THI RD DI VI SI ON

DOYLE, P. J.

, REESE and BROWN, 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.

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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

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June 22, 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 41 3 . CONNIE v . GARNETT.

B R O W N , J u d g e.

Key l a Co n n i e fi l ed t hi s m ed i cal m al p ract i ce s u i t ag ai n s t Do c t o r s Ho s p i t al o f

Au g u s t a, LLC (“ DHA”), HCA H o l d i n g s

, In c., W il l i am S. Hi l t z, M .D., an d Ro b ert P.

Garn et t

, M .D. 1 Th e t ri al co u rt g ran ted s u m m ary ju d g m en t i n fav o r o f Garn et t

, an d

Co n n i e no w ap p eal s. Sh e al s o ap p eal s t h e t ri al co u rt ’ s d en i al o f h er m o t i o n t o a d d

M el is s a Tu rn er, a p h y si ci an as s i s t an t wh o t r e a t ed h er, as a part y -d efen d an t an d t h e

g ran t o f Tu rn er’ s s p eci al ap p earan c e m o t i o n to d i s m i s s

. Fo r t h e reas o n s ex p l ai n ed

b el o w, we affi rm t h e t ri al co u rt ’ s o rd er d en y in g Co n ni e’ s m o t io n t o ad d T u rn er as a

p art y -d efen d an t , b u t rev ers e t h e g ran t o f s um m ary ju d g m en t i n fav o r o f Garn et t

.

1 HCA Ho l di ng s

, In c., Hi l t z, an d DHA were s u bs eq u en t l y d i sm i s s ed fro m t h e

act i on an d are n o t p art ies t o t hi s ap peal

.Th e un d erl y i ng fact s of t h i s cas e are l arg el y u n d i s p u t ed

. Co n n i e, a 29 -y ear-o ld

wo m an

, p res en t ed to t h e DHA em erg en cy ro o m o n t h e ni g h t of O c t o b e r 1 1

, 2 0 1 4,

wi t h co m p lai n t s o f acu t e lo wer ri g h t l eg p ai n

. Sh e rep ort ed t h e p ai n as a n i n e o u t o f

t en

. Sh e was ev al u at ed b y Tu rn er, a p h y s i ci an as si s tan t

, an d t h e p hy s i cal ex am i n at i o n

s h o wed b i l at eral pu l s es / n orm al p u ls es

. Tu rn er o rd ered a v en ou s d u p l ex u l t ras o u n d

b as ed o n s u s p i ci o n of p o s s ib l e d eep v ei n t h ro m bo s is (“ D VT”). Dr. H i l tz rev i ewed t h e

res u l ts an d fo u n d n o ev i d en ce o f DVT. A ft er b el i ev i n g s h e f o u n d n o ev i d en ce o f

b l o o d cl o t s

, Tu rn er p res cri b ed p ai n m ed icat i o n

, d i sch arg ed Co n n ie, an d ad v i s ed h er

t o fo l l o w u p wi t h h er p h y s i ci an

. It ap p ears fro m t h e reco rd t h at wh i le Garn et t was o n

s h i ft

, h e was n o t p res en t wh en Tu rn er t reat ed C o n n i e

, b u t h e l at er rev i ewed an d

s i gn ed Co n n i e’ s m ed ical ch art as Tu rn er’ s s u p erv i s in g p h y s i ci an

.

Th ree d ay s l at er, Co n n i e p res en t ed to Au g us t a Un i v ers i t y M ed i cal Cen t er wi th

s wel l i n g an d di s co l o rat i o n i n h er ri gh t fo ot an d w o r s e ni n g fo o t p ai n

. Sh e was

d i ag n o s ed wi t h ri g ht l ower ex t rem i t y i s ch em i a an d u n d erwen t an o p e n t i b i al

t h ro m b ect o m y t h at day

. Ten d ay s aft er t he t h ro m bect o m y

, Co n n i e ag ai n p res en t ed to

DHA wi t h a “ co o l t o t h e t o u ch

, ” d i s co l ored ri g h t fo o t

. Co n n i e’ s fo o t w as u l t i m at el y

p art i al l y am p u t at ed i n Decem

b er 2 0 1 4

.

2Co n ni e fi l ed h er i n i t ial co m pl ai n t i n J u n e 2 0 1 6, al l eg i n g t hat t h e p u l s e ex am

an d v en o u s d u p l ex u l t ras ou n d p erfo rm ed “ were n ei t h er ap pro p ri at e no r s u f fi ci en t

m ean s of d et erm i n i ng wh et h er [s h e] was co n t en d i n g wi t h a s eri o u s art eri al

d y s fu n ct i o n,” an d th at unde r t he ci rcu m s tan ces t h e d efen d an t s sh o ul d h av e p erfo rm ed

o r o r d e r e d an art eri al d u p l ex s can an d / o r Do p p l er p ro b e o f h er art eri al s y s t em

. On

Oct o b er 7

, 2 0 1 6

, Co n n i e fi led a s eco nd am en d ed co m p l ai n t n a m i n g Tu rn er as a

d efen d an t

, b u t Co nn i e nei t h er fi l ed a m o t io n t o ad d Tu rn er as a p art y no r s o u g h t l eav e

fro m t he t ri al co u rt t o fi l e t h e am en d ed co m p l a i n t

. C o n n i e fai l ed t o s erv e Tu rn er

b efo re t h e s t at u te o f l im i tat i o n ex p i red o n O c t o b e r 11

, 2 0 1 6

. 2 In No v em b er 2 0 1 6,

Tu rn er fi l ed a s p eci al ap p earan ce an swer an d m o ti o n t o d i s m i s s

, as s ert i n g t h at Co n n i e

fai l ed t o m o v e t o ad d h er as a p art y an d t o ob t ai n l eav e o f t h e co u rt to d o so p ri o r to

fi li n g t h e s eco nd am en d ed co m p l ai n t as req u i r ed b y OCGA § 9-1 1 -2 1, an d t h at t h e

s t at u te o f l i m i t at i o n b arred Co n n i e’ s cl ai m s

. Tu rn er al t ern at i v el y co n t en d ed t h at ev en

i f s h e h ad b een p ro p erl y ad d ed t o t h e act i o n

, t h ere was an i n s u ffi ci en cy of p ro ces s an d

2 A m ed ical m al p ract i ce act i on m us t b e b ro u g h t “ wi t h i n t w o y ears aft er t h e d at e

o n wh ich an i n

ju ry o r d eat h ari s i n g fro m a n e g l i g en t o r wro n g fu l act o r o m i s s i o n

o ccu rred .” OCGA § 9 -3 -7 1 (a).

