Altine v. Eastside Med. Ctr.

• Docket Number: A24A0088
• Decision Date: 17 July 2024
• Citation: 904 S.E.2d 396
• Parties: ALTINE v. EASTSIDE MEDICAL CENTER, LLC.
• Court: Georgia Court of Appeals

904 S.E.2d 396

ALTINE

v.EASTSIDE MEDICAL CENTER, LLC.

A24A0088

Court of Appeals of Georgia.

July 2, 2024

Reconsideration Denied July 17, 2024

Wayne Grant, Kimberly Waters Grant, Atlanta, Willard Tilden Bullock IV, Charles Madden Cork III, for Appellant.

Rachel E. Reed, Atlanta, Brian K. Mathis, Randolph Page Powell Jr., Mikell Paul Reynolds, Alexander Collins Vey, for Appellee.

Markle, Judge.

[1–4] After suffering complications from bariatric surgery, Philip Altine filed suit against the doctor who performed the surgery, and Eastside Medical Center, LLC.("Eastside"), who employed the nurses treating Altine post surgery.¹The doctor settled the claims against him and was dismissed from the suit.The negligence claims against Eastside proceeded to trial, and Eastside was allowed to proffer evidence that the doctor had settled.After an eight-day trial, the jury found in favor of Eastside.Altine now appeals, arguing that it was error to allow evidence of the doctor’s settlement.For the reasons that follow, we affirm.

A trial court’s decision to admit evidence … will not be disturbed absent an abuse of discretion.An abuse of discretion occurs where the trial court’s ruling is unsupported by any evidence of record or where that ruling misstates or misapplies the relevant law.However, to be reversible error, it is not enough that the trial court erred; the plaintiffs also must show that the error had an effect on the outcome of the proceedings.Erroneous evidentiary rulings are subject to the harmless error doctrine, meaning we may not reverse a judgment because of such an error unless refusal to take such action appears to the court inconsistent with substantial justice.When we consider whether an error was harmless, we review the record de novo and weigh the evidence as we would expect reasonable jurors to have done so.

(Citations and punctuation omitted.)Ross-Stubblefield v. Weakland,359 Ga. App. 523, 526-527, 859 S.E.2d 502(2021);see alsoOCGA §§ 9-11-61; 24-1-103 (a)("Error shall not be predicated upon a ruling which admits or excludes evidence unless a substantial right of the party is affected[.]").

So viewed, the evidence shows that Dr. Suraj Menachery performed Altine’s bariatric surgery at Eastside in April 2016.During the surgery, Dr. Menachery accidentally injured the connective tissue, causing some bleeding, but he repaired the damage.Altine was taken to recovery, where he had good vital signs and stable blood pressure.About two hours later, however, Altine experienced a drop in blood pressure and brief loss of consciousness.The nurses were able to revive him.Around 1:30 p.m., one of the nurses noted bloody drainage at the incision site, and she called Dr. Menachery to inform him of Altine’s condition.Dr. Menachery ordered further lab work, medication to improve Altine’s blood pressure, and a cardiology consultation.Although Dr. Menachery considered bleeding as a possible cause of the blood pressure concerns, he did not think it was the most likely cause of Altine’s symptoms at that time.

Altine’s blood pressure remained low throughout the afternoon, and his lab work was abnormal.Dr. Menachery ordered repeat blood work and awaited the results of the consultation.The cardiologist observed Altine around 2 p.m., concluding that there was no cardiac issue and recommending Altine be transferred to the ICU.In the ICU, doctors prepared to do a blood transfusion and repeated blood work.Altine did not improve, and, after speaking with the ICU physician, Dr. Menachery brought Altine back to surgery that evening, at which point he discovered that Altine was bleeding from the earlier injury.He repaired the damage, but due to the delay, Altine’s kidneys were severely impaired and he lost vision in one eye.

Altine filed a medical malpractice suit against Dr. Menachery and Eastside.After settling his claims with Dr. Menachery, Altine moved to exclude any evidence of the settlement at Eastside’s trial under OCGA § 24-4-408 (a).The trial court found that the fact that there was a settlement was admissible, but the parties could not introduce any evidence of the terms.

