Sumrall v. Singing River Health Sys.
| Decision Date | 14 April 2020 |
| Docket Number | NO. 2018-CA-01260-COA,2018-CA-01260-COA |
| Citation | 303 So.3d 798 |
| Parties | ESTATE OF Roy SUMRALL and Estate of Della Sumrall, Appellants v. SINGING RIVER HEALTH SYSTEM, Appellee |
| Court | Mississippi Court of Appeals |
ATTORNEY FOR APPELLANTS: ROBERT W. SMITH, Biloxi
ATTORNEYS FOR APPELLEE: BRETT K. WILLIAMS, JAMES EVERETT LAMBERT III
BEFORE BARNES, C.J., GREENLEE AND McDONALD, JJ.
GREENLEE, J., FOR THE COURT:
¶1. Roy and Della Sumrall (the Sumralls) filed a medical-malpractice claim against Singing River Health System (Singing River) under the Mississippi Tort Claims Act (MTCA), Mississippi Code Annotated sections 11-46-1 to -23 (Rev. 2002), for injuries sustained to Della after the removal of a central venous catheter. After a bench trial, the circuit court entered judgment in favor of Singing River. The Sumralls appealed from that judgment to this Court, citing five errors. This Court reversed and remanded the case ( Sumrall I ), finding the circuit court abused its discretion by allowing Singing River's expert witness to testify outside the scope of his designation.1 After a second bench trial, the circuit court again entered judgment in favor of Singing River. It is from that order the Sumralls2 now appeal. Finding no error, we affirm the circuit court's judgment.
FACTS AND PROCEDURAL BACKGROUND
¶2. On February 23, 2012, sixty-eight-year-old Della Sumrall was admitted to Ocean Springs Hospital (OSH), a facility owned and operated by Singing River, with severe inflammation of the gallbladder3 and a pancreatic pseudocyst. In addition, Della suffered from a litany of other co-morbidities, including diabetes, a renal artery stent, coronary artery bypass grafting, coronary artery disease, a partially collapsed lung, chronic obstructive pulmonary disease (COPD), and more. The record also shows that Della smoked heavily prior to 2012. Although Della was considered a high risk for surgery, Dr. Edward Dvorak, her attending physician, recommended removal of Della's gallbladder and ordered a central line be placed in her external jugular vein because of the expectation of a prolonged recovery course.4 The surgery was successful.
¶3. Nurse Chequita Steele, a registered nurse employed at OSH at the time of the proceedings, was tasked with caring for Della from or around the time of her surgery to the date of her discharge. Nurse Steele testified that Della had complained about not being able to breathe while lying flat on her back and that she preferred to sit up.
¶4. On February 29, 2012, Dr. Dvorak ordered that Della be discharged to the Comprehensive Rehabilitation Center (CRC) in Pascagoula.5 At the time, Della suffered from a partially collapsed lung,6 pneumonia, and chronic COPD, and she required oxygen. At or around 12:00 p.m., Nurse Steele reclined Della's chair at an angle less than ninety degrees. According to Nurse Steele's trial testimony, Della had been reclined Thereafter, Nurse Steele informed Della about the need to remove the central line and the removal process. At or around 4:10 p.m., Nurse Steele began the removal process. The record shows that Nurse Steele removed the dressing that covered the central line's insertion site, cut the sutures, applied pressure to the site using gauze, instructed Della to take a breath and bear down, and then removed the line. Nurse Steele testified that she held pressure over the removal sight for approximately one minute. After one minute had elapsed, Della started gasping for breath and became unresponsive.
¶5. Della was given emergency treatment in her room. Shortly after, Della was transported to the intensive-care unit (ICU) where she was observed in respiratory arrest. The respiratory arrest resulted in anoxic brain injury and with a degree of permanent impairment. Due to her condition, a second central line was inserted while she was in the ICU. Della's condition improved over nineteen days, so she was ordered to be discharged from the ICU to the nursing center. For discharge, her central line had to be removed. On March 19, 2017, the discharge nurse placed Della in the Trendelenburg position,7 followed protocol, and removed the central line without complication. Della ultimately departed OSH on March 29, 2012.
¶6. On May 18, 2012, the Sumralls filed a medical-malpractice suit against Singing River. The complaint alleged that Nurse Steele was "substandard and negligent" in removing the first central line, which caused an air embolus, respiratory arrest, and anoxic brain damage. The complaint also alleged that Singing River was vicariously liable for Nurse Steele's actions.
