Ruffino v. Archer
| Decision Date | 25 July 2018 |
| Docket Number | NO. 3:17-cv-00725,3:17-cv-00725 |
| Parties | JOHN RUFFINO, et al., Plaintiffs, v. DR. CLARK ARCHER, et al. Defendants. |
| Court | U.S. District Court — Middle District of Tennessee |
MEMORANDUM
Pending before the Court is a Motion for Summary Judgment filed by Defendant HCA Health Services of Tennessee, Inc. ("HCA"). (Doc. No. 38). For the reasons stated herein, HCA's Motion for Summary Judgment is denied.
In this health care liability action, Plaintiffs allege that Defendant HCA d/b/a StoneCrest Medical Center, through its employees and agents, was negligent in its care and treatment of John Ruffino on February 17, 2016. Plaintiffs contend that the ways HCA's employees and agents failed to comply with the acceptable standard of care include:
(1) not providing proper care and treatment to Mr. Ruffino during his ER presentation;
(2) not effectively communicating with a physician that Mr. Ruffino was neurologically normal from 0949 to 1200;
(3) not timely acting to lead to the ordering of a neurology consult for Mr. Ruffino;
(4) not timely acting to lead to the ordering of an MRI of the brain for Mr. Ruffino;
(5) not timely acting to lead to the administration of tPA for Mr. Ruffino; (6) not timely acting to lead to the ordering of a thrombectomy to be performed on Mr. Ruffino;
(7) not following StoneCrest's written policies and procedures as applied to the work-up, diagnosis and treatment of ER patients with a suspected stroke;
(8) not timely diagnosing Mr. Ruffino with a thrombotic stroke; and
(9) not timely arranging for treatment of Mr. Ruffino's thrombotic stroke.
(Doc. No. 61). Plaintiffs also contend that HCA is vicariously liable for the alleged negligence of Defendant Archer.
HCA seeks summary judgment by arguing the undisputed facts establish that it complied with accepted standards of care and did not cause any injury to Mr. Ruffino that would not otherwise have occurred. (Doc. No. 38).
Summary judgment is appropriate where there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c); Pennington v. State Farm Mut. Automobile Ins. Co., 553 F.3d 447, 450 (6th Cir. 2009). The party bringing the summary judgment motion has the initial burden of informing the Court of the basis for its motion and identifying portions of the record that demonstrate the absence of a genuine dispute over material facts. Rodgers v. Banks, 344 F.3d 587, 595 (6th Cir. 2003). The moving party may satisfy this burden by presenting affirmative evidence that negates an element of the non-moving party's claim or by demonstrating an absence of evidence to support the nonmoving party's case. Id.
In deciding a motion for summary judgment, the Court must review all the evidence, facts and inferences in the light most favorable to the nonmoving party. Van Gorder v. Grand Trunk Western Railroad, Inc., 509 F.3d 265, 268 (6th Cir. 2007). The Court does not, however, weigh theevidence, judge the credibility of witnesses, or determine the truth of the matter. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). The Court determines whether sufficient evidence has been presented to make the issue of fact a proper jury question. Id. The mere existence of a scintilla of evidence in support of the nonmoving party's position will be insufficient to survive summary judgment; rather, there must be evidence on which the jury could reasonably find for the nonmoving party. Rodgers, 344 F.3d at 595.
Tennessee law provides that a "health care liability action" includes any civil action alleging that a health care provider or providers have caused an injury related to the provision of, or failure to provide, health care services to a person, regardless of the theory of liability on which the action is based. Tenn. Code Ann. § 29-26-101(a)(1). In such an action, the claimant has the burden of proving:
(1) the recognized standard of acceptable professional practice in the profession and the specialty thereof, if any, that the defendant practices in the community in which the defendant practices or in a similar community at the time the alleged injury or wrongful action occurred;
(2) that the defendant acted with less than, or failed to act with, ordinary and reasonable care in accordance with such standard; and
(3) as a proximate result of the defendant's negligent act or omission, the plaintiff suffered injuries which would not otherwise have occurred.
Tenn. Code Ann. § 29-26-115(a).
Each of the elements of a health care liability action must be established by expert testimony. Mitchell v. Jackson Clinic, P.A., 420 S.W.3d 1, 6 (Tenn. Ct. App. 2013). In addition, the expert witness must (1) be licensed to practice in Tennessee or one of its eight contiguous bordering states; (2) practice a procession or specialty which would make his or her expert testimony relevant to theissues in the case; and (3) have practiced this profession or specialty in one of these states during the year preceding the date of the alleged injury or wrongful act. Id. (citing Tenn. Code Ann. § 29-26-115(b)).
HCA has moved to strike the affidavits of Plaintiff's experts, Dr. Callahan and Dr. Pope, and the Court is denying that motion by contemporaneous Order.
