Hampton v. Hearn

• Decision Date: 21 January 2020
• Docket Number: No. COA19-378,COA19-378
• Parties: Debbie Thompson HAMPTON; as Executrix of the Estate of Delacy Beatrice Thompson Miles, Deceased, v. Andrew Taylor HEARN, M.D., Defendant.
• Court: North Carolina Court of Appeals

269 N.C.App. 397

838 S.E.2d 650

Debbie Thompson HAMPTON; as Executrix of the Estate of Delacy Beatrice Thompson Miles, Deceased,

v.Andrew Taylor HEARN, M.D., Defendant.

No. COA19-378

Court of Appeals of North Carolina.

Filed: January 21, 2020

Wake Forest University School of Law Appellate Clinic, by John J. Korzen, for plaintiff-appellant.

Nelson Mullins Riley & Scarborough LLP, Winston-Salem, by G. Gray Wilson, Linda L. Helms, and Lorin J. Lapidus, for defendant-appellee.

BERGER, Judge.

Debbie Thompson Hampton ("Plaintiff), as Executrix of the Estate of Delacy Beatrice Thompson Miles ("Ms. Miles"), appeals from a judgment entered after a jury returned a verdict finding Dr. Andrew Taylor Hearn ("Dr. Hearn") not liable for negligence. Plaintiff contends the trial court erroneously instructed the jury on intervening negligence and erroneously admitted expert witness testimony. We disagree and find no error.

Factual and Procedural Background

On March 8, 2011, Ms. Miles was treated by Dr. Hearn at Alamance Regional Medical Center for angioplasty and stent placement in her innominate vein related to her dialysis treatments. Angioplasty is "the dilatation [sic ] of a vessel." The innominate vein runs from the collarbone across the chest and then "enters the superior vena cava, which is the main blood vessel entering the heart on the right side." Dr. Hearn inserted the stent to unblock the vein, which was likely blocked from previous catheter placements in dialysis treatments.

Dr. Hearn first performed the angioplasty, or "balloon" insertion, to expand the vein. He then implanted a stent. The stent was about 60 millimeters, or about 2.5 inches, in length. The manufacturers put metallic markers on the ends of the stents so its location can be easily identified radiologically. In Ms. Miles’ case, the stent was to be placed at the junction of the left innominate vein and the superior vena cava.

Three days later, on March 11, 2011, Ms. Miles needed a "permacath placement" in her right internal jugular vein to establish new access for her ongoing dialysis. In order to establish access, Dr. Gregory Schnier ("Dr. Schnier"), passed a catheter from the right jugular vein through the superior vena cava to the right atrium of the heart. No evidence tended to show Dr. Schnier knew or had been informed that the stent Dr. Hearn placed on March 8 was obstructing the superior vena cava.

During the procedure, Ms. Miles experienced ventricular tachycardia. Providers at Alamance Regional Medical Center placed Ms. Miles on medication for the arrhythmia, and discovered there was a "foreign body" in the right ventricle. Ms. Miles was transferred to Duke Hospital on March 12, 2011, and the foreign stent was removed on March 14, 2011. The Duke pathology report revealed that "a foreign body" was found in the right ventricle. The foreign body was determined to be a 30 millimeter "self-expanding stent which had a fracture on one portion of it." It was part of the stent that Dr. Hearn had placed in Ms. Miles.

Ms. Miles remained in the hospital from March 14, 2011 until March 23, 2011. She returned to Duke from March 29 to April 3, 2011 due to bleeding from the dialysis site. After her release from Duke Hospital, Ms. Miles entered a nursing home in Georgia. Ms. Miles subsequently died from other causes.

Plaintiff filed a complaint against Hearn Vascular Surgery, P.A.; Alamance Regional Medical Center, Inc.; Dr. Hearn; and Dr. Schnier. Plaintiff alleged her complaint was "an action for medical negligence resulting in severe and permanent disabling injuries to [Ms. Miles] as a result of injuries sustained when a stent improperly placed in [Ms. Miles’] vein for better dialysis access, was broken during a subsequent procedure and went into [Ms. Miles’] heart causing severe, permanent and disabling injuries." At trial, before the opening statements, Plaintiff took a voluntary dismissal without prejudice against Dr. Schnier, leaving Dr. Hearn as the sole defendant in the suit.

During trial, Plaintiff's expert witness regarding the standard of care, Dr. Michael Dahn ("Dr. Dahn"), testified Defendant had placed the stent "too far into the superior vena cava." He acknowledged that it was acceptable medical practice for a vascular stent to extend into the superior vena cava, but he testified that extending "beyond one to two millimeters" is problematic. He further opined that Dr. Hearn's final positioning of the stent "set the stage for it ... being sheared in half causing it to migrate." Dr. Dahn concluded that Dr. Hearn's placement of the stent breached the applicable standard of care. Dr. Dahn also testified that Dr. Schnier's failure to recognize the position of the stent when he performed his procedure breached the standard of care.