3s erv i ce o f p r o c es s warran t i n g d i s m i s s al

. 3 Co n n i e m o ved t o ad d Tu rn er as a p art y

d efen d an t fo r t h e fi rs t t i m e o n Decem b er 1 9 , 2 01 6

.

Fo l l o w i n g a h eari n g, t h e t ri al co u rt is s ued a d et ai l ed o rd er d en y i n g Co n n i e’ s

m o t i o n a n d g ran t i n g Tu rn er’ s m o t i o n t o d is m i ss t h e co m p l ai n t ag ai n s t h er, fi n d i n g

t h at Tu rn er d i d no t recei v e no t i ce o f t h e i n st i tu t i o n o f t he act i o n p ri o r t o t h e

e x p i rat i o n o f t he st at ut e o f l i m i t at i o n an d th at Tu rn er d i d n o t k n o w n o r s h o u l d s h e

h av e k n o wn t h at

, b u t fo r a m i s t ak e b y Co n n i e co n cern i n g h er i den t i fy

, s h e wo u ld

h av e b een a d efen d an t i n t h e cas e. 4

Garn et t fi l ed a m o ti o n fo r s u m m ary ju dg m en t wh i ch t h e t ri al co u rt g ran t ed aft er

a heari n g

. In i t s o rd er, t h e co u rt fo u n d t h at Co n n i e “ fai l e d t o p ro d u ce su ffi ci en t

ev i d en ce s h o wi n g Dr. G arn et t v io l at ed t h e s tan d ard o f care o r t h at t h e al l eg ed

n eg li g en ce was th e cau s e o f [Co n n i e’ s ] d am ag es .” Co n n i e ap p eal s fro m t h i s o rd er an d

t h e t ri al co urt ’ s o rd er d en y i n g h er m o t i o n t o ad d Tu rn er as a p art y

.

3 In No vem

b er 2 0 1 6

, Co n n i e at t em p t ed t o s erv e T u r n er w i t h t h e s eco n d

am en d ed co m

p l ai nt an d s um m o n s , b u t t h e s u m m o n s w i t h wh i ch Tu rn er was s erv ed

was t he s u m

m on s i ss u ed wi t h t h e o ri g i n al co m p l ai n t an d d i d n o t l i s t h e r a s a p art y

.

4 Th e tri al co u rt cert i fi ed i t s o rd er fo r i m m ed i at e rev i ew, b u t t h i s Co u rt d en i ed

t h e ap p l i cat i o n fo r i n t erl o cu t ory rev i ew.

41

. Co n ni e co nt en d s th e t ri al co u rt erred in d en y i n g h er m o t i o n t o ad d Tu rn er

as a p art y

. As t h i s Co urt p rev i o u s l y h as ex p l a i n e d

, “ a n am en dm en t t o a co m p l ai nt

ad d in g a n ew p art y wi t h o ut fi rs t o bt ai n i n g l eav e o f t h e co u rt i s wi t h o u t effect .”

W r ig h t v. S a fa r i Cl u b In t l

. , 3 2 2 Ga. Ap p. 48 6

, 4 9 4 (5 ) (7 4 5 SE2 d 7 3 0 ) (2 0 13 ). W h i l e

Co n n i e fi l ed h er s eco n d am en d ed co m p l ai n t ad d i n g T urn er as a p art y -d efen d an t

wi t h i n t he st at u te o f l i m i t at i o n

, i t was wi t h o u t l eav e o f t h e tri al co u rt an d th u s was

wi t h o u t effect

. “ W h ere, as h ere, t h e p art y wo u l d b e ad d e d a f t e r t h e ru n ni n g o f t h e

s t at u te of l i m i t at i o n

, i t m

u s t b e d et erm i n ed w h e t her u nd er OCGA § 9-1 1 -1 5 (c) t h e

cl ai m ag ai n s t t h e n ew p art y rel at es back t o t he d at e o f t h e o ri g i n al p l ead i n g.”

( C i t at i o n an d p u n ct u at i o n o m i t t ed .) Ca l l a wa y v. Qu i n n

, 3 4 7 G a. Ap p

. 3 2 5

, 3 2 9 ( 2 )

(8 1 9 SE2 d 4 9 3 ) (2 0 1 8 ). Un d er OCGA § 9-1 1 -1 5 (c), an am en d ed co m p l ai n t ad d i n g

a n ew p art y aft er t h e ru n n i n g o f t h e s t at u te o f l i m i t at i o n m ay rel at e b ack t o t h e d at e

o f t h e o ri g in al co m

pl ai n t if t h e fo l l o wi n g t h ree el em en ts are s at i s fi ed :

(1 ) Th at t h e am en d m en t ad di n g t h e n ew defen d an t ari s e o u t o f t he s am e

fact s as t h e o ri g i n al co m

p l ai nt ; (2 ) Th at t he n ew d efen d an t h ad su ffi ci en t

n o t i ce o f t h e act i o n ; an d, (3 ) Th at t he n ew d efe n d a n t k n ew or s h o u l d

h av e k n o wn t h at

, b u t fo r a m i s t ak e co n cern i n g h i s i den t i t y a s a p r op er

p art y , t h e act io n wo u ld h av e b een b ro u gh t ag ai ns t h i m

.

