Ruiz v. Tenet Hialeah Healthsystem, Inc.
| Decision Date | 09 August 2017 |
| Docket Number | No. 3D15-2474.,3D15-2474. |
| Citation | 224 So.3d 828 |
| Parties | Rolando P. RUIZ, etc., Appellant, v. TENET HIALEAH HEALTHSYSTEM, INC., et al., Appellees. |
| Court | Florida District Court of Appeals |
Philip D. Parrish ; The Gutierrez Firm, and Jorge P. Gutierrez, Jr., for appellant.
Chimpoulis, Hunter & Lynn, P.A., and Jonathon P. Lynn (Plantation); Hicks, Porter, Ebenfeld & Stein, P.A., Dinah Stein and Erik P. Bartenhagen, for appellees.
Before SUAREZ, EMAS, and FERNANDEZ, JJ.
Rolando P. Ruiz, etc., appeals from a final judgment entered in favor of appellees Tenet Hialeah Healthsystem, Inc. and Arturo Lorenzo, M.D., and the denial of his motion for reconsideration of the trial court's directed verdict in this medical malpractice action, or in the alternative, for a new trial. We affirm the trial court's entry of directed verdict in favor of Dr. Lorenzo because there is no competent, substantial evidence that Dr. Lorenzo caused the tragic death of Ruiz's wife.
Ruiz, the personal representative of the Estate of Maria Elena Espinosa, sued to recover damages for the death of his wife Espinosa who died of exsanguination during a surgical procedure to remove a cancerous tumor from her skull. Dr. Lorenzo is the anesthesiologist who conducted Espinosa's pre-anesthesia evaluation.1
Dr. Lorenzo declared in his sworn answer to an interrogatory that "[a]ll [he] did was [Espinosa's] anesthesia preparation evaluation." Dr. Lorenzo testified at trial that he saw Espinosa for three to five minutes after which Dr. Velazquez completed the evaluation. Dr. Lorenzo check marked a series of boxes on the pre-anesthesia evaluation. He signed the evaluation under the line marked "Physician" and wrote the date and time. He told Dr. Velazquez that Dr. Lorenzo saw the EKG, which was blurry but readable. The EKG reflected an abnormality. He told Dr. Velasquez that the EKG was blurry. Dr. Lorenzo neither advised Dr. Yates or Dr. Albanes that the EKG was blurry nor advised that it reflected an abnormality. Dr. Lorenzo testified that the abnormal EKG did not mean anything in light of the number of abnormal EKGs he saw on an average week. The history and physical well-being of the patient must be considered and Espinosa was one of the healthiest patients he had ever seen.
Dr. Lorenzo further testified that he never saw the protein level in Espinosa's urine. He reviewed only the first page of lab results. The remaining two pages of lab results included the results of Espinosa's urinalysis, which reflected an abnormal amount of protein in her urine. Dr. Lorenzo testified that, had he seen the protein level, he would have told Dr. Yates that he needed to "find out" why Espinosa was "spilling protein." Dr. Lorenzo testified that the protein level would not have affected his anesthetic.
Dr. Velazquez testified that he did a full evaluation on Espinosa from beginning to end after Dr. Lorenzo's evaluation. Dr. Velazquez completed and signed the anesthesia evaluation. He evaluated the EKG and all three pages of Espinosa's lab results. He also made the determination that Espinosa could safely undergo general anesthesia.
Numerous other witnesses testified at trial. Dr. Yates and Dr. Albanes testified. Ruiz introduced the expert testimony of anesthesiologist Dr. William Mazzei, neurosurgeon Dr. Michael Joseph Chaparro, and Dr. Carlos Moreau, anesthesiologist and Medical Director at the hospital where Espinosa died. None of the expert witnesses testified that Dr. Lorenzo's evaluation of Espinosa fell below the standard of care such that any breach more likely than not caused Espinosa's death.
The trial court granted Dr. Lorenzo's motion for directed verdict, finding that there was no proof of causation. We agree with this conclusion.
A de novo standard of review governs the review on appeal of a trial court's decision to grant a directed verdict. Hancock v. Schorr, 941 So.2d 409, 412 (Fla. 4th DCA 2006). The plaintiff in a medical malpractice case must establish (1) the standard of care the defendant owes; (2) the defendant's breach of the standard of care; (3) and that said breach proximately caused the damages claimed. Chaskes v. Gutierrez, 116 So.3d 479, 485 (Fla. 3d DCA 2013). See also Hancock, 941 So.2d at 412. "Florida courts follow the more likely than not standard of causation and require proof that the negligence probably caused the plaintiff's injury." Chaskes, 116 So.3d at 487 ; Hancock, 941 So.2d at 412.
