Opinion ID: 2493500
Heading Depth: 2
Heading Rank: 2

Heading: whether the trial court erred in granting summary judgment in favor of the defendants.

Text: ¶ 38. The trial court granted summary judgment in favor of all three defendants after it excluded the testimony of Dr. Shukan and Dr. Hayne. The trial court stated that summary judgment was proper because Patterson could not show causation without the excluded testimony. Patterson now argues that she can show causation without the excluded testimony and that summary judgment was improper.
¶ 39. Because of the unusual procedural posture of this case, a brief discussion of the procedural facts relating to this issue is necessary. The trial court entered its order excluding the testimony of Dr. Shukan and Dr. Hayne on January 14, 2009. It is important to note that the order excluded only the testimony that related to the predeath levels of Demerol in Atravius's system. The order did not exclude the testimony as a whole. On June 11, 2009, the trial court granted summary judgment in favor of all three defendants. The judgment stated that the defendants had made an ore tenus motion for summary judgment. There is no record of the motion, or Patterson's response, in the transcript. [10] ¶ 40. At oral argument, counsel for Dr. Tibbs stated that he had drafted the judgment and submitted it to the trial court. Counsel admitted that the defendants did not file a motion for summary judgment and that a summary judgment hearing was never held. Patterson's counsel argued in his brief and at oral argument that Patterson could show causation without the excluded Demerol testimony.
¶ 41. Mississippi Rule of Civil Procedure 56 governs motions for summary judgment. This Court reviews de novo a trial court's grant of summary judgment. Chisolm v. Miss. Dep't. of Transp., 942 So.2d 136, 140 (Miss.2006) (citing Webb v. Braswell, 930 So.2d 387, 395 (Miss. 2006)). This Court examines all evidence, including pleadings, answers to interrogatories, depositions, and affidavits. Id. (citing McCullough v. Cook, 679 So.2d 627, 630 (Miss.1996)). The evidence must be viewed in the light most favorable to the nonmoving party. Id. (citing Hataway v. Nicholls, 893 So.2d 1054, 1057 (Miss. 2005)). Summary judgment is appropriate when the nonmoving party has failed sufficiently to establish an essential element of that party's claim. Buckel v. Chaney, 47 So.3d 148, 153 (Miss.2010) (citations omitted). The essential elements of a medical-malpractice claim are: (1) the existence of a duty on the part of a physician to conform to the specific standard of conduct, (2) the applicable standard of care, (3) the failure to perform to that standard, (4) that the breach of duty by the physician was the proximate cause of the plaintiff's injury, and (5) that damages to the plaintiff resulted. Estate of Northrop v. Hutto, 9 So.3d 381, 384 (Miss.2009) (citing Barner v. Gorman, 605 So.2d 805, 808-09 (Miss.1992)). ¶ 42. The foregoing standard is even more important when considering the unusual procedural history of this case. We are without the benefit of parts of the record commonly used by this Court to guide our analysis of summary judgment issues: the defendants' motion and supporting documents, the plaintiff's response, or a hearing transcript. Thus, in accord with our standard, we examined all the evidentiary matters in this case in the light most favorable to the nonmoving party. After a careful examination of the record, we find that the trial court did not err in granting summary judgment in favor of Dr. McArthur. We do find, however, that the trial court erred in granting summary judgment in favor of BMC and Dr. Tibbs. Because the causation testimony relating to Dr. McArthur is distinct from the testimony relating to Dr. Tibbs and BMC, we address Dr. McArthur first. Then, because of the similar analysis used, we address Dr. Tibbs and BMC together.
¶ 43. Dr. McArthur delivered Atravius and performed his circumcision. The causation testimony relating to Dr. McArthur focused on Dr. Hayne's theory that Angelia Patterson had received an overdose of Demerol during labor and Dr. Shukan's testimony that Atravius had received an overdose of Demerol during his circumcision. Dr. Shukan also testified that Dr. McArthur had breached the standard of care by failing to include a surgical note documenting whether he had given Atravius Demerol during the circumcision. Other than the testimony relating to the Demerol theories, there is no evidence of causation relating to Dr. McArthur in the record. There is no need to discuss the other elements of medical malpractice because Patterson has failed to establish the essential element of causation. See Estate of Northrop, 9 So.3d at 384; Buckel, 47 So.3d at 153. Accordingly, the trial judge did not err in granting summary judgment in favor of Dr. McArthur.