5Co b b v. S t ep hen s

, 1 8 6 Ga. Ap p

. 6 4 8

, 6 4 9 -6 5 0 (3 6 8 SE2 d 3 4 1 ) (1 9 8 8). “ A t ri al co urt ’ s

d eci s i o n as t o wh et h er a p art y sh o u l d b e ad d ed t o a l aws ui t li es i n t h e co u rt ’ s s o u n d

d i s c r e t i o n an d wi l l b e o v ert u rn ed o n ap p eal o n l y u p o n a s h o wi n g of ab u se o f t h a t

d i s cret i o n .” (Ci t at i o n an d p un ct u at i o n o m i t t ed .) Ra s heed v. Kl o p p En t er p ri s es , 2 7 6

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

Th ere i s n o i ss ue reg ard i n g t h e fi rs t rel at i o n-b ack el em en t

— Co n ni e’ s cl ai m s

ag ai n s t Tu rn er aro s e ou t o f t h e o ccu rren ce s et fo rt h i n t h e o ri g i n al co m p l ai n t

, t h at i s

,

t h e m e d i cal t reat m en t Co n n i e recei v ed o n Oct o b er 1 1

, 2 0 1 4

. As t o t h e s eco n d

el em en t

, Tu rn er av erred t h at s h e h ad no n ot i ce o f t h e l aws u i t u n t i l aft er th e s t at u t e o f

l i m i tat i on h ad ru n. Co n n i e c l a i m s t h at Tu rn er’ s ro l e as a p h y s i ci an as s i s t an t was

“ u n eq u iv o cal l y co n n ect ed an d i n t e r t wi n ed ” wi t h Garn et t’ s ro l e as h er s u p erv i s i n g

p h y s i ci an

, an d t h u s no t i ce t o Garn et t was t an tam o u n t t o n o t i ce t o T u r n e r. Co n n i e

rel i es o n t wo cas es i n wh i ch t h e wro n g co rp o rat e d efen d an t was s ued t o s u p p o rt h er

p ro p os i t i on t h at n o ti ce as to o n e d efen d an t i s n o t i ce t o a rel at ed defen d an t

. H o wev er,

t h o s e cas es are d i st i n gu i s h ab l e fro m t h e fact s at h an d

.

In Fo n t a i n e v. Ho me Dep o t

, In c.

, 2 5 0 Ga. A pp

. 1 23 (5 5 0 SE2 d 6 9 1 ) (2 0 0 1 ), t h e

p l ai n t i ff fel l at a Ho m e Dep o t faci l it y

. Th e p lai n t i ff s u ed “ H o m e Dep ot

, In c.” i n s t ead

o f t h e act u al p ro p ert y o wn er, “ Ho m e Dep o t U

. S. A.” Id

. Becau s e b o t h Ho m e Dep o t

,

6In c. an d Ho m e Dep o t U. S. A. o ccu pi ed po rt i o n s o f th e b u i l d i n g i n wh i ch t h e p l ai n t i ff

fel l

, h ad t h e sam e reg i st ered ag en t

, us ed t h e t i t l e “ Ho m e Dep ot ” g en eri cal l y i n t h ei r

b ri efs

, an d b ecau s e H o m e D ep o t U. S. A. h ad n o t i ce o f t h e cl ai m b as ed o n t h e s h ared

reg i s tered ag en t

, th is Co urt fo u nd t h at an am en d ed co m pl ai n t ad d in g Ho m e D ep o t U.

S. A. rel at ed b ack t o t h e o ri gi n al co m p lai n t

. Id

. at 1 2 4 -1 2 6

. W e ev en n o t ed o u r o wn

“ d i ffi cu l t [y ] t o i d en t i fy wh et h er an at t orn ey ’ s

, dep o n en t ’ s

, o r affi an t’ s referen ce to

‘ H o m e Dep o t ’ refer[red ] t o T h e Ho m e Dep o t

, In c. o r Ho m e D ep o t U.S.A.” Id

. at 1 2 4.

In Ra s h eed

, s up ra, t h e p l a i n t i ff was i n ju red w h en h i s car was s t ru ck b y a

co m m erci al van

. 2 7 6 Ga. Ap p

. at 9 2 (1 ). Kl o pp E n t erp ri s es in s u red t h e v an

, an d Eas y

T. V. w as l i s t ed as an ad d i ti o n al i n s u red

. Id

. at 9 2 -9 3 (1 ). Th e p l ai n t i ff b el i ev ed Kl o p p

En t erp ri s es em

p l o y ed t he v an ’ s d ri v er an d fi l ed s u i t ag ai n s t Kl o p p

. Id

. In fact

, t h e

d ri v er was em

pl o y ed b y Eas y T. V., wh i ch was a s u bs i d iary o f Kl op p . Id

. at 9 3 (1 ).

Bo t h en t i t i es w ere o wn ed b y t h e s am e, s i n g l e s h areh o l d er wh o s erv ed as th e ch ai rm an

o f t he b o ard fo r bo t h b u si n es s es

. Id

. Bo t h co m p an i es al s o h ad t h e s am e p res i d en t an d

reg i s tered ag en t , o p erat ed o u t of t h e s am e o ffi ce, an d were rep res en t ed b y th e s am e

at t o rn ey in t h e l i t i gat i o n

. Id

. Un d er t ho s e ci rcu m s t an ces

, we fo u n d t h at Eas y T. V.

—

t h e p ro p er d efen d an t

— had n o ti ce o f th e cl ai m wh en Kl o p p En t erp ri s es was s erv ed

.

Id

.

