Opinion ID: 1744914
Heading Depth: 1
Heading Rank: 4

Heading: Whether the circuit court abused its discretion in allowing Dr. Pruett and his expert witnesses to testify about their own practices and the practices of other physicians in the community which they observed, regarding prescribing antibiotics for acute mild diverticulitis.

Text: ¶ 26. Dr. Pruett [12] and Dr. George McGee were permitted to testify, over the Hartels' objection, regarding antibiotics other emergency room physicians prescribe for acute mild diverticulitis. The Hartels argue that this testimony constituted inadmissible hearsay, lacked the proper foundation, and was outside the designations of these expert witnesses. ¶ 27. Regarding hearsay, the testimony of Dr. Pruett and Dr. McGee did not quote other physicians. Their testimony was based upon their personal observations of the antibiotic regimens employed by other emergency room physicians in treating patients suffering from acute mild diverticulitis. Accordingly, because their testimony was based on personal observation and knowledge, the Hartels' contention that no proper foundation was laid lacks merit. Moreover, this testimony was within their expert designations, as it was given for the purpose of establishing the standard of care. Therefore, this Court finds that the circuit court did not abuse its discretion in allowing the above-referenced testimony.
¶ 28. In reviewing the circuit court's grant of EM Care's motion for directed verdict, this Court considers whether the evidence, as applied to the elements of a party's case, is either so indisputable, or so deficient, that the necessity of a trier of fact has been obviated. Spotlite Skating Rink, Inc. v. Barnes, 988 So.2d 364, 368 (Miss.2008) (quoting White v. Stewman, 932 So.2d 27, 32 (Miss.2006)). ¶ 29. EM Care's motion for directed verdict maintained that no evidence had been introduced demonstrating the existence of an employment relationship between EM Care and Dr. Pruett. The circuit court granted EM Care's motion because the record lacked any mention of EM Care. On appeal, the Hartels claim, over EM Care's vigorous denial, that EM Care admitted in its pleadings that it was Dr. Pruett's employer and, therefore, could be held vicariously liable under the doctrine of respondeat superior if Dr. Pruett was deemed negligent in treating Betty. ¶ 30. In its answer to Biloxi Regional's cross-claim, EM Care merely admitted that it had a duty of indemnification to Biloxi Regional for the negligence of Dr. Pruett. In short, EM Care did not admit that Dr. Pruett was its employee. In Biloxi Regional's motion for separate trial, later joined by EM Care, it is asserted that EM Care contracted with [Biloxi Regional] to furnish physicians to staff the Emergency Department at the hospital. Again, this statement does not constitute an admission by EM Care that it employed Dr. Pruett. ¶ 31. Regardless, no evidence was presented at trial linking EM Care to Dr. Pruett. Absent proof of an employment relationship, the evidence was either so indisputable, or so deficient, that the necessity of a trier of fact [was] obviated, id., and the circuit court had no alternative but to grant EM Care's motion for directed verdict. See Vines v. Windham, 606 So.2d 128, 131 (Miss.1992) ([a] trial court should submit an issue to the jury only if the evidence creates a question of fact concerning which reasonable jurors could disagree.) (citations omitted). Accordingly, this Court finds that this issue is without merit. [13]
¶ 32. A motion for new trial challenges the weight of the evidence. Sheffield v. State, 749 So.2d 123, 127 (Miss. 1999). A reversal is warranted only if the trial court abused its discretion in denying a motion for new trial. Ivy v. State, 949 So.2d 748, 753 (Miss.2007) (emphasis added). In Bush v. State, 895 So.2d 836 (Miss.2005), this Court set out the standard of review for weight of the evidence, stating: [w]hen reviewing a denial of a motion for a new trial based on an objection to the weight of the evidence, we will only disturb a verdict when it is so contrary to the overwhelming weight of the evidence that to allow it to stand would sanction an unconscionable injustice. Herring v. State, 691 So.2d 948, 957 (Miss.1997). We have stated that on a motion for new trial[:] the court sits as a thirteenth juror. The motion, however, is addressed to the discretion of the court, which should be exercised with caution, and the power to grant a new trial should be invoked only in exceptional cases in which the evidence preponderates heavily against the verdict. Amiker v. Drugs For Less, Inc., 796 So.2d 942, 947 (Miss.2000).... [T]he evidence should be weighed in the light most favorable to the verdict. Herring, 691 So.2d at 957. Bush, 895 So.2d at 844. ¶ 33. [I]n order to prevail in a medical malpractice action, a plaintiff must establish, by expert testimony, the standard of acceptable professional practice; that the defendant physician deviated from that standard; and that the deviation from the standard of acceptable professional practice was the proximate cause of the injury of which plaintiff complains. Brown v. Baptist Mem'l Hosp.