Helderman v. Smolin
| Citation | 179 S.W.3d 493 |
| Decision Date | 24 October 2005 |
| Docket Number | No. W2004-01206-COA-R3-CV.,W2004-01206-COA-R3-CV. |
| Parties | Regina HELDERMAN and husband, Troy Helderman v. Matthew R. SMOLIN, M.D., et al. |
| Court | Supreme Court of Tennessee |
v.
Matthew R. SMOLIN, M.D., et al.
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J. Houston Gordon, Covington, TN, for Appellants.
Charles M. Purcell, Andrew V. Sellers, Jackson, TN, for Appellees.
ALAN E. HIGHERS, J., delivered the opinion of the court, in which W. FRANK CRAWFORD, P.J., W.S., and DAVID R. FARMER, J., joined.
This appeal involves a claim for medical malpractice. The plaintiff's cardiologist initially diagnosed her as having a heart condition which required surgery to repair. The plaintiff's cardiologist referred the plaintiff to a cardiothoracic surgeon for surgical repair of the condition. The plaintiff subsequently sought a second opinion, and the second cardiologist determined that the plaintiff did not need surgery. Thereafter, the plaintiff's original cardiologist apparently changed his diagnosis of the plaintiff's condition. After some time passed, the cardiothoracic surgeon performed surgery on the plaintiff, which was ultimately determined to be unnecessary. The plaintiff sued her original cardiologist and the cardiothoracic surgeon for medical malpractice. Through discovery, it was determined that the cardiothoracic surgeon did not review the plaintiff's entire medical records prior to performing the surgery. The cardiologist filed a motion for summary judgment arguing the cardiothoracic surgeon was the sole proximate cause of the plaintiff's injuries. In response, the plaintiff submitted an affidavit from her expert witness stating that the cardiologist had a duty under the applicable standard of care to directly communicate his changed diagnosis to the cardiothoracic surgeon, and his actions were a "significant contributing factor" to the plaintiff's injuries. The cardiologist filed a motion to strike the affidavit of the plaintiff's expert as contradictory to his deposition testimony. The trial court partially granted the cardiologist's motion. After doing so, the trial court granted the cardiologist's motion for summary judgment. The plaintiff appealed to this Court, and we reverse.
In 1997, Regina Helderman's ("Helderman" or "Appellant") primary care physician referred her to Dr. Matthew R. Smolin ("Dr. Smolin" or "Appellee"), a cardiologist practicing in Jackson, Tennessee, after Helderman reported having chest pains. On May 12, 1997, Dr. Smolin performed a transesophageal echocardiogram on Helderman to determine whether she had an atrial septal defect.1 As a result of this test, Dr. Smolin determined that Helderman did, in fact, have an atrial septal defect. On May 14, 1997, Dr. Smolin performed a cardiac catheterization on Helderman to determine whether the atrial septal defect was hemodynamically significant, thereby requiring
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surgery to repair.2 As a result of this test, Dr. Smolin diagnosed Helderman with a hemodynamically significant defect.
After performing these tests, Dr. Smolin referred Helderman to Dr. Arthur Grimball ("Dr.Grimball"), a cardiothoracic surgeon, for an evaluation to determine whether surgery was needed to close the atrial septal defect. Dr. Grimball evaluated Helderman the same day as the cardiac catheterization and determined that Helderman required surgery to repair the defect in her heart. He scheduled Helderman's surgery for June 3, 1997. The record contains a document entitled "Outpatient Summary" dated May 14, 1997, which indicates that Dr. Smolin changed his diagnosis to reflect that Helderman had a hemodynamically insignificant atrial septal defect. This document also indicates that Dr. Smolin forwarded it to Dr. Grimball. However, the document states that Dr. Smolin did not dictate it until June 6, 1997, and it was not transcribed until June 9, 1997.
Helderman subsequently obtained a referral from her primary care physician to seek a second opinion. On May 30, 1997, Helderman visited Dr. James Crenshaw ("Dr.Crenshaw"), a cardiologist. Dr. Crenshaw reviewed the cardiac catheterization report and determined that the atrial septal defect was hemodynamically insignificant, therefore, surgery was not required. Armed with this new information, Helderman left Dr. Crenshaw's office and proceeded directly to Dr. Smolin's office where she confronted him with Dr. Crenshaw's findings. According to Dr. Smolin, he reviewed the testing data and concluded that the laboratory computer performing the test had made an error. Dr. Smolin asserts that he recalculated the data by hand and determined Helderman's atrial septal defect to be insignificant, and he advised Helderman that no surgery would be required to fix the defect. Dr. Smolin's office notes from May 30, 1997, show that he noted the computer error, determined Helderman's atrial septal defect to be insignificant, and advised her to forgo surgical repair. According to Dr. Smolin, he forwarded a copy of his May 30, 1997, office notes indicating the corrected diagnosis to Dr. Grimball.