7Nei t her of t h es e cas es s t an d s f o r t h e p ro p o s i t i o n t h at no t i ce o f t h e l aws u i t to

Garn et t can be co ns t ru ed as n o ti ce t o Tu rn er. Rat h er, t h i s cas e i s m o re an al o g o u s to

Bea ver v. S t ei n i ch en

, 1 8 2 Ga. A p p

. 30 3 (3 5 5 SE2 d 6 9 8 ) (1 9 8 7 ), i n wh i ch a p l ai n t i ff

fi led a m ed i cal m al p ract i ce act i o n ag ai n st a ho s p i t al

. Id

. at 3 0 4

. Aft er t h e s t at u t e o f

l i m i tat i on ran

, th e p l ai n t i ff at t em p t ed t o ad d as d efen d an t s t wo d oct o rs i n v o l ved i n h er

care. Id

. W e co n cl u ded t h at t h e n ew co m p l ai n t d i d n o t rel at e b ack u n d er O CGA § 9

-

1 1 -1 5 (c) b ecau s e t h e p l ai n t i ff was no t s eek i n g t o s im p l y ch an g e p art i es b u t to

co m m en ce s u i t ag ai n s t n ew d efen d an t s

, “ s tran g ers t o t h e act i o n ” ag ai n s t t h e h o s p i t al

.

Id

. Here, al t ho u g h Garn et t was Tu rn er’ s s u perv i s i n g p h y s i ci an wh il e s h e was

em pl o y ed a t t h e h o s p i t al

, 5 t he t wo n ei t h er h ad a co rp o rat e affi l i at i o n n o r a s h ared

reg i s tered ag en t

. In d eed

, Tu rn er was n e i t h e r wo rk i n g at DHA no r s u perv i s ed by

Garn et t at t h e t i m e Co n n i e fi l ed h er ori g i nal co m p l ai n t

. See S t

. Fr a n ci s Hea l t h v.

W en g

, 3 5 4 Ga. A p p

. 3 1 0, 3 1 2 (8 4 0 SE2 d 7 1 2 ) (2 0 20 ) (t h e req u i red n o t i ce i s “ n o t i ce

o f t h e i n s t i t u t i on o f t h e act i o n (i .e., n o t i ce o f t h e l aws u i t i ts el f) an d no t m erel y n o t i ce

o f t h e i n ci d en t s g i v i n g ri s e to s u ch act i o n ”) (ci t at i o n an d p u n ct uat i on o m i t ted ). Gi v en

Co n n i e’ s fai l u re t o co m e fo rward wi t h an y ev i d en ce s h o wi ng t h at Tu rn er h ad

5 Th e reco rd refl ect s t h at Tu rn er h ad ei gh t o th er s up erv i s i n g p h y s i ci an s ap art

fro m Garn et t

.

8k n o wl ed g e o f h er l aws u i t b efo re t h e li m i t at i o n p eri od ex p i red

, t h e t ri al co u rt p ro p erl y

d en ied Co nn i e’ s m o t i o n t o ad d Tu rn er as a p art y d efen dan t an d gran t ed Tu rn er’ s

m o ti o n t o d i s m i s s t he am en d ed co m p l ai n t ag ai ns t h er. 6

2

. Co n n ie co n t en d s t h 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 to

Garn et t

, t h e l as t r e m a i n i n g d efen d an t i n t he cas e. Th e tri al co u rt fo u n d th at Co n n i e

h ad fai l ed t o p ro d uce s u ffi ci en t ev i d en ce s h owi n g t h at Garn et t vi o l at ed t h e s t an d ard

o f care o r t h at Garn et t ’ s al l eg ed n eg l i gen ce was t h e cau s e o f Co n n i e’ s d am ag es

.

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

fact an d t h e m o v an t i s en t i t l ed t o j u d gm en t as a m at t er o f l aw. OCGA §

9 -1 1 -5 6 (c). A d e n o v o s t an d ard o f rev i ew ap p l i e s t o an ap p eal fro m a

g ran t o f s um m ary ju d g m en t

, an d we v i ew t h e e v i d en ce, an d al l

reas o n ab l e co n cl u s i o n s an d i n feren ces d rawn fro m i t , i n t h e l i g h t m o s t

fav o rab le t o th e n on m o v an t

.

6 Co n ni e ci t es s ev eral cas es i n h er b ri ef fo r t h e p ro po s it i on th at “ a m ere l ap s e

i n t i m e i s n o t en o ug h t o s up p o rt

. . . d en i al of a m o t i o n t o a d d [a] part y .” H o wev er,

t h es e cas es are i n ap pl i cab le as th ey d i d n o t ad d res s OCGA § 9 -1 1 -1 5 (c). Co n n i e al s o

co n ten d s t h at b as ed on t h i s Co u rt ’ s h o l d i n g i n Pr ef er re d W o men ’s Hea l t hca r e v. S

a i n,

3 4 8 Ga. Ap p. 4 8 1 (8 2 3 SE2 d 5 6 9 ) ( 2 0 1 9 ), s h e sh o ul d no t h av e b een b arred fro m

ad d in g Tu rn er as a p art y -d efen d an t s i m p l y b ecau s e s h e w as u n ab le t o s erv e h er wi th

p ro ces s wi t h i n t h e st at u te o f l i m i t at i on

. Th e S a i n c as e ad d res s ed o n l y a p l ai n t i ff’ s

ab i l i t y to am en d h er co m p lai n t t o ad d a p art y -d efen dan t i n a m e d i c al m al p ract i ce

act i on aft er t h e fi v e-y ear m ed ical m al p ract i ce s t a t u t e o f rep o s e h ad ru n

, an i s s u e

d i fferen t fro m

t h e o n e at h an d . Id . at 4 9 0 -4 9 1

.

9(Ci t at i o n an d p u nct u at io n o m i tt ed .) Bea mo n v. M a h ad eva n

, 32 9 Ga. Ap p . 6 8 5 , 6 8 6

(7 6 6 SE2 d 9 8 ) (2 0 1 4 ).

