Chalfant v. Carolinas Dermatology Grp.
| Decision Date | 12 April 2023 |
| Docket Number | 5977,Appellate Case 2019-001145 |
| Parties | Jackie Eadon Chalfant, Individually and as a Personal Representative of the Estate of Michael Dallas Chalfant, Appellant, v. Carolinas Dermatology Group, P.A., a South Carolina Professional Association, and Mark G. Blaskis, M.D., Individually, Respondents. |
| Court | South Carolina Court of Appeals |
Heard June 15, 2022
Appeal From Richland County R. Keith Kelly, Circuit Court Judge
William T. Geddings, Jr., of Geddings Law Firm, PA, of Manning, and Michael G. Fink, of Fort Myers, Florida, both for Appellant.
Brandon Robert Gottschall, of Sweeny Wingate & Barrow PA, of Columbia, and Martin S. Driggers, Jr., of Driggers Law Firm, of Hartsville, both for Respondents.
LOCKEMY, A.J.
In this medical malpractice action, Jackie Eadon Chalfant (Appellant) appeals the trial court's grant of a directed verdict in favor of Carolinas Dermatology Group, P.A. (CDG) and Dr. Mark G. Blaskis (collectively, Respondents). Appellant argues (1) expert witness testimony was unnecessary because the common knowledge exception applied to Respondents' failure to provide after-hours contact information and post-operative instructions to her husband, Michael Dallas Chalfant (Decedent); (2) the record contained conflicting testimony as to whether Respondents breached the standard of care in providing post-operative instructions; and (3) expert witness testimony created a question of fact as to whether the Decedent's tachycardia was a contraindication to performing surgery on May 12, 2015, without proper cardiac follow-up. We affirm in part, reverse in part, and remand.
FACTS/PROCEDURAL HISTORY
On March 31, 2015, Dr. Peter J. Stahl, who was Decedent's primary care physician, referred Decedent to CDG for a consultation regarding skin cancer on his left ear and forehead. Dr. Stahl indicated that at the time of the visit, Decedent was seventy-four years old, weighed 103 pounds, and measured five feet, eight inches. Dr. Stahl also listed Decedent's pulse as 120 beats per minute (bpm) on the referral form.
On May 12, 2015, Decedent completed a surgery consent form which authorized Dr. Blaskis to treat the basal cell carcinoma on his left ear and left cheek with Mohs micrographic surgery. The consent form articulated the risks involved with surgery, including bleeding, infection, scarring, nerve damage, incomplete removal, recurrence, and pain. The same day, Dr. Blaskis performed Mohs surgery on Decedent. Following surgery, the medical report stated: Dr. Blaskis's paper discharge instructions instructed a patient to leave the pressure bandage on for forty-eight hours and to call "(803) 771-7506 ext. 209" with questions.
Unfortunately, Decedent passed away on May 13, 2015. According to Decedent's death certificate, his primary cause of death was exsanguination and hemorrhage from his left ear surgical site. The death certificate also listed chronic obstructive pulmonary disease and coronary artery disease as other significant conditions.
In January 2017, Appellant, individually and as personal representative of Decedent's estate, filed a complaint against Dr. Blaskis and CDG, alleging medical malpractice, wrongful death, ordinary negligence, and gross negligence.
At trial in 2019, Appellant testified she remained present with Decedent during the entirety of his office visit with Dr. Blaskis. She stated Dr. Blaskis never mentioned the risk of bleeding after surgery and that "[t]he only place [she] saw the word bleeding at all was on the consent form [Decedent] signed before the surgery." Appellant denied Dr. Blaskis ever said anything to them about calling 911 or going to the emergency room (ER) if there was bleeding after surgery. She indicated they were only told not to remove the pressure bandage on Decedent's ear.
According to Appellant, she and Decedent left Dr. Blaskis's office around 4:00 p.m. She recalled that when they got home from the surgery, Decedent poured himself a glass of vodka and cranberry juice, which he drank over the course of the evening. Appellant stated Dr. Blaskis did not advise Decedent to avoid drinking alcohol or that it would increase the risk of bleeding. She indicated she noticed "blood oozing from underneath [Decedent's] bandage" around 7:00 p.m. and gave him some paper towels. Appellant testified she then looked at the post-op instructions sheet and called the number on the sheet due to her concerns. She stated she dialed the number and the first prompt said "if this is a true emergency, hang up, [and] dial 911" but she did not believe the situation was a true emergency. Appellant explained the next prompt directed her, "if you know your party's extension, dial it now," and she entered the extension listed on the instructions sheet. She testified that because she entered the extension, she did not hear the rest of the message prompt, as detailed below.
