A lice L itt le, A lish a ’s g ra n d m o th e r, w h o w a s w ith heri n the ambul ance , concurr ed w i th thi s deci s i on. A ct i ng acc or di ng t o E M S pr ot ocol , M i ng
w as r equi r ed t o cons ul tw i th L i t t l e aboutherw i s hes forA l i s ha’ s t r eatm ent . L i t t l e advi s ed

### 14

M i ng thats he w ant ed A l i s ha t o be t aken t o M ethodi s tN or th, w hi ch i s w her e A l i s ha’ s baby
wa s t o b e d e l i v e r e d
. M i n g e x p l a i n e d th a tM e th o d i s tNo r th d i d n o th a v e a n e me r g e n c y r o o m,
an d there fore , in h is op inion , w as n o t a ap p rop ri ate o p ti o n co n side ri n g A li sh a’s se v ere
co n d it ion
. M ing ad v ised L ittl e tha t bec au se A li sh a’s m en tal s tatu s an d v it al si g n s w ere di m i ni s hi ng, t he am bul ance s houl d pr ocee d t o the cl os es thos pi t al w i th an emer gency r oom
so e m e rg e n c y tre a tm e n t co u ld b e g in . A t th is p o in t, L itt le g a v e h e r c o n se n t to tak e A lish a to R i verO aks
. M i ng r adi oed R i verO aks t o i nf or m t he st af

f of the st atus of the pat i enthe w as br i ngi ng t o the hos pi t al
. A tthi s t i m e, Ri verO aks m ade no a t t empt t o di vertthe ambul ance t o anotherhos pi t al ori nf or m M i ng thatthey w er e notequi pped t o handl e A l i s ha’ s condi t i on. ¶24. “The l aw deal i ng w i th the duty t o f or es ee the i m prudent act s of other s appea r s under the gene r al rubr i c of

the j ur i s prudence of

‘ i nt erveni ng cause . ’ ” Southland M gm t . Co. v. Br o wn b y & Th r o u g h Br o wn , 7 3 0 S o . 2 d 4 3 , 4 6 (M is s . 1 9 9 8 ). 

### The Se cond Re st at em ent of To rts defin es a sup ersedin g cau se as “an act o f a thirdperso n o r oth er force wh ic hb yits int er vention preve nts theac tor from be ing l ia

blefor har m to another

whic h his ant ec ede nt neg ligen ce is a sub stantial facto r in b ring ingabo ut.” Id . ( ci ting Res tatem ent (Se cond) of To rts § 4 40 (19 65 )). Un der th is theo ry, an or i gi nal act or ’ s negl i gence m ay be s uper cede d by a s ubs equentact or ’ s negl i gence , i f t he subs equentnegl i gence w as unf or es eeabl e. S o u th la n d

M g m t. Co ., 730 S o. 2d at46. H ow ever , m er el y f i ndi ng thatthe negl i gence of R iv e r O a k s , b y a n d th ro u g h D r. D ick e n s, w a s a n in ter v e n in g c a u se in th e c h a in o f e v e n ts l eadi ng f r om the A m bul ance Servi ce D ef endant s a ct i on i n tr ans por t i ng A l i s ha t o R i verO aksS tate d d iffe re n tly , the se c a se s h o ld th a t “n e g lig e n c e is re m o te a n d n o n -a c tio n a b le 2 w hi ch mer el y caus es a per s on to be ata part i cul arpl ace ata part i cul art i m e w her e s uch 

### 15 t o A l i s ha’ s de ath i s nots uf f i ci entt o r enderthe A m bul ance Servi ce D ef endant s ’ ear l i er act i ons non- act i onabl e. I d. I ns t ead, thi s Courtha s he l d thati f “ the i nt erveni ng caus e i s one
w hi ch i n o r di na ry h uman e xp e r i e nc e i s r e a s on a bl y t o b e a nt i c i pa t e d, oron e w hi c h the d efe n d a n t h a s re a so n to a n ticip a te u n d e r th e p a rticu lar c irc u m sta n c e s," the su b seq u en t actor’s negl i gence i s for es eeabl e and does notbre ak the chai n of event s betw een the negl i gence of the firstac tor an d the in jury . I d. ( ci t i ng W . Page K eet on etal
. , Pr os s erand K eet on on the L aw of T or t s § 44 ( 5th ed. 1984) )
. A s s uch, underpr i nci pl es of "f or es eeabi l i ty, " a def

endant
m a y b e h e ld liab le f

o r h is fa ilu re to a n ticip a te a n e a sily -p re d icte d in ter v e n in g c a u se a n d to p ro p e rl y g u a rd a g a in s t it. I d . See al s o P a rg a s o

f T a ylorsvil le, In c. v. Cra

ft , 249 So. 2d 403, 408 (M i s s . 1971) ( hol di ng t hata def endanti s char geabl e onl y w i th a n ticip a tin gre a so n a b le prob ab i l i t i es, ther ef