(a) S t a n da r d o

f Ca r e. Co n n ie c o n t e n d s t h at t h e t ri al co u rt erred i n g ran t i n g

Garn et t su m

m ary ju d g m en t o n t h e is s u e o f s t an d ard of care b ecau s e a q u es t i o n o f fact

rem ai n s as t o wh et h er sh e w as p ro v i d ed “ em erg en cy m ed i cal care” s uch t hat Garn et t

m ay cl ai m t h e p ro t ec t i o n s o f t he h ei g h t en ed s tan d ard s et o u t i n OCGA § 5 1 -1 -2 9

. 5

(c). In an act i o n fo r m ed i cal m al p ract i ce b as ed o n t h e p ro v i s io n o f em erg en cy m ed i cal

care i n a n em erg en cy d ep art m en t

, Geo rg i a l aw req u i res cl ear an d co n v i nci n g p ro o f

o f a h eal t h care p ro v id er’ s g ro s s n eg l i g en ce. See O C G A § 5 1

- 1 -2 9 .5 (c). 7 W e

p rev i o u s l y h av e h el d t hat t h ere are t h ree co n d i t io n s wh i ch m u s t b e p res en t i n o rd er

fo r OCGA § 5 1 -1 -2 9 .5 t o ap p l y :

(a) t h e l aws u it m

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

m u s t ari s e o u t of t h e p ro v i s io n o f “ em erg en cy m ed i cal care”; an d (c) th e

care m u s t hav e been p ro v i d ed t o th e p at i en t “ i n a h o s p i t al em erg en cy

7 OCGA § 5 1 -1 -2 9

. 5 (c) p ro v i d es :

In an act i o n i n v o l vi n g a h eal t h care l i ab i l i t y cl ai m ari s in g o ut o f

t h e p ro vi s i on o f em erg en cy m e d i cal care i n a h o sp 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 c a l s ui t e i m m ed i at el y

fo l l o wi ng t h e ev a l u a t i o n o r 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, 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 pro v en by 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.

10d ep art m en t o r ob s t et ri cal u n it 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 reat m en t o f a p a t i en t i n a h o s p i t al

em erg en cy

d ep art m en t.”

(Ci t at i o n an d p u n ct u at i o n o m i t t ed .) S o u t h wes t er n Emer

g en cy Ph ys i ci a ns v. Ng u

yen

,

3 3 0 G a

. A p p

. 1 56

, 1 5 8 (1 ) (7 6 7 SE2 d 81 8 ) (2 0 1 4 ). T h e s t at u t e fu rt h er s peci fi cal l y

ex cl u d es fro m t h e d efi n i t i on o f em erg en cy m ed i cal care “ care o r t reat m en t t h at o ccu rs

a f t er t h e p at i en t i s s t ab il i z e d an d i s cap ab l e o f recei vi n g m ed ical t reat m en t as a

n o n em erg en cy p at i en t o r care t h at i s u n rel at ed t o t h e o r i g i n a l m ed i cal em erg en cy .”

(Em p h as i s s u p p l i ed .) OCGA § 5 1 -1 -2 9

. 5 (a) (5 ). Here, i t i s u n d is pu t ed t h at Co n n i e’ s

co m p l ai n t rai s es a “ h eal t h care l i ab i l i t y cl ai m ” an d th at s h e recei v ed t reat m en t i n “ a

h o s p it al em erg en cy d ep art m en t .” Co n n i e co n t en d s

, h owev er, t h at a q u es t io n o f fact

rem ai n s as t o wh et h er sh e was s t ab l e at t h e t i m e s h e was d i s ch arg ed fro m t h e DHA

em erg en cy

ro o m . W e ag ree.

In s u p p o rt o f h er cl ai m s

, Co n n i e s u b m i t t ed th e affi d av i t s o f a vas cu l ar s u rg eo n

an d an e m e r g en cy ro o m ph y s i ci an

. W i t h reg ard t o t h e t i m i n g o f t h e al l eg ed

p ro fes s i on al n eg l i g en ce, on e o f Co n n i e’ s ex p ert s o p i n ed i n an affi dav it at t ach ed to

h er co m p l ai n t th at h er em erg en cy ro o m p ro v i d er “ s h ou l d h av e, u p o n l earn i n g o f h er

s ym p t o m s [an d h er h i s t o ry of l u p u s ]

, i m m ed i at el y p erfo rm ed o r ad v i s ed an o t h e r

11faci li t y or ca r e g i v er t o p erfo rm n o t ju s t a ven ou s s can

, b u t an art eri al d u p l ex s can

an d /o r h an dh el d Do pp ler p ro b e o f M s

. Co n n i e’s a r t eri al s y s t em

. ” T he o th er ex p ert

al s o o p in ed th at s u ch a s can or p ro b e s h o u l d h av e b een p erfo rm ed o r d i rect ed t o b e

d o n e “ i m m ed i at el y ” u p o n l earn i n g o f h er s y m pt o m s

, h i s to ry o f l up u s, an d “ hi s t o ry o f

l o wer ex trem it y n um

b n es s an d co l o r ch an g e.” W h i l e o n e o f Co n ni e’ s ex p ert s t es t i fi ed

t h at wh en s h e p res en t e d t o t h e DHA em erg en cy ro o m o n Oct o b er 1 1

, it was an

em erg en cy s i t u at i o n n eed i n g “ em erg en t m ed i cal care,” n ei t h er ex p ert ’ s t es t i m o ny

ad d res s ed wh et h er Co n n i e at an y p o i n t b ecam e “ cap a b 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

