Glenn v. Peoples

• Decision Date: 10 December 2015
• Docket Number: No. 2014–CA–00231–SCT.,2014–CA–00231–SCT.
• Citation: 185 So.3d 981
• Parties: Tamara GLENN, Individually, as Administratrix for the Estate of Mattie Hazel Aldridge, and on Behalf of the Wrongful Death Beneficiaries for Mattie Hazel Aldridge. v. James T. PEOPLES, M.D.
• Court: Mississippi Supreme Court

185 So.3d 981

Tamara GLENN, Individually, as Administratrix for the Estate of Mattie Hazel Aldridge, and on Behalf of the Wrongful Death Beneficiaries for Mattie Hazel Aldridge.

v.James T. PEOPLES, M.D.

No. 2014–CA–00231–SCT.

Supreme Court of Mississippi.

Dec. 10, 2015.

Rehearing Denied March 17, 2016.

William W. Fulgham, Jackson, attorney for appellants.

Dennis J. Childress, Kimberly N. Howland, Jackson, attorneys for appellee.

EN BANC.

DICKINSON, Presiding Justice, for the Court:

¶ 1. On April 24, 2010, Dr. James T. Peoples treated Mattie Hazel Aldridge ("Aldridge") when she presented to St. Dominic Hospital with a recurrent deep-vein thrombosis. During her stay at the hospital, Dr. Peoples placed Aldridge on anticoagulation therapy. Almost two months later, on June 25, 2010, after she had been transferred into the care of Trinity Mission Health & Rehabilitation of Clinton ("Trinity"), Aldridge presented to St. Dominic with a brain bleed. And two months after that, on September 24, 2010, Aldridge died. On May 13, 2011, Tamara Glenn, Aldridge's daughter, filed suit alleging that Dr. Peoples negligently had caused Aldridge's death by prescribing Coumadin. Dr. Peoples filed a motion for summary judgment, which the trial court granted. Finding no error, we affirm.

FACTUAL AND PROCEDURAL BACKGROUND

¶ 2. Dr. Peoples provided medical care for Aldridge beginning on or about April 24, 2010, after she was admitted to St. Dominic with right-leg swelling and pain—which was later diagnosed as a recurrent deep-vein thrombosis (DVT), which occurs when a blood clot (thrombus ) forms in one or more of the deep veins in the body. After conducting a risk-benefit analysis, Dr. Peoples decided to place Aldridge on anticoagulation therapy, specifically prescribing Lovenox and Coumadin.

¶ 3. On April 30, 2010, Aldridge was discharged from St. Dominic and transferred into the care of Trinity and its medical director, Dr. Samuel Jones. At the time of her discharge, Aldridge appeared stable. She presented a subtherapeutic INR level at 1.79 and was not suffering from any internal bleeding. INR (international normalized ratio ) levels indicate the length of time it takes for blood to clot. As INR levels rise, blood thinners such as Coumadin are more risky. In his discharge orders, Dr. Peoples recommended daily INR-level testing and monitoring to ensure that Aldridge's INR levels remained within a safe range.

¶ 4. After Aldridge was transferred to Trinity, Dr. Jones took over, and from that point forward was solely responsible for her medical care. He initially ordered that Aldridge continue to receive Coumadin, and that INRs be drawn. After this initial order, Dr. Jones began monitoring the INR levels and adjusting Aldridge's intake of Coumadin accordingly.

¶ 5. On May 3, 2010, Aldridge's INR level was supratherapeutic at 3.6. Consequently, Dr. Jones ordered that Coumadin be withheld for a day, but that the intake be resumed at a dosage of five milligrams and that INR levels be rechecked. On May 6, 2010, Aldridge's INR level was still supratherapeutic at 3.4, so Dr. Jones issued orders to withhold Coumadin for two days, then to resume with the five-milligram dose, and to recheck her INR level. On May 10, 2010, Aldridge's INR level was within the therapeutic range at 2.3, so Dr. Jones ordered that the five-milligram dose be continued but did not order any further INR draws.

¶ 6. On May 24, 2010—after Aldridge complained of severe swelling in her right lower leg—Dr. Jones ordered an INR draw, but the level remained therapeutic at 2.1. Following this incident, Dr. Jones failed to order any further INR draws, despite the fact that a pharmacist consultant recommended that further INR draws be conducted, and despite the fact that Dr. Jones noted his agreement with the pharmacy consultant's recommendation.

¶ 7. On June 25, 2010—after being out of Dr. Peoples's care for almost two months—Aldridge presented at St. Dominic with a right hemorrhagic stroke (brain bleed), following which she was taken off Coumadin. Two months later, on September 24, 2010, Aldridge died. The nonphysician who filled out Aldridge's death certificate identified the cause of death as a cardiopulmonary arrest, secondary to hemorrhagic stroke (brain bleed).

