Columbia Medical Center Subsidiary v. Meier

• Decision Date: 21 July 2006
• Docket Number: No. 05-05-00172-CV.,05-05-00172-CV.
• Citation: 198 S.W.3d 408
• Parties: COLUMBIA MEDICAL CENTER SUBSIDIARY, L.P. d/b/a North Central Medical Center, Appellant, v. John MEIER, Appellee.
• Court: Texas Court of Appeals

198 S.W.3d 408

COLUMBIA MEDICAL CENTER SUBSIDIARY, L.P. d/b/a North Central Medical Center, Appellant, v. John MEIER, Appellee.

No. 05-05-00172-CV.

Court of Appeals of Texas, Dallas.

July 21, 2006.

Diana L. Faust, Cooper & Scully, P.C., Dallas, for appellant.

James Craig Orr, Haygood, Orr & Reyes, Irving, Jason Thomas Mackey, Law

Office of Jason T. Mackey, L.L.C., Dallas, for appellee.

Before Justices FITZGERALD, FRANCIS, and LANG-MIERS.

OPINION

Opinion by Justice LANG-MIERS.

This is a medical malpractice case. John Meier was hospitalized in the intensive care unit of Columbia Medical Center Subsidiary, L.P. d/b/a North Central Medical Center following surgeries for gallstones and bowel obstruction. While gravely ill and in the ICU, he developed a decubitus ulcer (pressure ulcer or bed sore) on his coccyx (tailbone). He sued North Central for damages, claiming North Central was negligent by failing to provide pressure relief, which proximately caused the development of the decubitus ulcer, and by failing to provide proper care and treatment for the decubitus ulcer after it was discovered. North Central argued the development of the decubitus ulcer was unavoidable and was caused by Meier's grave medical condition. The jury found in favor of Meier. On appeal, North Central argues (1) the trial court erroneously excluded evidence essential to North Central's defense, and (2) the evidence is legally and factually insufficient to support the jury's verdict. For the reasons that follow, we affirm the judgment of the trial court.

BACKGROUND

On the night of January 2, 2001, Meier arrived at North Central's emergency room complaining of abdominal pain. He was 81 years old at the time. Meier was diagnosed with gallstones and underwent gall bladder surgery the next day. Following the surgery, Meier developed a bowel obstruction which required two additional surgeries over the next ten days. His health began to deteriorate following the last surgery, and Meier was transferred to the ICU on January 13, 2001. Meier was diagnosed with multiple medical conditions, the most serious being adult respiratory distress syndrome, which caused his lungs to fill up with liquids and required him to be on a ventilator providing him 100 percent oxygen; septic shock, an infection in the blood that caused his heart not to pump effectively and lowered his blood pressure; and multiorgan failure. That same day, Dr. Boatman, Meier's primary treating physician, discontinued Meier's total parenteral nutrition (TPN) (tube feeding of calories, proteins, and vitamins) because he believed the TPN might aggravate Meier's failing kidneys. A "do not resuscitate" order was given. Meier was sedated, on a paralytic, and unable to turn or reposition himself.

While in the ICU, Meier developed a skin tear on his tailbone that developed into a serious decubitus ulcer. Eventually, Meier's medical condition improved and on February 6 he was transferred to Life Care Hospital of Dallas, a rehabilitation hospital. At Life Care, Meier developed decubitus ulcers on his heels. On April 19, Meier was transferred from Life Care to a VA hospital. The decubitus ulcer on his tailbone healed by August 2001. He was discharged from the VA hospital in August 2002. Meier testified that, even though the decubitus ulcer on his tailbone has healed, a portion of the wound area is hard and painful, that he experiences daily discomfort in this area, and he is no longer able to perform many of the activities he enjoyed before his hospitalization.

The jury found North Central's negligence proximately caused Meier's injuries and awarded him $35,000 for medical expenses, $135,000 for past physical pain and mental anguish, $25,000 for future pain and mental anguish, $25,000 for physical impairment in the past, and $25,000 for future physical impairment. The trial court entered judgment in accordance with the jury's verdict.

EXCLUSION OF MEDICAL RECORDS

In its first issue, North Central argues the trial court abused its discretion by not admitting Meier's medical records from Life Care and the related expert testimony. It argues this evidence was essential to its defense because Meier claimed that the failure by the North Central nurses to provide pressure relief every two hours caused the development of the decubitus ulcer on his tailbone. It contends the evidence was relevant to show that North Central's failure to turn him was not the proximate cause of his injuries because the Life Care medical records showed that Meier developed decubitus ulcers on his heels despite being turned every two hours while he was in that facility. North Central argues this evidence shows the ulcer was unpreventable and unavoidable. It also argues these records and the related expert testimony were the only evidence of their kind on a material issue in the case, proximate cause.

