Knight v. Knight

• Decision Date: 03 July 2012
• Docket Number: A12A0770.,A12A0741,Nos. A12A0740,s. A12A0740
• Citation: 12 FCDR 2227,730 S.E.2d 78,316 Ga.App. 599
• Parties: KNIGHT et al. v. ROBERTS. Cone v. Knight et al. The Medical Center, Inc. v. Knight et al.
• Court: Georgia Court of Appeals

316 Ga.App. 599

730 S.E.2d 78

12 FCDR 2227

KNIGHT et al.

v.ROBERTS.

Cone

v.Knight et al.

The Medical Center, Inc.

v.Knight et al.

Nos. A12A0740, A12A0741, A12A0770.

Court of Appeals of Georgia.

July 3, 2012.

Katherine Lee McArthur, Richard Thomas Tebeau III, Caleb Frank Walker, Macon, for Arthur Knight.

Broderick Wardell Harrell, Atlanta, for Appellee.

MILLER, Judge.

Arthur F. Knight, Jr., individually and as executor of the estate of Barbara P. Knight (collectively “Knight”), brought the instant medical malpractice action against Dr. Fred T. Roberts, Dr. Terry A. Cone, and The Medical Center, Inc. d/b/a Columbus Regional Medical Center (“TMC”), alleging that the doctors and nursing staff had failed to timely diagnose Mrs. Knight's aortic dissection heart condition, which led to her death. Dr. Roberts, Dr. Cone, and TMC each filed motions for summary judgment, contending that Knight had failed to present evidence that their acts or omissions caused or contributed to Mrs. Knight's death. TMC also filed a motion to exclude the testimony of Knight's expert nurse, Cathleen A. Provins Churbock, challenging her qualifications as an expert in emergency room nursing procedures.¹ The trial court granted Dr. Roberts's motion for summary judgment, but denied Dr. Cone's and TMC's motions for summary judgment. The trial court further denied TMC's motion to exclude the testimony of Knight's expert nurse.

We granted Dr. Cone's and TMC's applications for interlocutory appeal for review of the trial court's denial of their motions for summary judgment. Knight cross-appeals the trial court's order granting summary judgment for Dr. Roberts. Since these appeals involve the same set of facts and legal principles, we consolidated them for review. We conclude that the evidence presents a genuine issue of material fact as to whether the negligence of Dr. Roberts, Dr. Cone, and the nursing staff proximately caused Mrs. Knight's death; therefore, we reverse the trial court's grant of summary judgment in favor of Dr. Roberts in Case No. A12A0740. We affirm the trial court's decisions denying summary judgment to Dr. Cone and TMC in Case Nos. A12A0741 and A12A0770. We also affirm the trial court's denial of TMC's motion to exclude the expert nurse's testimony in Case No. A12A0770.

To prevail at summary judgment under OCGA § 9–11–56, the moving party must demonstrate that there is no genuine issue of material fact and that the undisputed facts, viewed in the light most favorable to the nonmoving party, warrant judgment as a matter of law. A defendant may do this by showing the court that the documents, affidavits, depositions and other evidence in the record reveal that there is no evidence sufficient to create a jury issue on at least one essential element of plaintiff's case.

When ruling on a motion for summary judgment, the opposing party should be given the benefit of all reasonable doubt, and the court should construe the evidence and all inferences and conclusions therefrom most favorably toward the party opposing the motion. Further, any doubts on the existence of a genuine issue of material fact are resolved against the movant for summary judgment. When this Court reviews the grant or denial of a motion for summary judgment, it conducts a de novo review of the law and the evidence.

(Punctuation and footnotes omitted.) Beasley v. Northside Hosp., Inc., 289 Ga.App. 685, 685–686, 658 S.E.2d 233 (2008).

So viewed, the record shows that on the afternoon of February 17, 2001, Mrs. Knight was bathing her dog when she suddenly began experiencing a pain in her chest. Later that evening, Mrs. Knight went to TMC's Emergency Department (“ER”), arriving at approximately 8:00 p.m. Mrs. Knight registered into the ER at approximately 8:14 p.m. and saw a nurse for an initial assessment at 8:20 p.m. Mrs. Knight reported that she was 61 years old, had a history of smoking and hypertension, and was then experiencing severe chest pain that radiated down her arm, back, and neck. She stated that her pain level was a “10,” which was the highest level. Her blood pressure was elevated to 228/104. The nurse placed Mrs. Knight into the triage category of “urgent,” rather than “emergent.”

Dr. Roberts was the attending physician in the ER that evening, and he saw Mrs. Knight at 8:35 p.m., approximately 15 minutes after her initial assessment. Dr. Roberts reviewed the nurse's notes describing Mrs. Knight's symptoms and history, and he performed a physical examination. Upon his examination at 8:35 p.m., he ordered a CCU panel, chest x-ray, placement on a monitor, sublingual nitroglycerine, and a GI cocktail. The nurses, however, did not begin to carry out the orders immediately; instead, Mrs. Knight was not placed on a monitor until 9:20 p.m., and her medications were not given until 9:30 p.m., almost an hour later after the orders were given.