or e a pe r s on i s notbound t o ant i ci pat e the unusual, i m pr obabl e, or extr aor di nary occurr ence , al though s uch happe ni ng i s w i thi n the r ange of pos s i bi l i t i es (cit ati o n o m itted)). ¶25. N otw i ths t andi ng, thi s C our tal s o has hel d tha t“ ne gl i ge nc e w hi c h mer el y f urni s hed the condi t i on orocca s i on upon w hi ch i nj ur i es ar e r ece i ved, butdoes notputi n m ot i on the age ncy by orthr ough w hi ch the i nj ur i es a r e i nf l i ct ed, i s notthe pr oxi m at e caus e ther eof
. ” R obis on
v. McD o w e ll , 24 7 S o . 2 d 6 8 6 , 6 8 8 (M iss. 1 9 7 1 ) ( quot i ng Ho k e v . W .L . Ho lc o m b & A s s o c ., I nc . , 1 8 6 S o . 2 d 4 7 4 (M iss. 1 9 6 6 ); Mis s is s ip p i City L in e s, I

n c . v. B u llo c k, 194 M i s s . 630, 13 So. 2d 34 ( 1943) )
. Thus, “[ i ] f the ac tcompl ai ned of

i s onl y a r emot e ca us e, s uper s eded 2per s on i s i nj ur ed as a r es ul tof the negl i gentactof another , w ho put s i n m ot i on a di f f er entand i nt erveni ng caus e w hi ch ef f i ci ent l y l eads i n unbr oken s equenc e t o the i nj ury. 

### ” Id.

16 by an i ndepende nt , e f

f i ci enti nt erveni ng c aus e thatl eads i n unbr oken s equenc e t o the i nj ury, t he or i gi na l ne gl i ge nta c ti s no ta pr ox i mat e , bu ta r e mot e , c a us e . Thus , no tbe i ng f or es eeabl e, the or i gi nal caus e i s notact i onabl e. ” Robis on, 247 S o. 2d. at689. I n R obis on , a dr i verpul l ed a tr act orouti nt o a hi ghw ay and bl ocked both l anes of tr avel
. A s a r es ul t , the in ju re d p a rt y w a s re q u ir e d to s to p h is v e h ic le
. I d. W h ile th e in

ju r e d p a rt y w a s s to p p e d , a
s econd ve hi cl e hi thi m f r om behi nd. T he dr i verappeal ed the j udgm entent er ed i n f avorof th e in ju re d p a rt y . I

d. T hi s C our tf

ound thatal though the j ury w as j us t i f i ed i n f i ndi ng thatthe dr i vernegl i gent l y pul l ed t he t ra ct orouti nt o the hi ghw ay, hi s negl i gence w as notthe p ro x im a te c a u s e o f t h e a c c id e n t. I d . a t6 88
- 68 9. Rathe r , the i nt e r ve ni ng n e gl i ge nce of t he
se c o n d o p e ra to r su p e rc e d e d th a t o f th e d riv e r, th u s re n d e rin g th e d riv e r’s n e g lig e n c e a re m o te
c a u s e . I d . a t68 8- 68 9. A dd i t i on a l l y, thi s Cour ts t a t e d tha t“ [ t ] he qu e s t i on of s up e r c e di ng i nt erveni ng caus e i s s o i nextr i cabl y t i ed t o caus at i on, i ti s di f f i cul tt o i m agi ne a c i r cumst ance
w her e s uch i s s ue w oul d notbe one f orthe tr i erof

f act . ” O ’ Cain v. H

ar v e y Fre e m an & Sons, I nc ., 6 0 3 S o . 2 d 8 2 4 , 8 3 0 (M iss. 1 9 9 1 ). ¶2 6. W hi l e t he t r i a l c ou r trul e d tha tthe a l l e ge d n e gl i ge nc e of the A mbul ance Ser vi ce D e fe n d a n ts in tra n sp o rtin g A lish a to R iv e r O a k s ra th e r th a n to a n o th e r h o sp ital c o u ld b e o n ly
a r emot e caus e of

A l i s ha’ s death, w e f

i nd thatther e i s evi dence i n the r ecor d t o s uppor tthe
ar gum ent s f

orboth s i des , ther eby cr eat i ng a ques t i on f ort he j ury. T her ef

or e, w hetherthe A m b u lan c e S e rv ice D e fe n d a n ts k n e w o r sh o u ld h a v e k n o w n tha t R iv e r O a k s w a s n o t ca p a b le

### 17

of managi ng A l i s ha’ s c ondi t i on a nd w hetherthei ra l l eged negl i gence , i f a ny, i n t aki ng her to th a t h o sp ital w a s o n ly a re m o te, a n d th u s n o t p ro x im a te, c a u se o f h e r d e a th , is q u e stio n to be det erm i ned by the j ury. W e s ugges tno opi ni on on the mer i t s of E ntr i can’ s cl ai m orher abi l i ty t o m eett he re qui s i t es of a negl i gence act i on. W e f i nd onl y thatthe di r ect ed ver di ct in fa v o r o f th e A m b u lan c e S e rv ice D e fe n d a n ts w a s n o t p ro p e r, as th e iss u e o f c a u s a tio n in th is c a se is a ju ry q u e stio n . A c c o rd in g ly , w e re m a n d to th e trial c o u rt to su b m it th is iss u e to th e ju ry in a c c o rd a n c e w ith th is o p in io n . CO NC L US I ON ¶27. For the f

or egoi ng r eas ons , the di r ect ed ver di ct i s r ever s ed and thi s cas e i s r emanded to th e trial c o u rt. ¶ 2 8
. REVERSED AND REM AND ED . W AL LER AN D D I AZ , P. J J . , EAS LEY, CA RL SON , DI CK I NSO N, RA ND O LPH AN D L AMAR , J J . , CO NC UR . GR AV E S , J . , NO T P AR T I CI P AT I NG .