At trial, in his opening statement, Altine mentioned the settlement, informing the jury that he had originally sued the doctor, and the jury would decide what percentage of fault belonged to the doctor and what percentage belonged to the hospital.²

The jury heard Dr. Menachery’s deposition testimony, in which he stated that he was in contact with the nurses throughout the afternoon post-surgery; they informed him of bleeding and oozing at the drainage site; he ordered medications, repeat blood work, and consultations to try to determine the cause of Altine’s abnormal post-operative labwork and bleeding; and he ultimately determined another surgery was needed.He explained that he did not believe Altine was experiencing active bleeding that caused a hemorrhage when he spoke with nursing staff at 1:30 p.m.Nevertheless, he stated that, even if the nurses had informed him at that time that Altine was experiencing new bleeding, he would have made the same decisions in how he monitored and provided care to Altine.

One of the nurses testified that the nurses were monitoring Altine’s condition, updating the doctor, and carrying out the doctor’s orders throughout the day.³Another nurse confirmed that there was no bleeding until after Altine was moved from post-op to a room, but even at that point there was not a large amount of blood; and Dr. Menachery was informed of Altine’s status, including his low blood pressure and the bloody drainage.⁴Importantly, the medical records reflect that the nurses informed Dr. Menachery of Altine’s low blood pressure and bloody drainage at 1:30 p.m., and that Dr. Menachery gave orders for additional labwork, medications, and consultations.By 3 p.m., the cardiologist had determined that there was no cardiac issue, and Altine was then transferred to ICU, where, in consultation with Dr. Menachery, the medical staff prepared for a blood transfusion and further surgery.

Altine presented expert testimony regarding the nurses’ conduct and causation.The nursing expert testified that he was critical of the nurses’ conduct in treating Altine and their communication with Dr. Menachery during the 1:30 call, opining that they had breached the standard of care.He conceded, however, that if the nurses informed the doctor about the bloody drainage, the nurses’ conduct would have met the standard of care.Altine’s causation expert testified that bleeding was the cause of Altine’s post-operative complications; the doctor should have recognized that immediately; and if the doctor had recognized that Altine was bleeding and performed the second surgery earlier, Altine would not have developed kidney failure requiring dialysis.

The jury then heard from Eastside’s causation expert, who opined that the injury to the kidney could have been reversed had Dr. Menachery performed the surgery earlier.He testified that the kidney damage was caused by shock from the hemorrhage and was exacerbated by Altine’s pre-existing stage III chronic kidney disease and other health problems.But he did not attribute the cause of Altine’s kidney injury to the nurses’ conduct.

[5]The parties stipulated that the doctor had resolved the claims against him, and the trial court read this stipulation to the jury.At Altine’s request, the trial court also instructed the jury that⁵

[i]f you determine that the defendant was negligent so as to be liable to the Plaintiff, you shall then consider the alleged negligence of non-partySuraj Menachery, MD.In that consideration, if you find that Dr. Menachery, was also negligent in some degree, thereby contributing to Plaintiff’s injury and/or damages, then you are required to determine the percentage of Dr. Menachery’s fault … You should not make any reduction in the amount of damages based on the negligence, if any, of Dr. Menachery.In determining whether Dr. Menachery departed from the standard of care, you may not consider the fact that he settled Plaintiff’s claims against him.That fact that he has settled has no relevance to the issue of whether he departed from the standard of care.The court also gave instructions on the standard of care and causation on the part of both the nurses and the doctor.And, the parties submitted a verdict form that included Dr. Menachery.Specifically, the form first asked the jury if it found in favor of the plaintiff or defendant.If the jury found for the plaintiff, it was then asked whether it also found the non-party doctor to be at fault, and if so, to allocate fault among the doctor and the hospital.

The jury found in Eastside’s favor.Altine now appeals, arguing that the trial court erred by allowing the jury to hear that Dr. Menachery settled the claims against him.After a thorough review of the record, we conclude that any error in admitting evidence of the settlement was harmless.

Under OCGA § 24-4-408, evidence that a party has settled the claims against it is generally not admissible to establish liability, but may be admissible for another purpose, such as to show bias of a witness.⁶OCGA § 24-4-408 (a), (c).Here, Altine argues that there was no other basis that would allow the jury to hear of Dr. Menachery’s settlement.

[6–8] Pretermitting whether it was error to admit the fact that Dr. Menachery settled his claims, the admission of that evidence did not affect the verdict.

The new Evidence Code continues Georgia’s existing harmless error doctrine for erroneous evidentiary rulings.SeeOCGA § 24-1-103 (a)("Error shall not be predicated upon a ruling which admits or excludes evidence unless a substantial right of the party is affected.").In determiningwhether the error was harmless, we review the record de novo and weigh the evidence as we would expect reasonable jurors to have done so.The test for determining nonconstitutional harmless error is whether

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