EState S. French v. House

• Decision Date: 04 May 2010
• Docket Number: No. E2008–00539–SC–R11–CV.,E2008–00539–SC–R11–CV.
• Citation: 333 S.W.3d 546
• Parties: ESTATE OF Martha S. FRENCHv.STRATFORD HOUSE et al.
• Court: Tennessee Supreme Court

333 S.W.3d 546

ESTATE OF Martha S. FRENCH

v.STRATFORD HOUSE et al.

No. E2008–00539–SC–R11–CV.

Supreme Court of Tennessee, at Knoxville.

May 4, 2010 Session.Jan. 26, 2011.

S. Drake Martin and Michael Chad Trammell, Jackson, Tennessee; Richard C. May, Knoxville, Tennessee; and Brian G. Brooks, Greenbrier, Arkansas, for the appellant, Kimberly S. French.Alaric H. Henry and Thomas Mitchell Horne, Chattanooga, Tennessee, for the appellees, Stratford House, OP Chattanooga, Inc., Tandem Health Care, Inc., and Tandem Health Care of Ohio, Inc.Clifford Wilson and Melissa Bradford Muller, Nashville, Tennessee, for the appellees, HP/Stratford House, Inc. and HP/Holding, Inc.Karla C. Hewitt, Nashville, Tennessee, for the amicus curiae, Tennessee Citizen Action.Wayne Allen Ritchie II, Nashville, Tennessee, for the amicus curiae, Tennessee Association for Justice.F. Laurens Brock, David J. Ward, and T. Ryan Malone, Chattanooga, Tennessee; and John Lyell, Nashville, Tennessee, for the amicus curiae, Tennessee Health Care Association.

OPINION

GARY R. WADE, J., delivered the opinion of the Court, in which CORNELIA A. CLARK, C.J., JANICE M. HOLDER, and SHARON G. LEE, JJ., joined. WILLIAM C. KOCH, JR., J., filed a separate opinion dissenting in part.GARY R. WADE, J.

The administratrix of the estate of the deceased brought this wrongful death suit against the defendant nursing home and its controlling entities, alleging damages as the result of ordinary negligence, negligence per se, and violations of the Tennessee Adult Protection Act. The trial court granted the defendants' motion for partial summary judgment, holding that the Tennessee Medical Malpractice Act applied to the ordinary negligence claims, thereby precluding allegations of negligence per se or violations of the Tennessee Adult Protection Act. The trial court also dismissed a claim for punitive damages. The Court of Appeals affirmed, but vacated the portion of the order dismissing the punitive damages claim. This Court granted the administratix's application for permission to appeal in an effort to clarify the standards governing nursing home liability and to resolve a conflict in the decisions rendered by the Court of Appeals. We hold that, because the administratrix of the estate of the deceased has alleged violations of the standard of care pertaining to both medical treatment and routine care, she has made claims based upon both medical malpractice and ordinary negligence. Further, she may offer proof of negligence per se and violations of the Tennessee Adult Protection Act as support for her ordinary negligence claims. We affirm the Court of Appeals' reinstatement of the punitive damages claim. The judgment of the Court of Appeals is, therefore, affirmed in part and reversed in part. The cause is remanded to the trial court.

Facts and Procedural History¹

In 2000, Martha French (“Ms. French”), age 54, suffered a debilitating stroke, her second, and was admitted to total care at the Highland Manor Nursing Home (“Highland Manor”) in Portland. Also afflicted with diabetes, arterial fibrillation, depression, hypertension, and anxiety, Ms. French periodically experienced pressure ulcers ² at Highland Manor. After Ms. French had been a patient at Highland Manor for approximately three years, her daughter, Kimberly S. French (the “Administratrix”), arranged for her transfer to the Stratford House, a long-term care facility in Chattanooga. At the time of her admittance on April 3, 2003, Ms. French had no pressure ulcers. Because of her immobility, however, Ms. French was at significant risk of developing ulcers. The facility's Patient Transfer Form, Resident Assessment Protocol (“RAP”) Summary, and Care Plan all documented Ms. French's susceptibility to pressure ulcers. A course of treatment was prescribed in order to prevent a reoccurrence of the condition. According to the plan of care established at the facility, Ms. French had to be turned by nursing home personnel and repositioned frequently, kept clean and dry after incontinence, and provided with adequate hydration and nutrition.³

Ms. French's condition deteriorated during her time at the Stratford House. By the middle of July 2003, she had both a low-grade fever and low blood pressure and, on July 23, the Administratrix arranged for a transfer to Erlanger Medical Center (“Erlanger”), where physicians attempted to increase her blood pressure by hydrating her intravenously. When she was admitted to Erlanger, Ms. French had a urinary tract infection and a number of pressure ulcers that had become infected. She developed pulmonary swelling after her admission, and medical devices were required to assist with her breathing. A feeding tube was inserted. Later, when the Administratrix discovered the gravity of her mother's condition, she instructed the physicians to halt the aggressive measures, including the breathing assistance and the use of a feeding tube. Ms. French died on July 26, 2003. Her death certificate lists sepsis (commonly known as blood poisoning) as the cause of her death.