In this case, there are material issues of fact that underlie the competing experts' testimony. For example, HCA asserts (and Plaintiffs agree) that Mr. Ruffino was transported to StoneCrest with a complaint of dizziness. (Doc. No. 47, ¶ 12). HCA contends that Mr. Ruffino's reported symptoms upon arrival to the ER were dizziness and/or seizures, neither of which is an indication of a stroke. (Id., ¶ 26; Doc. No. 39 at 8-9). HCA also contends, however, that Mr. Ruffino later reported to his physician at Centennial Medical Center (see Doc. No. 41-1, Ex. B), that he had awakened with right facial weakness, facial droop, slurred speech and expressive aphasia first thing on the morning of February 17, 2016. (Doc. No. 47, ¶ 13). Mr. Ruffino disputes this statement, and the StoneCrest nurses disagree with this statement. (Id.);1 HCA's experts, based upon this information from Centennial Medical Center, conclude that Mr. Ruffino's last known time of normal was when he went to bed on the night of February 16, 2016. (Doc. No. 47, ¶ 24). The parties agree that a patient who wakes up with a neurological deficit is considered "last normal" at the time he went to sleep. (Doc. No. 47, ¶ 23). The parties disagree about when Mr. Ruffino was last neurologically normal onFebruary 17, 2016. (Id., ¶ 24). Because there are questions of fact about Mr. Ruffino's medical condition when he arrived at the ER, there are disagreements as to the proper standard of care required for his treatment and care.
Plaintiffs assert that Mr. Ruffino was "neurologically normal" between 9:49 a.m., and 12 noon on February 17, 2016. They base this factual assertion on medical records from StoneCrest and deposition testimony from two nurses involved with Mr. Ruffino's care in the StoneCrest ER. (Doc. No. 46-1 at ¶ 10; Doc. No. 46-2 at ¶ 15). The nurse who did the initial ER assessment of Mr. Ruffino, Carol McCullough, testified that she observed no neurological deficits during her initial assessment of Mr. Ruffino. (Doc. No. 46-4 at 7-9 (dep., pp. 22-23 and 28-29)). Moreover, there are no neurological deficits documented in her medical record for Mr. Ruffino. (Id.) McCullough testified that Mr. Ruffino reported having dizziness while he was driving, but he did not complain of dizziness in the ER. (Id. at 6 (dep., pp. 17-19)). She reported that Mr. Ruffino was relatively normal at the time of her assessment at about 9:56 a.m. and she did not think he was having a stroke. (Id. at 8 (dep., pp. 25-28)).
Similarly, Nurse Robert Bromley, who began caring for Mr. Ruffino in the ER at 10 a.m., testified that all Ruffino's neurological signs or symptoms were normal at 10 a.m. (Doc. No. 46-5 at 4 (dep., pp. 55-56)); at 10:08 a.m. (Id. at 5 (dep., p. 58)); at 10:15 a.m. (Id. at 11 (dep., p. 92)); at 10:30 a.m. (Id.); at 10:45 a.m. (Id. at 12 (dep., p. 94)); at 11 a.m. (Id. (dep, p. 95)); and at noon. (Id.) Plaintiffs assert that Mr. Ruffino had new stroke symptoms at 12:20, when he was first seen by Dr. Archer. The parties disagree about whether Dr. Archer knew that Mr. Ruffino was neurologically normal from 10 a.m. until noon. Nurse Bromley testified that he let Dr. Archer know that, per his neuro checks, Ruffino had been neurologically normal from 10 a.m. until noon. (Doc. No. 48-1 at5 (dep., p. 123)). Dr. Archer testified that he does not remember any exact discussions with Bromley from that day. (Doc. No. 84-1 at 10-11 (dep., pp. 68-69)).
The experts also disagree about whether administration of tPA and a thrombectomy were appropriate treatments for Mr. Ruffino. And which expert one believes depends, in large part, on which version of the facts one accepts as true. The experts are relying upon different facts to assert their opinions, and the testimony of the nurses and some of the records at StoneCrest conflict with the records at Centennial. The Court cannot make these factual determinations on the current motion.2
HCA argues there is no genuine issue of material fact as to whether it could have done anything that would have changed the outcome for Mr. Ruffino. The medical experts disagree as to the consequences of what Defendants did and/or did not do. HCA's experts opined that no action or inaction by any healthcare provider at StoneCrest was the cause of any injury to Plaintiffs that would not otherwise have occurred. (Doc. No. 40, ¶ 36). Plaintiffs' experts, on the other hand, opined that had HCA and/or Dr. Archer provided appropriate treatment (tPA and transfer to a comprehensive stroke center) within at least six hours of the stroke symptoms at 12:20, Mr. Ruffino would have had a better outcome from...
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