Conversely, Helderman asserts that a different series of events transpired when she visited Dr. Smolin on May 30, 1997. Helderman stated that Dr. Smolin seemed puzzled and agitated by Dr. Crenshaw's findings, and he continued to represent to her that she had a hemodynamically significant atrial septal defect requiring surgery to repair. According to Helderman, Dr. Smolin told her that the laboratory computer may have made a mistake, and he decided to postpone the surgery. Helderman asserts that, prior to leaving Dr. Smolin's office, she never received any further instructions or advice. Helderman never saw Dr. Smolin perform any calculations, and he never called Dr. Grimball while she was present in his office on May 30, 1997. According to Dr. Grimball, he never received any communications from Dr. Smolin alerting him to the fact that the previous calculations were incorrect. In any event, Helderman did not report for surgery on June 3, 1997.
In the interim, Helderman continued to seek treatment from Dr. Smolin at the request of her primary care physicians
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through the middle of 1999. On January 19, 1999, Helderman went to the emergency room at the Jackson/Madison County General Hospital complaining of fatigue. The emergency room physician's notes state that "[s]he was found to have a very small atrial septal defect back in 1997, felt to be hemodynamically insignificant. She, apparently, initially got some conflicting opinion concerning that."
According to Helderman, in the early part of 1999, Dr. Smolin continuously encouraged her to make an appointment with Dr. Grimball to have the atrial septal defect repaired. On May 12, 1999, Helderman visited Dr. Grimball's office and stated that Dr. Smolin told her to have the atrial septal defect repaired because her symptoms were worsening. After meeting with Helderman, Dr. Grimball reviewed his consultation report from 1997 showing a hemodynamically significant atrial septal defect, discussed the operation with her, and made arrangments to admit her to the hospital for the operation on June 10, 1999. Dr. Grimball admitted to not reviewing any other records prior to scheduling the surgery. Specifically, Dr. Grimball stated that he did not review his own medical records on Helderman prior to scheduling the operation. Thus, he had no knowledge of whether the report allegedly prepared by Dr. Smolin regarding the May 30, 1997, office visit, which set forth his new finding of a hemodynamically insignificant atrial septal defect, was contained in those records.
Dr. Grimball performed the surgery on Helderman on June 10, 1999, as scheduled. As a result, Helderman experienced complications related to the unnecessary surgery. On July 7, 1999, Dr. Crenshaw requested, in writing, that Dr. Smolin's office forward to him all records pertaining to Helderman. Dr. Smolin's office faxed the records to Dr. Crenshaw that same day. Dr. Crenshaw stated that the records forwarded did not contain a copy of Dr. Smolin's May 30, 1997, office note indicating a change in diagnosis, nor did he receive any documents indicating Helderman's atrial septal defect had subsequently been determined to be hemodynamically insignificant.
On May 5, 2000, Helderman, along with her husband, filed a complaint in the Circuit Court of Madison County, Tennessee, against Dr. Smolin individually and his business, Medical Specialty Clinic, P.C., alleging medical malpractice. In addition, Helderman named Dr. Grimball individually and his business, Cardiothoracic Surgery Center, P.L.C., as defendants.3 She also secured the services of an expert witness, Dr. David Hansen ("Dr.Hansen").
Thereafter, Dr. Smolin filed a motion for summary judgment with the trial court alleging that Dr. Grimball was the sole proximate cause of Helderman's injuries. In support of his motion, Dr. Smolin submitted his own deposition testimony; the deposition testimony of Dr. Crenshaw, Dr. Grimball, and Dr. Hansen; excerpts from the deposition of Stephanie Geibel ("Ms.Geibel"), records custodian for Dr. Grimball; and relevant portions of Helderman's medical records. Dr. Smolin also submitted the affidavit of his own expert, Dr. Dale Wortham, who opined that Dr. Smolin complied with the applicable standard of care, and that Dr. Grimball's actions were the sole proximate cause of Helderman's injuries. In response to Dr. Smolin's motion, Helderman filed Dr. Hansen's affidavit and his deposition testimony.
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Helderman also submitted relevant portions of her medical records and excerpts from the depositions of various witnesses.
In his affidavit, Dr. Hansen stated, in relevant part, as follows:
7. The misdiagnosis and misreferral in the first instance was a...
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