¶ 8. On May 13, 2011, Glenn filed a wrongful death action against Dr. Peoples in the Circuit Court of the First Judicial District of Hinds County, alleging that Dr. Peoples had negligently prescribed Coumadin to Aldridge and that the Coumadin had caused her death. Glenn asserted four theories of liability: (1) negligent monitoring, (2) negligent prescription of Coumadin, (3) respondeat superior, and (4) res ipsa loquitor.

¶ 9. On December 16, 2013, Dr. Peoples filed a motion for summary judgment and, with respect to each theory of liability, argued the following: (1) he was not liable for negligent monitoring because his duty to monitor ceased once Aldridge had been transferred into the care of Trinity and Dr. Jones; (2) he was not liable on the negligent-prescription claim because any Coumadin prescribed by him would have been out of her body by the time Aldridge experienced the brain bleed and because no evidence established that the Coumadin actually had caused Aldridge's brain bleed; (3) he was not liable on the basis of respondeat superior because he did not have any authority or control over Trinity; and (4) res ipsa loquitor did not apply because the elements of the doctrine were not met. On January 20, 2014, the trial court entered a final judgment granting Dr. Peoples's motion and dismissing Glenn's claims. Glenn filed a timely notice of appeal on February 11, 2014, raising only one issue—that is, whether the trial court erred in granting summary judgment to Dr. Peoples on the negligent-prescription and negligent-monitoring claims.

STANDARD OF REVIEW

¶ 10. When reviewing a grant or denial of a motion for summary judgment, this Court employs a de novo standard of review.¹ Summary judgment should be granted only when no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law.² The evidence must be viewed in the light most favorable to the nonmoving party.³ The party opposing the motion "may not rest upon the mere allegations or denials of his pleadings, but his response, by affidavits or as otherwise provided by this rule, must set forth specific facts showing that there is a genuine issue for trial."⁴

ANALYSIS

¶ 11. To establish a prima facie case of medical negligence, the plaintiff must show that:

(1) the defendant had a duty to conform to a specific standard of conduct for the protection of others against an unreasonable risk of injury; (2) the defendant failed to conform to that required standard; (3) the defendant's breach of duty was a proximate cause of the plaintiff's injury, and; (4) the plaintiff was injured as a result.⁵

A. Standard of Care and Breach

¶ 12. "Mississippi physicians are bound by nationally-recognized standards of care; they have a duty to employ ‘reasonable and ordinary care’ in the treatment of their patients."⁶ "[O]ur law requires a plaintiff to establish—through a qualified expert—what is required of a minimally competent [physician], ‘whose skills and knowledge are sufficient to meet the licensure or certification requirements for the profession or specialty practiced.’ "⁷ "[Physicians] are not required to do what is generally done, or what the average [physician] would do."⁸

¶ 13. This case does not present a "battle of the experts." But we must draw attention to the fact that Dr. Davey—Glenn's designated testifying expert—is board-certified only in "wound care" and nothing else, and certainly not internal medicine. Dr. Davey was ineligible to be board-certified in internal medicine because he had not completed the required internal-medicine residency program. Dr. Reddix—Dr. Peoples's designated testifying expert—is, however, board-certified in internal medicine and he devotes his medical practice solely to this area. But for purposes of this analysis, we will assume that Dr. Davey does in fact meet the necessary qualifications to testify as an "expert" regarding issues of internal medicine.

¶ 14. Both doctors articulated the same standard of care for the treatment of DVT or recurrent DVT—which was Aldridge's diagnosis at the time Dr. Peoples prescribed Coumadin. Specifically, the doctors agreed that the standard treatment was anticoagulation therapy—typically with Lovenox and Coumadin —unless there were "contraindications to anticoagulation ," or more simply put, unless medical tests indicated the risk of bleeds became too high. According to the experts, to properly determine whether contraindications to anticoagulation exist, a treating physician should conduct a risk-benefit analysis.

¶ 15. Where the experts differed was on the issue of whether Dr. Peoples had breached the standard of care, that is, whether Dr. Peoples had acted negligently in prescribing Coumadin to Aldridge. Dr. Davey conceded that opinions can differ regarding whether the risks outweigh the benefits, and he did not deny that Dr. Peoples had followed the standard of care by conducting the risk-benefit analysis. Despite this, Dr. Davey maintained that the risk factors concerning Aldridge's medical condition weighed too heavily against the possible benefits to be gained by the Coumadin, and that any opinion to the contrary was a breach of the standard of care.

¶ 16. Drs. Reddix and Peoples argued the opposite—asserting that Dr. Peoples had carefully considered all of the risk factors, conducted the appropriate tests ruling out some of the risks, weighed the multitude of benefits, and then ultimately had decided that the benefits gained substantially outweighed the risks—and that as a result, no breach had occurred.

¶ 17. Because we are required to view the evidence in the light most favorable to the nonmoving party—which in the case would be Glenn—we hold that there remains a genuine...