Clark v. SSM Healthcare St. Louis
| Decision Date | 07 March 2023 |
| Docket Number | ED110638 |
| Parties | STEPHANIE CLARK, Appellant, v. SSM HEALTHCARE ST. LOUIS, D/B/A/ SSM HEALTH ST. JOSEPH HOSPITAL, WENTZVILLE, DAWN HOLEMON, M.D., LEE M. FREUND, D.O., and ST. CHARLES EMERGENCY GROUP, LLC, Respondents. |
| Court | Missouri Court of Appeals |
Appeal from the Circuit Court of St. Charles County 1811-CC00191 Honorable Michael J. Fagras
OPINION
This medical negligence/wrongful death case arose on April 20 2016, when Destiny Gleason (hereinafter D.G.), the fourteen-year-old daughter of appellant Stephanie Clark committed suicide. The evening before, D.G. had become suicidal and was taken to the SSM Health St. Joseph Hospital emergency room in Wentzville, Missouri where she came under the care of Respondents SSM Healthcare St. Louis, d/b/a/ SSM Health St. Joseph Hospital, Dr. Dawn Holemon, Dr. Lee Freund and St. Charles Emergency Group, LLC. Psychiatric evaluation took place and D.G. was released later that evening. She hung herself from a pull-up bar the next morning and died a few days later.
Appellant Clark's petition alleged that Respondents' psychiatric evaluation and the decision to discharge D.G from the hospital fell below the standard of care for health care providers under the same or similar circumstances and caused or contributed to cause D.G.'s death.
In granting summary judgment in favor of Respondents, the trial court held that (1) under the court's interpretation of Missouri law governing causation in wrongful death cases, it was a matter of undisputed fact that Respondents did not cause D.G.'s death, (2) Respondents were immune from civil liability under section 632.440 of the Missouri comprehensive psychiatric services law (CPS law), sections 632.005-632.575, and (3) under the 2020 version of section 538.210, Clark failed to adduce competent evidence in support of her claim for aggravating circumstances damages.[1]
We reverse on all three bases. First, as to causation, by imposing on Clark the burden to show that the Respondents first inflicted an injury upon D.G. and then that that injury caused her suicide, the trial court misconstrued the Supreme Court's opinion in Kivland v. Columbia Orthopaedic Group, LLP, 331 S.W.3d 299 (Mo. banc 2011). Missouri law on causation in wrongful death cases is the same whether the death is by suicide or by any other means. Id. at 310. Applying the correct standard then, we reverse because the evidence Clark adduced through her medical expert witness that Respondents' alleged medical negligence caused or contributed to cause D.G.'s death by suicide made the causation element of Clark's wrongful death claim a disputed issue of fact precluding summary judgment.
Second we reverse the trial court's blanket grant of immunity to Respondents because there is no basis in this record that the CPS law, sections 632.005-632.575, had been invoked, triggered, or had any application to this case whatsoever.
Finally, in granting summary judgment on Clark's aggravating circumstances damages claim, the trial court applied the wrong version of section 538.210 and therefore applied the wrong burden of proof to Clark's claim. Applying the correct version of the statute, Clark adduced sufficient competent evidence to render her claim for aggravating circumstances damages a genuinely disputed issue precluding summary judgment.
On April 19, 2016, D.G. was suspended from school for ten days for fighting with another student. She was taken to the Warren County juvenile office and from there her mother, appellant Clark, took her home. That evening, D.G. became physically aggressive with her mother and with herself and threatened suicide. Her mother called the police. A Warrenton, Missouri police officer arrived to find D.G. sitting on the roof of the home. When the officer asked D.G. to reenter the home, she complied. D.G. told the officer that she was no longer suicidal but that she had formulated a plan on how she might do it. After discussing the matter with D.G. and with her parents, the officer arranged for an ambulance to take D.G. to SSM Health St. Joseph Hospital.
Upon arrival around 5 p.m., emergency department physician Dr. Laurel Baumstark evaluated D.G. and found her positive for depression and suicidal ideation. Dr. Baumstark described D.G. as labile[2] and depressed with suicidal ideation. D.G. told Dr. Baumstark she no longer felt suicidal. Nurse Sheila Feldman performed a suicide screening shortly after D.G. arrived at the hospital and found that she was having suicidal thoughts and was at an immediate risk of suicide.