The trial court did not admit the medical records and related expert testimony because it concluded they were not relevant and had great potential for confusing and misleading the jury. The trial court told North Central the evidence was not relevant because North Central had not shown that the two incidents were identical. North Central argues the trial court applied the wrong standard to the admissibility of those records because the incidents did not have to be identical to be relevant. It argues the trial court's exclusion of the evidence probably caused the rendition of an improper judgment.

A. Standard of Review

The trial court has discretion in deciding whether to admit or exclude evidence. Interstate Northborough P'ship v. State, 66 S.W.3d 213, 220 (Tex.2001); Gibson v. Ellis, 126 S.W.3d 324, 332-33 (Tex. App.-Dallas 2004, no pet.). A trial court abuses its discretion when it acts in an arbitrary and unreasonable manner, or when it acts without reference to any guiding principles. See Beaumont Bank, N.A. v. Buller, 806 S.W.2d 223, 226 (Tex.1991); Downer v. Aquamarine Operators, Inc., 701 S.W.2d 238, 241-42 (Tex.1985). Even if we find error, and before we will reverse a case based on an evidentiary ruling, appellant must show the evidence was controlling on a material issue and was not cumulative. See Tex. Dep't of Transp. v. Able, 35 S.W.3d 608, 617 (Tex.2000) (successful challenge to evidentiary ruling requires complainant to show judgment turned on particular evidence excluded or admitted); Williams Distrib. Co. v. Franklin, 898 S.W.2d 816, 817 (Tex.1995); Mentis v. Barnard, 870 S.W.2d 14, 16 (Tex.1994) (excluded testimony of accident reconstruction expert would have addressed central issue of comparative negligence and expert's noncumulative calculations and opinions were controlling, though not conclusive, on whether excessive speed caused death); Brookshire Grocery Co. v. Smith, 99 S.W.3d 819, 823 (Tex.App.-Beaumont 2003, pet. denied) (falsified answer on job application did not directly address elements of negligence action and therefore not controlling on a material issue). We will uphold a trial court's ruling if it is correct under any legal theory. See Custom Leasing, Inc. v. Tex. Bank & Trust Co. of Dallas, 516 S.W.2d 138, 142 (Tex. 1974); Seaman v. Seaman, 425 S.W.2d 339, 341 (Tex.1968).

B. Applicable Law

Relevant evidence is generally admissible. TEX.R. CIV.EVID. 402. An unrelated incident may be relevant and admissible if it and the incident involved in the lawsuit occurred under reasonably similar circumstances, the two incidents are connected in a special way, or the incidents occurred by means of the same instrumentality. See Mo.Pac. R.R. Co. v. Cooper, 563 S.W.2d 233, 236 (Tex.1978); Brookshire Bros. v. Wagnon, 979 S.W.2d 343, 348 (Tex.App.-Tyler 1998, pet. denied); McEwen v. Wal-Mart Stores, Inc., 975 S.W.2d 25, 29 (Tex.App.-San Antonio 1998, pet. denied). "Reasonably similar" generally means the same type of occurrence. Huckaby v. A.G. Perry & Son, Inc., 20 S.W.3d 194, 201 (Tex.App.-Texarkana 2000, pet. denied). The burden to show the incidents are reasonably similar, but not necessarily identical, is on the proponent of the evidence. See Nissan Motor Co. Ltd. v. Armstrong, 145 S.W.3d 131, 138 (Tex.2004); see also E-Z Mart Stores, Inc. v. Terry, 794 S.W.2d 63, 65 (Tex.App.-Texarkana 1990, writ denied). Evidence of similar incidents, even if relevant, is inadmissible if it creates undue prejudice or confusion. TEX.R.CIV. EVID. 403; Armstrong, 145 S.W.3d at 138.

C. Analysis

North Central argues the medical records from Life Care and the related expert testimony were relevant to prove its negligence was not a proximate cause of Meier's injuries because they show Meier would have developed the decubitus ulcer even if North Central's nurses had turned him every two hours. North Central offered the Life Care medical records through plaintiff's expert Nurse Simmons and through its own experts, Dr. Barnett and Dr. Brem.

1. Reasonably Similar Standard

Debora Simmons, a senior clinical quality analyst at University of Texas M.D. Anderson Cancer Center in Houston, testified as a nursing expert for Meier. Nurse Simmons stated that her job involves reviewing and writing policies and procedures for the hospital and instructing undergraduate nurses at Texas Women's University. She is certified by the American Association of Critical Care Nurses in bedside nursing and is an advanced practice nurse, licensed as a clinical nurse specializing in acute and critical care. Although North Central made an offer of proof for the Life Care medical records through Nurse Simmons, she did not testify that the conditions at Life Care were reasonably similar to the conditions at North Central or that Meier's condition was reasonably similar at both facilities.

North Central also offered Life Care's medical records through its two medical experts, Dr. Barnett, an internal medicine physician, and Dr. Brem, who testified he runs the wound healing center at Columbia University Medical Center and that his job...