-DeSoto, Inc., 806 So.2d 1131, 1134 (Miss.2002) (citations omitted). Regarding the applicable standard of care, this Court has stated that: each physician has a duty to use his or her knowledge and therewith treat through medical recovery, each patient, with such reasonable diligence, skill, competence, and prudence as are practiced by minimally competent physicians 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. McCaffrey v. Puckett, 784 So.2d 197, 203 (Miss.2001) (quoting Hall v. Hilbun, 466 So.2d 856, 873 (Miss.1985)). The issue here is whether Dr. Pruett deviated from this standard of care by prescribing only Cipro. The Hartels maintain that Dr. Pruett breached the standard of care in failing to prescribe an antibiotic for Betty that was effective against anaerobic bacteria, in addition to Cipro. ¶ 34. At trial, the Hartels called Dr. Ernest Kleier and Dr. Joseph Blackston as expert witnesses. Each testified that Dr. Pruett's treatment of Betty failed to satisfy the standard of care because Betty was not prescribed antibiotics for both aerobic and anaerobic bacteria. Dr. Kleier testified that it's common knowledge from medical students to residents to treating physicians that both aerobic and anaerobic bacterial organisms are located in the colon. He explained that aerobic bacteria grow in the presence of oxygen, while anaerobic bacteria grow in the absence of oxygen. As such, both Dr. Kleier and Dr. Blackston asserted that, in order to meet the standard of care, a physician who is treating a patient with diverticulitis must prescribe antibiotics that combat both types of bacteria. According to Dr. Kleier, [i]f you only kill one, the other is sometimes not suppressed. By only prescribing Cipro, to which aerobic bacteria are susceptible, Dr. Kleier and Dr. Blackston opined that Dr. Pruett failed to meet the standard of care. ¶ 35. The Hartels also introduced a microbiology report ordered by Dr. McKenney prior to surgery on May 15, 1998, [14] containing the results of an anaerobic culture of Betty's abdominal fluid. The culture revealed moderate growth of four types of anaerobic bacteria in Betty's colon: peptostreptococcus asaccharolyticus, bacteroides uniformis, fusobacterium varium, and capnocytopha species. With regard to the peptostreptococcus asaccharolyticus, the report stated that it would be 85-95% susceptible to the antibiotic metronidazole (marketed under the trade name Flagyl) and 70-84% susceptible to the antibiotic clindamycin (marketed under the trade name Cleocin). With regard to the bacteroides uniformis, the report stated that it was 95% susceptible to metronidazole. According to Dr. Kleier, Cipro: was very effective, and it killed all those germs. It did not effect [sic] at all the aerobic organisms, the ones that grow in the absence of oxygen. Subsequent [sic] that was what was cultured out at the time of her surgery, nothing but anaerobic organisms. So when you kill one, you allow the other organisms freedom to grow without resistence [sic] because you haven't provided antibiotics. Following surgery, Dr. McKenney prescribed Claforan, an antibiotic to which anaerobic bacteria are susceptible, for Betty. ¶ 36. Not only was evidence presented by Biloxi Regional and Dr. Pruett that the appropriate standard of care was met, their experts likewise refuted the Hartels' expert's opinions. Dr. Stodard testified that, in his expert opinion, prescribing only Cipro to a patient suffering from diverticulitis is sufficient to meet the applicable standard of care. Dr. Stodard testified that he had treated hundreds of patients for diverticulitis over the last 22 years. According to Dr. Stodard, Dr. Pruett prescribed an antibiotic that I use for this all the time and gave her appropriate discharge instructions. And so that is it in my opinion why he did indeed meet the standard of care. [15] Dr. Stodard testified that [h]e treated her exactly as I would have treated her under the same circumstances. ¶ 37. Dr. McGee likewise testified that in his expert opinion, Dr. Pruett met the applicable standard of care in his treatment plan for Betty. Regarding mild diverticulitis, Dr. McGee stated, I've treated hundreds of patients. I've done probably several hundred surgical resections for diverticulitis in the 23 years I've been in practice. According to Dr. McGee: I've been using quinolones, Cipro and more recently Levaquin which is a more recent type of quinolone almost identical to Cipro except that you just give it once a day. I've been using it for over ten years very effectually for treating mild acute diverticulitis. Not only that but in my consultation in the emergency room I frequently encounter the treatment plans of the emergency room physicians. And that's routinely used by the emergency room physicians at our hospital, the second busiest emergency room in the state. And it's very effective. In fact... since using the quinolones, I have never had a patient that progressed to requiring surgical treatment for that episode of the disease. As to Dr. Pruett's treatment plan, Dr. McGee testified: I would not have changed anything. In fact this is a routine consultation that I do in the emergency room at Forrest General where I discuss the treatment plan with the emergency room physicians when they have questions about whether their diagnosis is correct or whether their treatment plan is correct, and this is a very accepted form of treatment for me, and I approve it. ¶ 38. Our case law is axiomatic on the proposition that the jury is arbiter of the credibility of testimony. Collier v. State, 711 So.2d 458, 462 (Miss. 1998). At trial, the jury weighed the conflicting testimony of well-qualified experts on the subject of whether or not Dr. Pruett satisfied the applicable standard of care in his treatment plan for Betty. The jury then found in favor of Dr. Pruett and Biloxi Regional. Given that conflicting testimony, and weighing the evidence in the light most favorable to the verdict[,] Bush, 895 So.2d at 844, this Court concludes that the jury verdict in favor of Dr. Pruett and Biloxi Regional does not sanction an unconscionable injustice. Id. Accordingly, this Court finds that the circuit court did not abuse its discretion in denying the Hartels' motion for new trial.