Mekoya v. Clancy

Citation861 S.E.2d 409,360 Ga.App. 452
Decision Date01 July 2021
Docket NumberA21A0076, A21A0077
CourtGeorgia Court of Appeals
Parties MEKOYA v. CLANCY et al. University Health Services, Inc. v. Clancy et al.

Sandra E. Vinueza Foster, Savannah, James Vance Painter, Augusta, Travis Dale Windsor, Savannah, for Appellant in A21A0076.

Connor & Connor, Christopher Caleb Connor, Augusta, Kenneth Luke Connor, Anne Katharine Moore, Augusta, for Appellee.

Kilpatrick Townsend & Stockton, Joseph Hixon Huff, Laurel Payne Landon, Augusta, for Appellant in A21A0077.

Barnes, Presiding Judge.

After Christopher Shawn Clancy suffered a pericardial effusion

resulting from a microperforation caused by a pacemaker lead, Clancy and his wife, Linda G. Clancy ("appellees") filed the instant action against Dr. Abiy Mekoya and University Health Services ("UHS"). The appellees essentially alleged that the professional negligence of Dr. Mekoya and certain other medical staff in failing to timely diagnose and treat the microperforation resulted in pain and suffering to Clancy, emergency surgical intervention, and other complications. The trial court denied Dr. Mekoya and UHS's motions for summary judgment, and this Court granted interlocutory review from the denials of their motions, resulting in these appeals.

In Case No. A21A0076, Dr. Mekoya challenges the trial court's exercise of its discretion in the denial of his motion to exclude the standard-of-care opinion of the appellees’ expert, and also its denial of his motion for summary judgment based on his assertion that the appellees failed to offer expert testimony, to a reasonable degree of medical probability, that Dr. Mekoya's alleged delay in diagnosing pericardial effusion

proximately caused any harm. In Case No. A21A0077, UHS also challenges the denial of its motion for summary judgment, contending that there remain no genuine issues of material fact regarding the negligence theories, proximate causation, and the reliability of the expert's testimony. UHS also contends as error the trial court's reliance on certain inadmissible evidence. For the reasons set forth below, we affirm the trial court's judgment in both appeals.

"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 ... warrant judgment as a matter of law." Anthony v. Chambless , 231 Ga. App. 657, 658 (1), 500 S.E.2d 402 (1998). An appellate court's "review of the grant or denial of summary judgment is de novo, and we view the evidence, and all reasonable conclusions and inferences drawn from it, in the light most favorable to the nonmovant." Abdel-Samed v. Dailey , 294 Ga. 758, 760 (1), 755 S.E.2d 805 (2014). Consequently, we construe the evidence in both of these cases in the light most favorable toward the plaintiffs.

So viewed, the facts demonstrate that on July 26, 2015, Clancy visited the emergency department of UHS and was admitted with a diagnosis of sick sinus syndrome

. Dr. Peter Bigham, a cardiologist, implanted a pacemaker in Clancy's chest on July 28, and he was discharged on July 29, 2015.1 On August 3, 2015, Clancy visited Dr. Bigham's office complaining about chest discomfort and pain, and was advised to go to UHS's emergency department, which he did. Clancy was evaluated by a nonparty emergency room physician and referred to a hospitalist, Dr. Heera Motwani,2 who, based on images from a CT and blood work, admitted Clancy with a diagnosis of a pulmonary embolism

("PE"), a blood clot in the lungs. The recent pacemaker placement was noted, and because of the PE diagnosis, Clancy was treated with anticoagulants, also known as blood thinners, which prevent further clot formation. According to Dr. Motwani, there were no symptomatic indications of a pericardial effusion (fluid accumulation in pericardial space resulting from pericarditis ) or cardiac tamponade (when the fluid in pericardial space compresses the heart) at that time, so he did not consider either in his differential diagnosis. Dr. Motwani testified that other than the nature of the pain Clancy was experiencing, "there was no other suggestion of pericarditis [, inflamation of the pericardium membrane surrounding the heart,] based on the laboratory finding and the exam." He also testified that he also ruled out any complications associated with Clancy's recent pacemaker placement.

Dr. Mekoya, also a hospitalist,3 whose shift was from 7:00 a.m. until 7:00 p.m., first assessed Clancy the next day, on August 4. His initial notes on Clancy's progress were entered at 1:55 p.m., but Dr. Mekoya testified that it was likely not the first time he would have seen Clancy that day; it would have been "earlier than this time." Dr. Mekoya examined Clancy, noted his history, his continued pleuritic chest pain ("pain that gets worse during breathing, coughing, or chest movement"), and his PE diagnosis, and he continued the anticoagulant treatment with blood thinners. He also noted on Clancy's chart that he had discussed his treatment plan with Clancy's wife and daughter.