On March 22, 2004, the Administratrix filed suit on behalf of Ms. French's estate against the Stratford House, OP Chattanooga, Inc., Tandem Health Care, Inc., Tandem Health Care of Ohio, Inc., Cookeville Long Term Facility, Inc., f/k/a Tandem Health Care of Tennessee, Inc., HP/Stratford House, Inc., and HP/Holding, Inc. (the “Defendants”).⁴ The Administratrix alleged (1) ordinary negligence; (2) negligence per se based upon violations of state and federal nursing home regulations; and (3) violations of the Tennessee Adult Protection Act (“TAPA”), Tenn.Code. Ann. §§ 71–6–101 to –122 (2004 & Supp.2010). The complaint sought both compensatory and punitive damages. In response, the Defendants contended that all of the Administratix's allegations qualified as medical malpractice claims under the Tennessee Medical Malpractice Act (“TMMA”), Tenn.Code. Ann. §§ 29–26–115 to –122 (2000 & Supp.2010).

There is significant dispute between the parties regarding the cause of Ms. French's death. During depositions, Dr. Absalom Tilley, the medical director of several nursing homes in Arkansas, testified on the Administratrix's behalf. He asserted that it was more probable than not, and within a reasonable degree of medical certainty, that Ms. French died as a result of the infection that had caused her sepsis. It was his opinion that Ms. French suffered from Stage IV pressure ulcers when she was admitted to Erlanger, including an ulcer on her sacrum which was so severe as to expose the bones of her spinal column. According to Dr. Tilley, these ulcers became severely infected, giving off a foul odor, and had become necrotic, meaning that the cells and tissues surrounding the ulcers had died. Dr. Tilley and Nurse Teresa Lowery, the Administratrix's nursing expert, testified that these infections and, correspondingly, Ms. French's death, were caused by the Defendant's failure to provide the basic care that her condition required.

Dr. David Cifu, the Chairman of the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University and also the medical director at several rehabilitation facilities in Virginia, offered testimony on behalf of the Defendants. Dr. Cifu acknowledged that Ms. French suffered from infections upon her admission to Erlanger. Based on a lack of definitive evidence, however, it was his opinion that Ms. French's death was not the result of sepsis. Dr. Cifu concluded that Ms. French died of respiratory arrest or a failure of pulmonary function as a result of the aggressive methods used by Erlanger while attempting to resuscitate her. His assessment was that Ms. French had become overly hydrated from the excessive fluids she received at Erlanger. It was also Dr. Cifu's opinion that Ms. French was neither abused nor neglected at the Stratford House and that she had received adequate care and treatment at that facility.

The Administratrix introduced the deposition testimony of several nurses' aides (Certified Nursing Assistants, or CNAs) who had been employed at the Stratford House, some of whom confirmed that they had treated Ms. French while she was a patient there. A summary of the allegations contained in the various depositions is as follows:

(1) The CNAs provided most of the hands-on basic care at the Stratford House, including feeding the residents, providing them with water and encouraging them to drink, bathing them, cleaning them and changing the pads underneath them after periods of incontinence, and turning and repositioning them.

(2) The CNAs understood that this basic care was necessary to maintain the health of the residents and to prevent, among other things, the development of pressure ulcers.

(3) Understaffing at the Stratford House prevented the CNAs from performing basic care for the residents in a timely fashion.

(4) Understaffing was caused by the nursing home administrators' failure to allocate sufficient funds for staff in order to avoid “cut[ting] into ... bonuses” that were based on bottom-line profitability.

(5) As a result of understaffing and the lack of timely basic care, residents were sometimes left to lie in their own urine, which caused dried, brown rings on the bed sheets, and feces, which, after drying, were difficult to remove. Multiple pads were used as an alternative to changing a single wet pad.

(6) Martha French was not turned and repositioned as needed and was found languishing in her own urine for so long that it had dried on her bed sheets. Although Ms. French would eat and drink when encouraged to do so, the CNAs often did not have the necessary time to feed her or administer fluids. Further, they did not have time to reposition Ms. French as needed.

(7) The Defendants were aware of the shortage of caregivers at the Stratford House. Stephania Williams, Stratford House's staffing coordinator, testified to chronic staff shortages. Other CNAs stated...