¶ 44. At first blush, one might reasonably assume that a grant of summary judgment in favor of Dr. Tibbs and BMC would be appropriate. The bulk of the testimony in this case involved the Demerol theories propounded by Dr. Hayne and Dr. Shukan. Without this testimony, one would naturally think that Patterson cannot prove causation. Upon close examination of the record, however, this Court finds testimony which tends to show causation on the part of Dr. Tibbs and BMC. ¶ 45. During his deposition testimony, Dr. Shukan essentially discussed the timeline of events leading to Atravius's death, including the standards of care breached and whether those breaches caused Atravius's death. The following are excerpts of Dr. Shukan's deposition: Dr. Shukan: At 6 p.m. an IV was started, and this is where I think there was a breakdown in what is considered good nursing abilities and good nursing care. That IV was ordered at 5 p.m. and wasn't started in this child until 6 p.m. Counsel: Is that a deviation from the standard of care, in your opinion? Dr. Shukan: I certainly would agree. Counsel: That's my question. Is it  Dr. Shukan: I certainly would agree that it is a deviation  were a deviation from good nursing care. Ordered at 5 in a child who has a significant problem, started at 6. This is not medicine they had to go out and get. This is IV fluids that are usually available to most nurses. Counsel for BMC: Objection to the statement that this is medicine they did not have to go out and get. Counsel: All right. Do you have an opinion whether or not, based upon reasonable medical probability, this caused or contributed to the death of Atravius Coleman? Dr. Shukan: I certainly think that there's a possibility and probability here that it could have contributed. Counsel: Okay. All right. Go ahead. Dr. Shukan: Okay. At 7:30 a Dopamine drip was started. Now, Dopamine is a drug that helps to increase blood pressure. That's its sole usage. That is a full four hours after this child showed significant problems in respiration and significant problems in oxygenation, ability to get oxygen to his blood. At 5:30 he showed a very significant decrease in blood pressure, and we didn't see this started for another two hours after that, the Dopamine. By that time  Counsel: I'm sorry. Dr. Shukan: Uh-huh. Counsel: So let me ask you this: Based upon reasonable medical probability, is that a deviation in the standard of care to not start the Dopamine until 7:30? Dr. Shukan: I would think so. This child needed Dopamine before. Counsel: All right. Who do you feel that deviated from the standard of care  Dr. Shukan: I would think when the doctor in charge looks at 5:30 at a blood pressure of 15 diastolic, that he would be the one that should have ordered that with rapidity. That should have been started much quicker. Counsel: All right. And your talking about what doctor? Dr. Shukan: Dr. Tibbs. Counsel: All right. And did this in any way cause or contribute to the death of Atravius Coleman? Counsel for Dr. Tibbs: Object to the form of the question. Counsel: You can answer it. Counsel: Based upon reasonable medical probability. Dr. Shukan: In my opinion, this very well could have aided in the death  contributed to the death of Atravius Coleman. Counsel: All right. Go ahead. Dr. Shukan: Critical in this chart are the next three entries. At 9:45, some six hours and  six and a quarter hours after the onset of this horrible event, he was noted to have a diastolic pressure of 13. This child is crashing. He is now officially in shock. 9:45. The only thing I can find documented here is that another blood gas was drawn one hour later. There are no changes in IVs; there are no changes in medications given; one hour later further evidence of crashing. This child now had  I'm sorry  9:45 he had 19 diastolic pressure, low. Here's 13  Counsel: What time is that? Dr. Shukan: That would be at 10:45. A whole hour went by and this child had nothing. This  and also, a blood gas was done back at 9:45 that showed a Ph of 7.22 so our acidosis is getting worse, and the critical agent here is a bicarbonate of 7.1. The normal bicarbonate being in the 26, 28 range. This means the child has used up all the ability to buffer the acid, and there's virtually no more ability  because bicarb is a base and buffers acid. It's almost gone. This child now has severe metabolic acidosis, and it's predictable at this point, you're going to have trouble. Very predictable. He needed bicarb. . . . . Counsel: All right. Based upon reasonable medical probability, at 9:45 p.m. was there a deviation from the standard of care, and if so, by whom was there a deviation? Dr. Shukan: Well, there's no question in my mind that bicarb should have been added here. This situation should have been also fraught with the medicines that we'll see that were given an hour later, and that would be Dr. Tibbs who should have been there, should have been in the nursery, and we'll find out in a moment that he wasn't and should have been in charge here trying to save this child's life. Counsel: In your opinion, was that a deviation of the standard of care? Dr. Shukan: Yes, sir. Counsel: By Dr. Tibbs? Dr. Shukan: Yes. Counsel: Did that cause or contribute to the death of Atravius Coleman? Dr. Shukan: I would think it contributed very possibly, to the death, yes. Counsel: All right. Dr. Shukan: Very probably to the death. Counsel: Okay. Now, what about the nurses at 9:45? Do you have any deviation from the standard of care as it pertains to the nurses at Bolivar Medical Center at that time? Dr. Shukan: I certainly do. Counsel: All right. What deviations did they have at that time? Dr. Shukan: Okay. As you note at 9:45, I am describing a situation that's terminal shock. If this isn't taken care of immediately, this child has no hope. And no phone call was made to Dr. Tibbs until one hour and twenty minutes later. Clearly