U.S. Anesthesia Partners v. Robinson
| Decision Date | 08 September 2022 |
| Docket Number | 01-21-00572-CV |
| Parties | US ANESTHESIA PARTNERS AND PAUL SIMS, JR., M.D., Appellants v. BRIAN BLAKE ROBINSON, INDIVIDUALLY AND ON BEHALF OF THEESTATE OF AUNDI GRIFFIN ROBINSON, GRIFFIN ROBINSON,JUSTIN ROBINSON, AND DUSTIN ROBINSON, Appellees |
| Court | Texas Court of Appeals |
US ANESTHESIA PARTNERS AND PAUL SIMS, JR., M.D., Appellants
v.
BRIAN BLAKE ROBINSON, INDIVIDUALLY AND ON BEHALF OF THEESTATE OF AUNDI GRIFFIN ROBINSON, GRIFFIN ROBINSON,JUSTIN ROBINSON, AND DUSTIN ROBINSON, Appellees
No. 01-21-00572-CV
Court of Appeals of Texas, First District
September 8, 2022
On Appeal from the 127th District Court Harris County, Texas Trial Court Case No. 2020-78191
Panel consists of Justices Kelly, Countiss, and Rivas-Molloy.
MEMORANDUM OPINION
Julie Countiss Justice
In this interlocutory appeal,[1] appellants, U.S. Anesthesia Partners and Paul Sims, Jr., M.D. (collectively, "appellants"), challenge the trial court's order denying
their amended motion to dismiss the health care liability claims[2] brought against them by appellees, Brian Blake Robinson, individually and on behalf of the Estate of Aundi Griffin Robinson, Griffin Robinson, Justin Robinson, and Dustin Robinson (collectively, "appellees"), in their suit for negligence, wrongful death, and survival. In three issues, appellants contend that the trial court erred in denying their amended motion to dismiss appellees' claims against them.[3]
We reverse and remand.
Background
In their petition, appellees allege that they are family members of Aundi Griffin Robinson ("Aundi"). Aundi was "a patient" of appellants and KPH-Consolidation, Inc., doing business as HCA Houston Healthcare Kingwood (the "hospital"), in October and November 2018. Aundi sustained unspecified "injuries . . . as a result of [the] medical treatment she received" while she was a patient. These unspecified injuries proximately caused her death.
Appellees bring health care liability claims against Dr. Sims, alleging that he was negligent.[4] Appellees also allege that U.S. Anesthesia Partners is vicariously
liable for the negligent "acts and omissions of [its unnamed] employees, physicians, nurses, staff, representatives[,] and agents." Appellees request damages.
To support their claims, appellees timely served appellants with an expert report authored by James Suliburk, M.D., F.A.C.S.[5] In his expert report, Dr. Suliburk states that he is a board-certified surgeon by the American Board of Surgery and "a fellow of the American College of Surgeons." He is "a tenured associate professor and full-time faculty [member at] Baylor College of Medicine." And he is "an instructor in Advanced Trauma Life Support for the American College of Surgery." He has nineteen years of experience "managing and evaluating complex surgical patients." He was previously an "attending faculty surgeon in acute care and trauma surgery at Ben Taub Hospital." Dr. Suliburk has an "extensive background in the delivery of quality surgical care and management of complex surgical patients." He also has "expertise and additional training in [the] development and implementation of safe surgical care pathways . . . [and] guideline development for optimal clinical care." He has "work[ed] with the administrative leadership [of a] hospital to implement best practice[s] to care for [the] patients," which has involved "performing multidisciplinary quality improvement
coordinating efforts by nurs[es], clinicians, respiratory therapists, dieticians, and administration." Dr. Suliburk states that he practices "general surgery" and has "knowledge about [the] treatment of patients with poorly healing diabetic foot wounds." And he sees, treats, and operates on patients with diabetic foot infections.
As to Aundi, in his report, Dr. Suliburk states that Aundi "suffered from multiple comorbidities[,] including [e]nd [s]tage [r]enal [d]isease, [d]iabetes, [h]ypertension, [d]iabetic [n]europathy[,] and [a]nemia." Aundi was admitted to the hospital "for acute management of a diabetic foot infection" in September 2018 and October 2018. During her hospital stay, she underwent treatment "for a non-healing infected diabetic foot." "This required multiple interventions surgically in addition to intravenous antibiotic therapy and wound care." Aundi also "continued with her dialysis as part of her routine medical care for her [e]nd [s]tage [r]enal [d]isease and management of her significant medical co[morbidities]."