That same evening of August 4, at approximately 7:00, Dr. Bigham visited Clancy and noted that he was being treated for a PE, and was receiving blood thinners and pain medication. After speaking with Clancy and his wife, he examined Clancy and, according to Dr. Bigham, "it seem[ed] like [the doctors] were on the right track with their medications, [and] their diagnosis." Dr. Bigham, however noted on Clancy's chart:

While not formally consulted, I am struck by the degree of discomfort compared to the reported findings. There is also ... a report of a low heart rate in the ER. May consider pacemaker evaluation by Boston Scientific for pacemaker function. May consider repeat echo for pericarditis

/pericardial effusion, although no rub.

He testified, however, that despite the suggestion in his note, had he believed that Clancy was suffering from pericarditis

or a pericardial effusion, he would have informed Dr. Mekoya or the on-call hospitalist.

Dr. Mekoya next saw Clancy on August 5 at 10:52 a.m., and noted no significant changes in Clancy's symptoms. Clancy was still experiencing pleuritic chest pain and nausea, but Dr. Mekoya charted that the pain was better. Dr. Mekoya testified that he read Dr. Bigham's note, but assumed that Dr. Bigham's note referred to a "plan in the future ... if things change."

That evening, at approximately 6:30, Clancy experienced low blood pressure, and a registered nurse, Jennifer Brooks Edwards, paged Mekoya twice "to advise of lowering BP." When she received no response, she advised the charge nurse, and "continued to monitor" Clancy's blood pressure. That night, Clancy was prescribed intravenous fluids to address his low blood pressure by the on-duty hospitalist. The next morning, August 6, Edwards was concerned that Clancy's blood pressure remained low, and that he also had a low pulse rate, which, according to Edwards, was unusual for someone with a pacemaker.

Dr. Mekoya ordered an evaluation of Clancy's pacemaker, an EKG, which was abnormal, and a consult with a nonparty cardiologist, Dr. Kellie Lane. Based on her review of Clancy's chart and his symptoms, Dr. Lane suspected that he was suffering from pericarditis

and an associated cardiac tamponade. Ensuing tests revealed that a pacemaker lead tip had caused a microperforation of the pericardium with resultant pericarditis, and pericardial effusion, which, in turn, had been enhanced by the prescribed anticoagulants.4 Dr. Lane told the family that the pericarditis was misinterpreted as a PE. Clancy received further treatment – including the surgical interventions of a pericardiocentesis

(insertion of needle in pericardial space to remove fluid) and pericardial window (removal of part of the pericardium) – to address these issues. Clancy was discharged on August 12, 2015, but continued to experience further complications from his hospital stay.

The appellees brought the underlying action for medical malpractice and loss of consortium, alleging, in relevant part, that UHS's nursing staff and Dr. Mekoya deviated from the standard of care in multiple ways, which resulted in a failure to timely or accurately diagnose his medical condition. The appellees essentially claimed that Clancy was misdiagnosed with a PE, when instead he had pericarditis

that was caused by a pacemaker lead microperforation into the pericardium, which resulted in surgical and emergent interventions and continuing complications.

The appellees sought damages for injuries alleged to have been sustained from the procedures, and the associated complications, including temporary renal failure

, the additional medical/surgical procedures, a longer and more complicated hospital stay, and the resulting pain, and physical limitations.

Attached to the complaint was the affidavit of Dr. Lisa A. Gillespie, an internal medicine physician and hospitalist. Dr. Gillespie averred that the minimum standard of care for a hospitalist "in like and similar circumstances" as Clancy's required an evaluation and work-up consistent with symptoms, an appropriate medical and surgical history, radiologic studies, and consultations with specialists. She detailed the various instances in which Dr. Mekoya and UHS deviated from the standard of care, including failing to recognize that Clancy's symptoms were inconsistent with a PE but were more closely associated with complications from his pacemaker, failing to recognize that the chest CT

was suggestive of chronic emboli, failing to order the proper radiologic tests, failing to order certain coronary tests, failing to obtain a pulmonary or cardiac consult, and failing to act upon Dr. Bigham's progress report which indicated inconsistencies in his diagnosis and symptoms and requested further cardiac evaluation.

Dr. Gillespie opined that

the acts and omissions of the part of University Hospital ... and [Dr. Mekoya] ... resulted in harm to Mr.

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