documented on the chart that this child at this point, the point that the nurse called Dr. Tibbs, the child was unresponsive to deep-pain stimuli, he had a PO2 of 92. Dr. Tibbs, who was in the lounge, in the doctor's lounge, was called. One hour and twenty minutes in shock. There is no increase in fluids; there was no antishock medicine; those will be enumerated down here, epinephrine, Atropine. These are all medicines used in shock, not an hour and 20 minutes after shock has started. So there's a big deviation here. Counsel: By whom? Dr. Shukan: Well, no nurse  the nurse to begin with for not making a phone call, not recognizing this as an agonal or painful, terminal end result  situation rather, and not calling the doctor for 1 hour and 20 minutes. And number two, I believe that Dr. Tibbs, being an intensive care pediatrician involved in this, should have known that this child is this sick. I can't go to the lounge. I need to be here. He was obviously out of the nursery for at least an hour and twenty minutes here. That's not what you do when you have a child who's in metabolic acidosis, and it's not getting better. . . . . Counsel: All right. As far as Dr. Tibbs is concerned, based upon reasonable medical probability, was there a deviation? Dr. Shukan: Yes. Counsel: Have you explained it? Dr. Shukan: I have explained it. Counsel: All right. Did this deviation cause or contribute to the death of Atravius Coleman, and base that upon reasonable medical probability. Dr. Shukan: I would think the probability at this point was that the fact that he wasn't cared for correctly, at least in this time frame, lead to his death 45 minutes later. Counsel: Okay. Now, do you have any  was there any deviations from the standard of care at 11:05 by the nurses of Bolivar Medical Center? . . . . Dr. Shukan: Yes, the standard  the deviation from normal care. In fact, they should have called him 1 hour and 20 minutes earlier, in my opinion  Counsel: Okay. Dr. Shukan:  and we may have saved his life. Counsel: All right. So, is that based upon reasonable medical probability, that deviation you just made reference to? Dr. Shukan: Certainly. Counsel: Did that, in your opinion, based upon reasonable medical probability, cause or contribute to the death of Atravius Coleman? Dr. Shukan: I would think that it contributed to the demise 45 minutes later of this child, yes. ¶ 46. Dr. Shukan also submitted an affidavit in which he stated that, regardless of the cause of Atravius's condition, Dr. Tibbs should have treated his condition more aggressively. Dr. Shukan stated: Dr. Tibbs should have recognized that the combination of metabolic acidosis and depressed respirations are not part of hypoplastic left ventricular syndrome. He should have treated the metabolic acidosis more aggressively. Regardless of the cause, the metabolic acidosis must be treated more aggressively and certainly Dr. Tibbs should have used life saving vasoactive medications earlier instead of saving them for the last few minutes of the child's life. ¶ 47. Although one may argue that the foregoing testimony was predicated on the assumption that Atravius died of a Demerol overdose, we must keep in mind that the cause of Atravius's death is an issue for the trier of fact to determine. See Worthy v. McNair, 37 So.3d 609, 620 (Miss.2010) (quoting Causey v. Sanders, 998 So.2d 393, 403 (Miss.2009)). The defendants argue that Atravius died of hypoplastic left heart syndrome. And although Patterson has argued that Atravius died of as a result of a Demerol overdose, the testimony above focused on the treatment that Atravius received after his condition began to deteriorate for whatever reason. Dr. Shukan was of the opinion that, regardless of the cause of Atravius's condition, Atravius should have received different treatment in the hours before his death. When viewing the testimony above in the light most favorable to Patterson, we find that genuine issues of material fact exist concerning whether BMC and Dr. Tibbs caused Atravius's death or failed to prevent it. See Palmer v. Anderson Infirmary Benevolent Ass'n, 656 So.2d 790, 796 (Miss.1995) (quoting Kelley v. Frederic, 573 So.2d 1385, 1389 (Miss.1990)) (There is no magical form to which a plaintiff's supporting expert opinion must conform, so long as its import is apparent.). ¶ 48. We also find that Patterson has presented sufficient evidence to withstand summary judgment concerning the other essential elements of a medical-malpractice claim against Dr. Tibbs and BMC. Dr. Tibbs and BMC had a duty to meet the following national standard of care: Given the circumstances of each patient, each care giver has the duty to use his or her knowledge and treat, through maximum reasonable medical recovery, each patient with such reasonable diligence, patience, skill, confidence, and prudence as are practiced by minimally competent care givers in the same specialty or general field of practice throughout the United States, who have available to them the same general facilities, services, equipment, and options. Jeffrey Jackson & Mary Miller, 6 Encyclopedia of Miss. Law § 58:5 (Miss. Practice Series 2001) (citing Starcher v. Byrne, 687 So.2d 737 (Miss.1997); Toche v. Killebrew, 734 So.2d 276 (Miss.1999); Palmer v. Biloxi Reg'l Med. Ctr., 564 So.2d 1346 (Miss.1990)). Dr. Shukan testified in his deposition to the specific standards that the nurses and Dr. Tibbs should have met while treating Atravius. Dr. Shukan also testified that the nurses and Dr. Tibbs failed to meet some of these standards. Finally, Patterson suffered various damages due to Atravius's death. ¶ 49. When viewing all of the evidence in the light most favorable to Patterson, we find that a genuine issue of material fact exists concerning Patterson's claims against Dr. Tibbs and BMC. Accordingly, we find that the trial court erred in granting summary judgment in favor of Dr. Tibbs and BMC.