. ” In f a c t

, t h e reco rd refl ect s t h at al t h o u g h

Co n n i e rep o rt ed h er p ai n a t a n i n e o u t o f t en wh en s he p res en t ed to t h e em erg en cy

ro o m

, reco rd s fro m h er em erg en cy ro om v is i t s ho w t h at s h e rep o rt ed h er p ai n at an

i n t en s i t y o f “ 3 ” b efo re d i s ch arg e. Tu rn er t es t i fi ed t h at “ b as ed o n [Co n n i e’ s ] h i s t o ry

a n d [ T u rn er’ s] p h y s i cal as s es s m en t ,” s h e d et erm i n ed t h at Co n ni e “ was no t i n an y

d i s t res s

, t h at h er art eri a l ci rcu l at i on w as i n t act .” Sh e fu rt h er t es t i fi ed t h at s h e

u n d ers t o o d em erg en t co n d i ti o n s t o m ean “ t hreat en i n g o f l i fe, l i m b

, or ey es i g h t

. An d

I wo u l d s ay th is was n o t an y o f t h at .” T h e em erg en cy ro o m reco rd s al so s ho w t h at

Co n n i e’ s co nd i t i o n h ad “ i m p ro v ed ” b efo re s h e was d i s ch arg ed

. Co n n i e

, h o wev er,

t es t i fi ed t h at u po n d i s ch arg e h er p ai n h ad n o t i m p ro v ed an d was at a t en ou t o f t en ;

12s h e di s pu t ed t he rep o rt s of h er p ai n l ev el an d read i n es s t o g o h o m e i n t h e em erg en cy

ro o m reco rd s

.

In ev al u at i ng wh et h er t h e p at i en t has “ s tab i li zed ” su ch t h at t h e care o r

t reat m en t p ro v id ed to t he pat i en t d o es no t q u al i fy as “ em erg en cy m ed i cal care” u n d er

t h e s t at u t e, “ t h e co n d i t io n o f t h e p at i en t co n t ro l s , n o t t h e o p i n io n o f t h e p hy s i ci an .”

Bo n ds v. Nes b it t

, 32 2 Ga. Ap p

. 8 5 2

, 8 5 5 (1 ) (7 4 7 SE2 d 4 0 ) (2 0 13 ). Th u s

, i f a h eal th

care p ro v i d er

m i s t ak en l y co ncl u d es t h at a p at ien t h as b eco m e “ s t ab i l i zed ” an d

“ cap ab l e of recei v i n g m ed i cal t reat m en t as a n on em erg en cy pat i en t ” an d

t h erefo r e s t o p s p ro vi di n g em erg en cy care t o t hat pat i en t

—

n o t wi t hs t an d i n g t h at t h e p at i en t s t i l l n eed s em erg en cy care

— an d i f th e

p at i en t i s i n

ju red o r k i l l ed as a res u l t o f t h e wi t h drawal o f em erg en cy

care, t h e p h y s i ci an o r h ea l t h care pro v i d er i s en ti t led t o cl ai m th e

p ro t ect i o n o f t h e g ro ss n eg l i g en ce s t an d ard

.

Id

. Here, T u r n e r ’s d et erm i nat i o n t h at Co n n i e was n o t i n an y d i s t res s an d t h at h er

co n di t i o n h ad im

p ro v ed wh i l e s h e w as i n t h e em erg en cy ro o m i s s o m e ev i d en ce t h at

Co n n i e w as i n fact s tab i l i zed

. Id

. Ho wev er, as al read y s t at ed

, “ t he co n d it i o n o f t h e

p at i en t co n t ro l s

, n o t t h e o p i n i on o f t h e p h y s i ci an

. ” Id

. at 8 5 5 (1 ). Co n n i e d is pu t ed t h at

h er p ai n lev el h ad d ecreas ed fro m a t en ou t o f t en an d t hat sh e had i m p r o v ed t o t h e

p o i n t th at s h e was read y t o b e di s ch arg ed

. An d

, b o t h of h er ex p ert s t es ti fi ed t h at s h e

13req u i red em erg en cy t reat m en t “ i m m ed i at el y .” In l i gh t o f t h e co nfl i ct in g ev id en ce o n

t h i s p oi n t

, we co n cl u d e th at w h et h er Co n n i e a t s o m e p o i n t h ad s t ab i l i zed an d was

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 wi t h i n t h e m ean i n g

o f O CGA § 5 1 -1 -2 9 .5 (a) (5 ) i s a q u es t i o n fo r th e t ri er of fac t

. S ee Ho wl a n d v.

W a d s wo r t h

, 3 2 4 G a. Ap p

. 1 7 5

, 1 8 0 -1 8 1 (2 ) (7 4 9 SE2 d 7 6 2) (2 0 1 3) (q u es t i o n o f fact

as t o wh et h er p at i en t p res en t i n g t o em erg en cy ro o m w i t h co m pl ai n t s o f p ai n i n feet

,

d i ffi cu l t y wal ki ng

, feet co l d t o t o u ch

, an d p al p ab l e p ul s es h ad s t ab i l i zed wi t h in

m ean i n g o f OCGA § 5 1 -1 -2 9

. 5 (a) (5 ); p hy s i ci an as s i st an t o rd ered v en o us u l t ras o u n d

ex am i n at i o n s b u t n o art eri al ul t ras ou n d o r o t h er t es t s t o ru l e o u t art eri al occl u s i o n ).

See Bo nd s

, 3 2 2 G a. Ap p

. at 85 5 -8 5 6 (1 ) (s u m m ary ju d g m en t n o t ap p ro p ri at e b ecau s e

q u es ti o n o f fact rem ai n ed as t o wh et her p at i en t ’ s co n d i t i o n s t ab il i zed s u ch t h at g ro ss

n eg li g en ce s t an dard d id n ot ap p l y ; p l ai n t i ff’ s ex p ert wi tn es s t es t i f i ed t h at p at i en t ’ s

co n di t i o n n ev er b ecam e st ab l e wh i l e h e was i n t h e em erg en cy ro o m b u t t reat i n g

p h y s i ci an d et erm i n ed t h at p at ien t ’ s c o n d i t i o n h ad i m p ro ved an d p at ien t co u l d b e

t ran s ferred t o a reg u lar h o sp i t al ro o m ). Co m p are Qu i n n ey v. Ph o e b e P u t n ey Mem.