Two expert witnesses retained by Dr. Hearn, Dr. Steve Powell ("Dr. Powell") and Dr. Ray Workman ("Dr. Workman"), testified that Dr. Hearn had complied with the standard of care when he performed the angioplasty and stent placement procedures. Dr. Hearn also presented deposition testimony by Dr. Jack Dawson and Dr. Michel Rinaldi ("Dr. Rinaldi"). Dr. Rinaldi was specifically retained to testify as an expert witness on causation.

During the charge conference, the trial court informed the parties of the proposed jury instructions, which included Dr. Hearn's requested instruction on intervening negligence. Plaintiff's objection to the instruction on intervening negligence was overruled. The intervening negligence instruction stated in pertinent part:

In this case, the defendant, Dr. Hearn, contends that, it [sic ] he was negligent, which he denies, such negligence was not a proximate cause of the Plaintiff's injury because it was insulated by the negligence of Dr. Gregory S[c]hnier. You will consider this matter only if you find that Dr. Hearn was negligent. If you do so find, Dr. Hearn's negligence would be insulated and Dr. Hearn would not be liable to the Plaintiff, if the negligence of Dr. S[c]hnier, was such to have broken the causal connection or sequence between Dr. Hearn's negligence and the Plaintiff's injury; thereby excluding Dr. Hearn's negligence as a proximate cause.

After deliberation, the jury determined that Dr. Hearn was not negligent. Plaintiff appeals, contending the trial court erred by instructing the jury on intervening negligence, and that the jury likely would have reached a different result but for the instruction. She further contends the trial court erred by allowing one of Dr. Hearn's expert witnesses on causation to opine on standard of care. We disagree and find no error.

Analysis

I. Jury Instructions on Intervening Negligence

Plaintiff first contends the trial court erred when it instructed the jury on intervening negligence because that instruction was not supported by the evidence. Plaintiff's main argument asserts an instruction on intervening negligence should not have been given because no expert witness directly established the standard of care Dr. Schnier owed; that he breached that standard of care; and that his breach of the standard of care was the proximate cause of Ms. Miles’ injury. As a result, she argues insufficient evidence that Dr. Schnier's negligence insulated Dr. Hearn's negligence, thereby rendering an instruction on intervening negligence erroneous.

We conclude direct expert testimony establishing those elements against Dr. Schnier was not required for an instruction on intervening negligence to be given.

When charging a jury in a civil case, the trial court has the duty to explain the law and apply it to the evidence on the substantial issues of the action. The trial court is permitted to instruct a jury on a claim or defense only if the evidence, when viewed in the light most favorable to the proponent, supports a reasonable inference of such claim or defense.

Estate of Hendrickson ex rel. Hendrickson v. Genesis Health Venture, Inc. , 151 N.C. App. 139, 151-52, 565 S.E.2d 254, 262 (2002) (citations and quotation marks omitted). "This Court is required to consider and review jury instructions in their entirety. Under the applicable standard of review, the appealing party must show not only that error occurred in the jury instructions but also that such error was likely, in light of the entire charge, to mislead the jury." Id. at 150-51, 565 S.E.2d at 262 (citation omitted).

"A plaintiff asserting medical negligence must offer evidence that establishes the following essential elements: (1) the applicable standard of care; (2) a breach of such standard of care by the defendant; (3) the injuries suffered by the plaintiff were proximately caused by such breach; and (4) the damages resulting to the plaintiff." Hawkins v. Emergency Med. Physicians of Craven Cnty. , PLLC, 240 N.C. App. 337, 341, 770 S.E.2d 159, 162 (2015) (internal citations and quotation marks omitted). Proximate cause is defined as:

a cause which in natural and continuous sequence, unbroken by any new and independent cause, produced the plaintiff's injuries, and without which the injuries would not have occurred, and one from which a person of ordinary prudence could have reasonably foreseen that such a result, or consequences of a generally injurious nature, was probable under all the facts as they existed.

Id. at 341-42, 770 S.E.2d at 162-63 (citation and quotation marks omitted).

Proximate cause is an inference of fact, to be drawn from other facts and circumstances. If the evidence be so slight as not reasonably to warrant the inference, the court will not leave the matter to the speculation of the jury.

It is only when the facts are all admitted and only one inference may be drawn from them that the court will declare whether an act was the proximate cause of an injury or not. But that is rarely the case. Hence, "what is the proximate cause of an injury is ordinarily a question for the jury. ... It is to be determined as a fact, in view of the circumstances of fact attending it."

Conley v. Pearce-Young-Angel Co. , ...