After this initial evaluation, Dr. Baumstark's shift ended and respondent Dr. Lee Freund's shift began. Nancy Wurtz, an intake clinician whose duties were to record and then convey the patient's history to a qualified mental health professional, performed a second suicide risk assessment. Wurtz then spoke by telephone for two to three minutes with respondent Dr. Holemon, the hospital's on-call psychiatrist. Based on the information provided by Wurtz, Dr. Holemon concluded that D.G. should be discharged. Dr. Freund agreed and discharged D.G. several hours after her arrival.
The next morning, D.G. became upset when she discovered negative social media posts by classmates referencing the fight for which D.G. had been suspended from school. A short time later, D.G. hung herself from a pull-up bar in her room and died two days later.
After Clark filed this action in February 2018, she retained Dr. Eric Caine, a board-certified psychiatrist, and Dr. Marian Betz, a board-certified emergency room physician. Dr. Caine testified that D.G.'s death was foreseeable and that the negligent actions and omissions of Dr. Holemon, Dr. Freund, SSM Healthcare St. Louis, and St. Charles Emergency Group caused or contributed to cause her death. Dr. Betz testified that Dr. Freund's actions fell below the standard of care because he did not provide a safe discharge plan.
On Clark's claim for aggravating circumstances damages, Dr. Caine testified that Respondents' treatment, assessment, and discharge of D.G., including their reliance on the assessment by Wurtz, who was unqualified to perform a psychiatric assessment, was reckless and demonstrated a complete indifference to or conscious disregard for D.G.'s health and safety.
Clark brings this appeal in eight points which we group as appropriate to address the three main issues before us - (1) whether in light of Clark's expert medical testimony, the causation element of her wrongful death claim is a genuinely disputed issue, (2) whether Missouri's CPS law, including its immunity provision, applies to this case, and (3) whether, under the correct version of section 538.210, Clark's claim that Respondents' conduct warrants the imposition of aggravating circumstances damages is a genuinely disputed issue of fact.
Summary judgment is appropriate when the movant establishes there are no genuine issues of material fact and are entitled to judgment as a matter of law. ITT Commercial Finance Corp. v. Mid-America Marine Supply Corp., 854 S.W.2d 371, 377 (Mo. banc 1993); Rule 74.04(c). A genuine issue of material fact exists when there is competent evidence of two plausible, but contradictory, accounts of essential facts. Armoneit v. Ezell, 59 S.W.3d 628, 631 (Mo. App. E.D. 2001). Thus, a defendant is entitled to summary judgment when he shows facts that negate any one of the necessary elements of the plaintiff's claim. Blackwell Motors, Inc. v. Manheim Services Corporation, 529 S.W.3d 367, 379 (Mo. App. E.D. 2017).
We review an appeal challenging the grant of a motion for summary judgment de novo. Day Advertising, Inc. v. Hasty, 606 S.W.3d 122, 129 (Mo. App. W.D. 2020). Thus, we do not defer to the trial court's order granting summary judgment "because the trial court's initial judgment is based on the record submitted and amounts to a decision on a question of law." Barry Harbor Homes Ass'n v. Ortega, 105 S.W.3d 903, 906 (Mo. App. W.D. 2003). "Rather, we use the same criteria the trial court should have employed in initially deciding whether to grant summary judgment." Id. We view the record in the light most favorable to the nonmoving party and afford that party the benefit of all inferences which may be reasonably drawn from the record. Barekman v. City of Republic, 232 S.W.3d 675, 677 (Mo. App. S.D. 2007) (citing ITT Commercial Finance Corp., 854 S.W.2d at 376). Moreover, summary judgment is an extreme and drastic remedy, and appellate courts should remain cautious in affirming such judgments. Boone County v. County Employees' Retirement Fund, 26 S.W.3d 257, 260 (Mo. App. W.D. 2000).
A. Summary judgment not warranted on the causation element of Clark's claim.
The evidence adduced by Clark that Respondents' negligence in connection with the psychiatric evaluation of D.G. and the decision to discharge her from the hospital on April 19 2016, was sufficient to withstand Respondents' summary judgment motions because it demonstrated that the causation element of Clark's claim was a genuinely disputed issue.
To survive summary judgment on the issue of causation in a wrongful death case, a plaintiff must demonstrate that there are genuine issues of material fact regarding whether the defendant's conduct was both the cause in fact and the proximate, or legal, cause of the death. Sundermeyer v SSM Regional Health Servs., 271 S.W.3d 552, 554 (Mo. banc 2008); Baker v. Guzon, 950 S.W.2d 635, 646 (Mo. App. E.D. 1997). The plaintiff must establish that, but for the defendant's actions or inactions, the patient would not have died. Sundermeyer, ...
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