Ho s p.

, 3 2 5 G a. Ap p

. 1 1 2

, 1 1 3

- 1 1 5

, 1 1 5-1 1 7 (1 ) (7 5 1 SE2 d 87 4 ) (2 0 1 3 ) (g ro ss

n eg li g en ce s tan d ard ap pl i ed t o p l ai n t i ff’ s cl ai m s wh ere ev i d en ce s h owed th at p at i en t

was u n ab l e t o wal k

, rep o rt ed p a i n at a n i n e o u t of t en

, rem ai ned s y m p t o m at i c wi th

14wo rs en in g p ai n an d v i t al s i g n s d es p i te ad m i n i s t rat i o n o f p ai n m ed i cat i o n

, a n d was

t ran s po rt ed b y am

b u lan ce to an o t her m ed i cal cen t er). Th u s, t h e t r i al co u rt erred in

g ran t i n g Garn et t s u m

m ary ju d g m en t o n t he i s s u e o f s t an d ard o f care.

(b ) Ca u s a t i o n

. Co nn i e al s o co n ten d s t h at t he 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 i n fav o r o f Garn et t o n t he b as i s o f cau s at i o n . Ag ai n

, we ag ree.

“ To reco v er i n a m ed i cal m al p ract i ce cas e, a p lai n t i ff m u s t s h ow n o t o n l y a

v i o l at i o n o f t h e ap p l i cab l e m ed i cal s t an d ard o f care b u t a l s o t h at t h e pu rp o rt ed

v i o l at i o n o r d ev i at i o n fro m t h e p ro p er s t an d ard of care i s t h e pro x i m at e cau s e o f t h e

i n ju ry s u s t ai n ed .” (Ci tat i o n an d p u n ct uat i o n o m i t ted .) Kn i g h t v. Ro b er t

s

, 3 1 6 Ga.

Ap p . 5 9 9 , 6 0 3 (1 ) (7 3 0 SE2 d 7 8 ) (2 01 2 ).

Cau s at i o n i s 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 et h er t h e al l eg ed p ro fes si o n al n eg l i g en ce cau sed 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 ized ex p ert k n owl ed g e. Th e ex p ert

m u s t st at e hi s o r h e r 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

s t ro n g er t han t hat o f m ed i cal p o s s i b i li t y

— e.g

., a reas o nab l e d eg ree o f

m ed i cal cert ai nt y o r reas o n ab l e m ed i cal p ro bab il i t y

. Th e u se o f th e

m ag i c w o r d s “ reas o n ab l e d eg ree o f m ed i cal cert ai n t y ” i s n o t req u i red

an d cau sat i on m ay b e es t ab l is h ed by l i n ki n g t h e t e s t i m o n y o f s ev eral

d i fferen t ex p ert s

.

15(Ci t at i o n s an d p u n ct uat i o n o m i t t ed .) S wi n t v. Ma e

, 3 40 Ga. Ap p

. 4 8 0, 4 8 2 (1 ) (7 9 8

SE2 d 2 3 ) (2 0 1 7 ). “ [Q] u es ti o n s reg ard i n g p r o x i m at e cau s e are u n d en i ab l y a ju ry

q u es ti o n an d m ay

o n ly b e d et erm i n ed b y t h e co u rt s i n p l ai n an d u n d i s p u t ed cas es .”

(Ci t at i o n an d p u n ct u at io n o m i t t ed .) Pr u et t e v. P ho eb e Pu tn ey Mem. Ho s p

. , 2 9 5 Ga.

Ap p . 3 3 5 , 3 3 8 (1 ) (6 7 1 SE2 d 8 4 4 ) (2 0 0 8 ).

Acco rd i ng t o b o t h o f t h e ex p ert affi d av i t s s u bm i t t ed by Co nn i e, th e h eal t h care

p ro v id ers at D HA s h ou l d h av e k n o wn t hat h er h i s t o ry o f lu p us p l aced her at a h i g h er

ri sk o f d ev el o p i ng art eri al occl u s i o n an d t h a t a p u l s e ex am is n ot al way s rel i ab l e.

Bo t h o p i n ed t h at i t was t h ei r

o p i n i o n t o a reas o n ab l e deg re e o f m e d i cal cert ai n ty t hat had Dr. Hi l t z,

Dr. G a r n e t t

, or an y o f Do ct o r[ ] s Ho s p it al ’ s p h y s ici an s an d st aff

p erfo rm ed or d i rect ed an o t h er careg i v er t o p e r fo rm an art eri al d u p lex

s can o r a h an d h el d Do p pl er p ro b e o f [Co n ni e’ s ] art eri es , o r at t h e v ery

l eas t referred h er t o a v as cu l ar s u rg eo n

, i t i s h i g h l y l i k el y t h at t h e ri g h t

ex t rem i ty art eri al b l o ck ag e wo u ld hav e b een d et ect ed an d rem o v ed

b efo re i s ch em ia dev el o p ed t o t h e po i n t t o wh ere a s u b s tan t i al am o un t o f

t i ss u e b ecam e n o n -v i ab le.

Th e em erg en cy s u rg eo n fu rt h er o p i n ed t hat Tu rn er’ s fai l ure “ t o m ak e an y n o t at i on s

i n [Co n n i e’ s ] reco rd s d em o n st rat i n g t h a t s h e as ked [Co n n i e] ab o u t t h e p res en ce o r

ab s en ce o f co l o r ch an g es i n t h e affect ed fo o t or t o es co n s ti t u t ed a dev iat i o n fro m t h e

16s t an d ard o f care”; t h at Garn et t

, as Tu rn er’ s s u perv i s i n g p h y s ici an

, “ was res p o n s i b l e

fo r an y act s o r o m i ss i o n s ” o f Tu rn er an d h ad Garn et t “ m o re d il i g en t l y su p erv i s ed

,

s cru t in i zed

, an d rev i ewed [h er] ex am i n at io ns an d fi n d i n g s

, as wel l as fo ll o wed u p

wi t h [Co nn i e] in p ers on b as ed o n h er s y m p t o m s

, t h e art eri al bl ock ag e

. . . wo u l d h av e

b een ti m el y di s co v ered an d rem o ved

. . .”; an d t h at “ b u t fo r t he t h r e e

- d a y d el ay

b et ween [Co n n i e’ s ] i n i t i al vi si t

. . . an d

. . . d i s co v ery of th e art eri al b l o ck ag e, t h e

. .