Appellant submitted CDG's after-hours phone message on the date of Decedent's death as an exhibit. The prompt read:
You have reached Carolinas Dermatology After-Hours. If this is a true emergency, please hang up now and call 911. If you know your party's extension you may dial it now. To hear our automated options, press 1. For a prescription refill or to leave a message to be returned on the next business day, please press 2. For all other serious medical concerns, dial 9 now for our answering service. To hear these options again, press the * key.
Appellant stated she left a message but never received a call back and "assumed that it must not be an emergency if they didn't immediately call me back."
According to Appellant, as they ate dinner and watched television, Decedent continued to dab the blood with paper towels. She explained she "suggested that [they] should go to the [ER] and have it checked out" but Decedent refused to go.
Appellant recalled a conversation with a friend named Bob, and Bob also suggested they go to the emergency room; however, Decedent refused. Appellant further indicated that if Dr. Blaskis had said to go to the ER if there was bleeding, Decedent "would certainly have done what the doctor said."
Appellant testified Decedent changed his shirt before bed because there was blood on his collar and t-shirt, and she placed a towel over his pillow before they went to bed. She recalled Decedent awoke at 3:30 a.m., sat on the side of the bed, used his inhaler, and then laid back down. Appellant stated she heard Decedent get up and walk to the bathroom around 4:30 a.m., where she found him sitting on the toilet. According to Appellant, she asked if he was okay, and he requested she bring his inhaler. She indicated that when she re-entered the bedroom and turned on the lights, she saw a large amount of coagulated blood on the pillow. Appellant explained she then heard something fall in the bathroom and returned to find Decedent slumped against the wall. Appellant testified the paramedics arrived at 5:51 a.m. to transport Decedent to the hospital; unfortunately, medical personnel were unable to revive him.
On cross-examination, Appellant testified she did not know there were more prompts on the after-hours message after the prompt to enter a party's extension. She further acknowledged she never tried to dial the number again.
Dr. Blaskis testified he only provided patients with one page of discharge instructions after completing surgery because he had been trained to give extensive verbal post-operative instructions. He maintained, "I've never had a patient in 20,000 patients I've treated, nobody has left my office without . . . having heard about post[-]op bleeding at least half a dozen times." Dr. Blaskis recalled Appellant and Decedent "were told extensively to call me if there was bleeding." He then stated that "the standard of care is . . . verbal instructions are as good as written."
Dr. Blaskis acknowledged he would have been able to save Decedent if Decedent had contacted him on the night of surgery. However, Dr. Blaskis further acknowledged he knew that when patients dialed extension 209, the call would go to his medical assistant's desk, not an answering service, but if a patient listened to the entire message prompt, he could reach the answering service. He indicated all of the doctors and partners of the practice approved the outgoing message and forms used in this case. Dr. Blaksis further stated another doctor who conducted Mohs surgery at his practice, Dr. Long Quan, gave patients his cellphone number.
Dr. Blaskis also testified that although Decedent's heartrate was 116 bpm on the day of surgery, he "felt very comfortable with" Decedent's primary care physician's assessment and referral for surgery with a heartrate of 120 bpm.
Prior to trial, Respondents completed an interrogatory indicating Debbie Clarke and Ashley Grant "had the duty or responsibility to establish and implement polic[]ies, procedures, rules, standing orders and/or protocols which [CDG] had in place regarding the recognition, management and prevention of post-operative complications on or about May 12, 2015." However, Clarke later testified she was not responsible for the forms used with regard to the care given to Decedent.
Dr Jing Zhang, the president of CDG, also testified at trial that Clarke and Grant- CDG's practice manager and office manager, respectively-had no medical training. He explained they were responsible for ensuring "all the policies [were] fulfilled to the criteria of the law[]" but were not responsible for ensuring the...
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