On October 15, 2018, Aundi "underwent a non-eventful adjustment of her external fixator on her foot using general anesthesia." Debridement was not performed, and Aundi was discharged from the hospital. Aundi was readmitted to the hospital on October 24, 2018, with a worsening infection in the same diabetic foot. On October 27, 2018, she "was dialyzed per routine" and "5.7[] [liters] of fluid" were removed from her body. During the evening of October 28, 2018, Aundi had surgery for the "ongoing infection in her foot." Because surgery did not occur
until the evening, Aundi was "kept in a prolonged fasted state without nutrition and minimal fluid while awaiting surgery."
During the October 28, 2018 surgery, "an additional general anesthetic was planned" and "it was necessary to change from laryngeal mask airway . . . to endo-tracheal tube intubation." According to Dr. Suliburk, the "need for airway exchanges indicate[d] that there was a transient period where [Aundi's] airway was not securely controlled for optimal oxygenation and ventilation." Also, during surgery, "there was a significant variation in [Aundi's] blood pressure as a result of [the] general anesthetic administration."
After the October 28, 2018 surgery, Aundi was transferred "by the perioperative team[,] including clinicians and nurses," to the post-anesthesia care unit ("PACU"), "where her mental status was poorly responsive." "Her gas exchange[] and respiratory physiology w[ere] checked via arterial blood gas assessment[,] and she was discharged from the PACU by the anesthesia and nursing teams." Aundi was "obtund[e]nt upon arriving to the ward and within [thirty] minutes of arriving a critical code event was called due to [her] continuing to be non-responsive." Aundi was intubated and transferred to the intensive care unit ("ICU"). "Her mental status never recovered, and she was transferred to a long-term acute care hospital" on November 13, 2018 "with [a] tracheostomy for airway protection and [a] gastrostomy tube for enteral nutrition." Aundi "eventually died."
As to the standard of care and breach of the standard of care, Dr. Suliburk generally states, in his report, without reference to any particular defendant, that the standard of care for a patient with multiple medical comorbidities, including end stage renal disease, "who must undergo serial procedures on an extremity[,] is a regional block anesthetic." "[T]he entire care team[,] including surgeons, anesthesia, and nurs[es,] must be aware of [the] standard practice for these patients." "This technique eliminates the significant variation in blood pressure and oxygenation associated with [the] induction and administration of general anesthesia" and "provides improved levels of compassionate post-operative pain control while minimizing the need for dangerous narcotic medication." The "[r]epeated plans by the treatment team for general anesthesia administration to [Aundi] continued to expose unnecessary risk to [an] already high-risk patient." "It [was] below [the] standard of care to not have available regional anesthesia for a high-risk patient needing a relatively minor surgical procedure on [an] extremity."
Dr. Suliburk further explains that, during the October 28, 2018 surgery, Aundi "likely suffered a hypoxic insult to the brain triggered by a combination of low oxygen tension in the blood (as a result of a non-secure airway) along with inadequate blood pressure (as a result of anesthetic medications) to maintain optimal cerebral perfusion." If Aundi had "a local-regional block of the extremity neither her oxygenation nor blood pressure would have been affected and her brain function
would be intact." "[T]he care team as well as the hospital did not maintain [the] standard of care in allowing [Aundi] to have ongoing serial high-risk general anesthetics." In Dr. Suliburk's opinion, there was a "substandard anesthetic plan, substandard execution of the anesthetic plan[,] and poor evaluation of [the] overall care plan for [Aundi's] acute diabetic foot infection [that] resulted in irreversible hypoxic encephalopathy." And if "a loco-regional block had been performed[,] [Aundi] would not have sustained cerebral damage and would be alive today." The aforementioned breaches of the standard of care "were a direct and proximate cause of the damage, injuries[,] and ultimate death of" Aundi.
Appellants objected to Dr. Suliburk's expert report and moved to dismiss appellees' health care liability claims against them. Appellants asserted that Dr. Suliburk's expert report was inadequate as to the standard of care and breach of the standard of care as to appellants. According to appellants, when there is more than one defendant in a health care liability action, "the expert report must set forth the standard of care for each defendant" and "provide an explanation of how each defendant specifically breached the standard and how that breach caused or contributed to the cause of injury." Dr. Suliburk, in his expert report, "fail[ed] to set forth an applicable standard of care as to [appellants]" and did not identify "what [appellants] should have done differently." The expert report "fail[ed] to delineate which of . . . [appellants'] actions or inactions constituted a breach of their duties of
care" to Aundi. Dr. Suliburk, in his report, also "fail[ed] to establish a causal nexus between the alleged breach [of the standard of care by appellants] and [appellees'] claimed damages." The expert report "d[id] not explain how any breach of the standard of care by [appellants], specifically and individually[,] caused the alleged injuries or death made the basis of th[e] litigation." And Dr. Suliburk did not...
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