. am pu t at i o n s h e u n d erwen t wo u l d n o t h av e been n eces sary .” Th e em erg en cy s u rg eo n

t es t i fi ed t h at s i m

p l y p erfo rm in g a p u l s e t e s t w as n o t a d i ag n o s t i c t es t t h at co u l d b e

u s ed t o ru l e o ut art eri al o ccl u s i o n

, an d t h at t h e v en o u s d u pl ex u l t r a s o u n d o rd ered

,

wh i le ap p ro p ri at e to d i ag n o se DVT, w as n o t t h e ap p ro pri at e di ag n o s t i c t es t to ru l e o ut

art eri al o ccl u s i o n

.

Bas ed o n t h e affi d av i t s an d t es t i m o n y, a ju ry q u es t i o n was pres en t ed as to

cau s at i o n

. M o re s p eci fi cal l y

, “ [t ] o t h e ex t en t t h a t t h e d el ay cau s ed b y [t h e]

m i s d i ag n o s i s co n tri b u t ed t o t h e d el ay i n [Co n n i e’ s] ab i l i t y t o recei v e t i m el y t reat m en t

an d s u rg i cal i nt erv en t i o n

, a j u ry q u es t i on as t o t h e el em en t of cau s at i on ex i s t ed .”

Kn i gh t

, 3 1 6 Ga. A p p. at 60 7 (1 ) (a) (co ncl u d i n g t h a t a j u r y i s s u e as t o cau s at i o n

ex i s t ed b as ed u p o n co m

b i n ed ex p ert t es t i m on y t h at i f em erg en cy ro o m p h y s i ci an h ad

o rd ered t h e ap p ro p ri at e d i ag n o s t i c t e s t s

, p at ien t ’ s ao rt i c d i s sect i o n

, wh i ch

17p ro g res s i v el y w o rs en ed o ver t i m e, wo u l d h av e b een d i s co v ered an d h er d eat h co u ld

h av e b een p rev en t ed ); MCG Hea l t h v. Ba r t o n

, 2 8 5 Ga. Ap p

. 5 7 7

, 58 3 -5 8 4 (2 ), (3 )

(6 4 7 SE2 d 8 1 ) (2 0 0 7) (affi rm i n g t h e d en i al o f defen d an t ’ s m o t io n fo r s u m m ary

j u d g m e n t s i n ce a ju ry q u es t i o n reg ard i n g cau s at i o n ex is t ed b as ed u p o n ex p ert

t e s t i m o n y t h at t h e p h y s i ci an ’ s d el ay i n d i ag no s i n g t h e p at i en t’ s t o rs i o n co n d i t i o n

p rev en ted em erg en cy

s u rg ery t o s al v ag e t h e p at i en t ’ s t es ti cl e).

Garn et t co n t en ds th at b o t h “ ex p ert s w ere as k ed i n t hei r res p ect i ve d ep o s i t i on s

wh et h er an y t h in g wo u l d h av e ch an g ed i f t h e care an d t reat m en t o n Oct o b er 1 1 wo u ld

h av e been di fferen t ” an d n ei t h er was “ ab l e t o s ay t h at

, m o re li k el y t h an n o t

, [Co n n i e]

wo u l d h av e k ep t h er to es i f s h e h ad n o t b een d i s ch arg ed [fro m D HA o n Oct o ber 1 1 ] .”

Ev en i f t h e reco rd w ere t o s u p p o rt t h i s ch aract eri zat i o n o f th e ex pert s’ d ep o s i t i o n

t es t i m o ny

, i t d o es n o t en ti t l e Garn et t t o s u m m ary ju dg m en t o n t h e i ss u e of cau s at i o n.

Fo cu s i n g o n l y o n s u ch t es t i m o n y wo u l d i g n ore t h e ex p ert s ’ affi d av i ts

, an d ev en i f t h e

affi d a v i t s c o n t rad i ct t h e ex p ert s ’ d ep o s i t i o n t es t i m o n y

, s u ch “ [c] o n trad i ct i o n s g o

s o l el y t o t h e ex p ert [s ’ ] cred i b i li t y

, an d are t o b e as ses s ed b y t h e ju ry wh en wei g h i n g

t h e ex p ert [s ’ ] t es t i m o ny .” (Ci t at i o n an d p u nc tua tion om itt ed .) Na i k v. B oo ker

, 3 0 3 Ga.

A p p

. 28 2

, 2 8 6 (6 9 2 SE2 d 8 55 ) (2 0 1 0 ) (ap pel l at e co u rt co u l d n o t res o l v e c o n f l i c t

b et ween ex p ert ’ s affi dav i t a n d ex p ert ’ s d ep o s i t i o n t es ti m o ny reg ard i n g wh et h er

18p at i en t w o u l d ha v e s urv i v ed h ad p h y si ci an -d efen dan t s u rg i cal l y i n t erv en ed ). See al s o

Th o mp so n v. Ez or , 2 7 2 Ga. 8 4 9 , 8 5 3 (2 ) (5 3 6 SE2 d 7 4 9 ) (2 0 0 0 ).

Ju d g men t a f f i r med i n p ar t a n d r e v e r

s ed i n p a rt

. Do

yl e, P. J., a nd Rees e, J.,

co n cu r

.

19