At 10:25 p.m., the results of the diagnostic testing were entered, and Dr. Roberts noted that Mrs. Knight's vital signs appeared to be normal and that diagnostic testing indicated that her cardiac enzymes were normal, her chest-x-ray was negative, and an EKG did not show any acute ischemic changes. The record shows that although Mrs. Knight's blood pressure had decreased to 154/88, it remained elevated throughout her treatment in the ER. Based upon his examination, Dr. Roberts made a differential diagnosis of angina, myocardial infarction, pleurisy, costochondritis, esophageal reflux, and chest wall pain.² He never considered thoracic aneurysm or an aortic dissection.

At approximately 11:45 p.m., Dr. Roberts contacted Dr. Cone, who was providing on-call coverage for Mrs. Knight's family physician, and advised that Mrs. Knight was in the ER. Dr. Cone ordered that Mrs. Knight be admitted to the hospital for further observation and testing. Dr. Cone also ordered that Mrs. Knight be given Lovenox, a blood thinner. Dr. Roberts stated that after treatment, and by his reassessment at 11:45 p.m., Mrs. Knight's symptoms were completely relieved. Notes in the medical record, however, indicate that Mrs. Knight had continued to complain of pain symptoms, and that Dr. Roberts gave a verbal order to give her morphine for pain in her back at 12:48 a.m.

On the following day, February 18th at 1:53 p.m., while Mrs. Knight remained hospitalized at TMC, Dr. Cone examined Mrs. Knight and reviewed her hospital chart. Dr. Cone indicated that Mrs. Knight's blood pressure had decreased to 142/76, and that she did not appear to be in distress. Dr. Cone noted that the diagnosis was chest pain and that there was a need to rule out ischemic heart disease. Dr. Cone did not consider a differential diagnosis of aortic dissection. He ordered that Mrs. Knight undergo a stress test, which was scheduled for the next morning.

Mrs. Knight continued to receive morphine for pain and a nitroglycerine drip. She complained that she was feeling weak and had a headache. She was given aspirin and Darvocet to relieve the headache. At approximately 11:00 p.m. on February 18th, the second day of Mrs. Knight's hospital stay, another EKG was performed and a different attending physician diagnosed an acute inferior wall myocardial infarction. Mrs. Knight was immediately transferred to TMC's intensive care unit, and a cardiologist at St. Francis Hospital was consulted. TMC did not have the capability of rendering non-medical treatment or performing heart surgery, and therefore, Mrs. Knight was transferred to St. Francis Hospital for a catheterization at approximately 1:00 a.m. on February 19, 2001.

The catheterization performed on February 19th revealed that Mrs. Knight had an aortic dissection, a tear in the ascending aorta above her heart, which required emergency surgery. She was immediately transferred to Emory Hospital for the emergency surgery at approximately 3:45 a.m. on February 19th. Mrs. Knight arrived at Emory Hospital on February 19th at approximately 6:00 a.m. and was in the operating room at 7:00 a.m. Dr. Robert A. Guyton, the cardiothoracic surgeon, testified that upon opening Mrs. Knight's chest for the surgery, he observed a large hemorrhage and a hematoma, amounting to excessive bleeding into the tissue around her right coronary artery and in the right ventricle. Dr. Guyton opined that the surgery would have been difficult since she had been given blood thinners at TMC, which increased the risk of bleeding and the risk of mortality. Based upon his observations, the surgeons determined that if they operated on Mrs. Knight, she had less than a 1% chance of surviving the surgery. As such, the surgeons decided not to proceed with the operation.

Thereafter, Mrs. Knight experienced a progressive deterioration of multiple organ systems since the heart was not able to pump enough blood to keep the rest of the body functioning. Mrs. Knight passed away less than a week later on February 27, 2001.

Case No. A12A0740

1. Knight contends that the trial court erred in granting summary judgment in favor of Dr. Roberts on the basis of causation. He argues that evidence shows that Dr. Roberts's negligent misdiagnosis delayed Mrs. Knight's treatment, which precluded immediate surgical intervention and repair and caused her death.

To recover in a medical malpractice case, a plaintiff must show not only a violation of the applicable medical standard of care but also that the purported violation or deviation from the proper standard of care is the proximate cause of the injury sustained. In other words, a plaintiff must prove that the defendants' negligence was both the cause in fact and the proximate cause of his injury.

(Citations omitted.) Walker v. Giles, 276 Ga.App. 632, 638, 624 S.E.2d 191 (2005). See also Zwiren v. Thompson, 276 Ga. 498, 499, 578 S.E.2d 862 (2003) (three essential elements to establish liability in a medical malpractice action under OCGA § 51–1–27 are “(1) the duty inherent in the doctor-patient relationship; (2) the breach of that duty by...