¶7. After a bench trial, this Court held in Sumrall I that the circuit court abused its discretion by allowing Dr. Corder to testify "inconsistent with, outside of, and beyond his designation." Sumrall I , 189 So. 3d at 669 (¶29). According to this Court, the circuit court's ruling that there was no applicable standard of care with regard to patient positioning during the removal of a central line was against the "overwhelming weight of the evidence." Id. at 670 (¶30). In addition, this Court held that Dr. Corder testified outside the scope of his designation by stating that Della suffered from a stroke. Id. at 669 (¶28). Because of those errors, this Court reversed and remanded the case further proceedings.8 Id. at 670 (¶32).
¶8. A second bench trial occurred on May 1, 2017, in the Jackson County Circuit Court.9 The parties submitted the first trial's transcript into the record and re-introduced all of the exhibits. The parties also agreed to redact Dr. Corder's testimony from the record to comply with the findings of this Court in Sumrall I . Dr. Corder was called to re-testify.10 The following trial testimony, from Sumrall I and Sumrall II , is now before this Court:
A. The Sumralls’ Case-in-Chief
¶9. The Sumralls presented two expert witnesses at the Sumrall I trial. Dr. Lidgia Vives was tendered as an expert in the field of vascular neurology. Nurse Crystal Keller was tendered as an expert in the field of nursing. Both experts were offered to present evidence about the standard of care during central line removal. The experts testified that under the generally accepted standard of care for central line removal, the nurse should (1) educate the patient about the procedure; (2) place the patient in the Trendelenburg position; (3) instruct the patient to hold his or her breath and bear down (the "Valsalva" maneuver11 ); (4) place pressure on removal site with gauze; and (5) remove the catheter and continue to hold pressure for approximately five minutes. According to Dr. Vives, Nurse Steele breached the standard of care by not putting Della into the Trendelenburg or supine position while removing the central line. Dr. Vives further concluded that Della suffered from an air embolism as a result of the removal. According to Nurse Keller, Nurse Steele deviated from the standard of care because she failed to "adequately assess" whether Della could tolerate the Trendelenburg position, "adequately position" Della, and "adequately educate" Della on the procedure. Both experts testified on cross-examination that if a hypothetical patient were unable to tolerate the Trendelenburg position (i.e., difficulty breathing in that position or intracranial pressure), then a position other than Trendelenburg (i.e., a position the patient could tolerate) would be acceptable during the removal of a central line. They also testified that there were indications that showed Della could tolerate the Trendelenburg position on February 29, 2012. This was based in part on the fact that Nurse Jenna Blaine was subsequently able to place Della in the Trendelenburg position on March 19, 2012.
¶10. Nurse Blaine also testified at the first trial. Nurse Blaine was a registered nurse who was assigned to Della after the removal of the first central line. She testified that she removed a second central line from Della's left subclavian vein on March 19, 2012. When asked about patient positioning, Nurse Blaine testified that she placed Della in the Trendelenburg position. According to Nurse Blaine, Della was able to tolerate the Trendelenburg position on that day. She further testified that if Della could not have tolerated that position, she would have placed Della in a supine position or "raised the head of the bed ... until [Della] could [have] tolerate[d] it."
¶11. Della's daughters, Nina Musgrove and Tina Danley, also testified. Both daughters testified as to their mother's physical well-being prior to and after the February 29 incident. Specifically, Musgrove testified that she was in the hospital room at the time Nurse Steele removed the central line. According to Musgrove, her mother was sitting "straight up" at the time the catheter was removed.
¶12. The Sumralls’ final witness at the first trial was Roy Sumrall. Roy testified about his relationship with Della and her health following the incident. In addition, Roy testified about a subsequent hospital trip that he and Della took in July 2012. During that visit, Della had another central line inserted. The next month, Della was ordered to be discharged. Roy testified that a doctor removed the central line while Della was in the Trendelenburg position.12
¶13. The Sumralls also introduced the sworn depositions of Dr. John Weldon, a hospitalist and full-time employee of Singing River; Dr. Frank Martin, the Medical Director of the Ocean Springs Nursing Center;13 and Nurse Steele.
B. The Defense's Case-in-Chief
¶14. Singing River called Nurse Steele as its first witness at the Sumrall I trial. Nurse Steele testified about her recollection of the events that occurred on February 29, 2012. According to Nurse Steele, she informed Della about removing her central line. She then positioned Della somewhere between thirty and forty-five degrees, applied pressure to the...
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