While all evidence must be viewed in a light most favorable to the nonmoving party, the court can only rely on reasonable conclusions drawn from competent, substantial evidence upon which a jury could rationally rely in finding for the non-movant. Hancock, 941 So.2d at 409. A review of the record in the light most favorable to Ruiz supports the trial court's conclusion on the issue of causation. There is no competent, substantial evidence at trial from which a jury could reasonably conclude that Dr. Lorenzo's behavior fell below the standard of care, or that any breach of the standard of care more likely than not caused Espinosa's death. It is undisputed that Dr. Lorenzo conducted a brief anesthesia evaluation on Espinosa and that he signed the anesthesia evaluation. The evidence is unequivocal that Dr. Velasquez completed the full anesthesia evaluation from beginning to end.
In addition, the record is devoid of competent, substantial evidence upon which to conclude that the blurry EKG or the abnormal protein level results caused Espinosa's death. The record reflects that no cardiac issues precluded Espinosa from undergoing safe anesthesia. Espinosa's autopsy revealed no evidence of coronary artery disease. The record is abundantly clear that the primary cause of Espinosa's death was exsanguination.
The trial court thus correctly granted Dr. Lorenzo's motion for directed verdict. We therefore affirm.
Affirmed.
The question presented is whether the trial court erred in directing a verdict upon its determination that there was insufficient evidence for a jury to find that Dr. Lorenzo's negligence was a legal cause of Mrs. Espinosa's death. Viewing the evidence and all reasonable inferences in a light most favorable to Rolando Ruiz, personal representative of Mrs. Espinosa's estate, I conclude there was sufficient evidence upon which the jury could have found that the negligence of Dr. Lorenzo was a legal cause of the death of Mrs. Espinosa. In my view, therefore, the trial court erred in granting a directed verdict in favor of Dr. Lorenzo at the close of Ruiz's case, and I respectfully dissent.
Established by Florida decisions so numerous as to preclude a need for their citation, are the rules that a trial court should not direct a verdict for defendant unless it is clear that there is no evidence whatever adduced that could in law support [ ] a verdict for plaintiff; and that an appellate court, on review of a judgment based on a directed verdict for defendant should consider the testimony adduced in the cause in the light most favorable to the plaintiff, disregarding conflicts in the evidence and indulging in the plaintiff's favor every reasonable intendment deducible from the evidence.
Hurst v. Krinzman, 237 So.2d 333, 334 (Fla. 3d DCA 1970). See also Coba v. Tricam Indus., Inc., 164 So.3d 637, 646 (Fla. 2015) () (citations omitted); Riedel v. Sheraton Bal Harbour Assoc., 806 So.2d 530 (Fla. 3d DCA 2001). This standard applies equally to this court's review. Posner v. Walker, 930 So.2d 659 (Fla. 3d DCA 2006).
More importantly, and pertinent to the issue in this appeal, "a directed verdict ‘is not appropriate in cases where there is conflicting evidence as to the causation or the likelihood of causation.’ " Friedrich v. Fetterman & Assoc., P.A., 137 So.3d 362, 365 (Fla. 2013) (quoting Cox v. St. Joseph's Hosp., 71 So.3d 795, 801 (Fla. 2011) ).
The evidence at trial, viewed in a light most favorable to Ruiz, the nonmoving party, established:
Discovery of the Tumor
Sometime prior to May 2009, Mrs. Espinosa, a forty-five year old woman, developed a soft lump on the back of her head and she reported it to her primary care physician, Dr. Jorge Venereo. After obtaining a computerized tomography (CT) scan, Dr. Venereo referred Mrs. Espinosa to neurosurgeons Dr. Yates and Dr. Albanes. Dr. Yates reviewed the CT imaging and advised Mrs. Espinosa that she had a two and one-half inch non-aggressive tumor in her skull, and recommended that it be removed as soon as possible.
Dr. Yates referred Mrs. Espinosa to a radiologist for a magnetic resonance imaging (MRI) study of her brain. After obtaining the MRI, Dr. Yates met with Mrs. Espinosa and advised her that she needed to undergo surgery to remove the tumor.
On the scheduled surgery date, after having been cleared for surgery by her primary care physician, Mrs. Espinosa arrived at Hialeah Hospital between 5:00 a.m. and 6:00 a.m. for her pre-anesthesia evaluation. The main responsibility for clearing a patient for surgery lies with the primary care physician and the anesthesiologist, and the purpose of the pre-anesthesia evaluation is to document the patient's condition for surgery, assess the patient's overall health, and uncover any hidden conditions that may affect or render the patient a poor candidate for surgery. Dr. Yates (Mrs. Espinosa's surgeon) testified that if the anesthesiologist does not clear the patient for surgery, he (Dr. Yates) would not go forward with the surgery.
The pre-anesthesia evaluation consists of an examination and...
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