Walker v. Giles, No. A05A1195.
| Decision Date | 05 December 2005 |
| Docket Number | No. A05A1195. |
| Citation | 624 S.E.2d 191,276 Ga. App. 632 |
| Parties | WALKER et al. v. GILES et al. |
| Court | Georgia Court of Appeals |
Schklar, Wright & Henderson, L.L.C., Robert U. Wright, Edward C. Henderson, Atlanta, for appellants.
Greenberg Traurig, Lori G. Cohen, Michael J. King, Atlanta, for appellees.
Appellants Kimberly D. Walker and her husband Scott Walker, individually and as the surviving parents of their unborn child, brought the instant medical malpractice action against appellees Dr. Wendy S. Giles, Dr. Vonda L. Klein, Dr. J. Philip Gingrey, and their OB-GYN practice, alleging that appellees failed to properly diagnose and treat Ms. Walker's acute appendicitis, causing her to suffer severe physical and cognitive damage and the loss of her fetus after her appendix ruptured. After a jury trial had commenced and appellants had presented their case-in-chief, appellees moved for directed verdict on the grounds that appellants had failed to present evidence showing cause-in-fact and proximate cause. The trial court granted the motion, from which appellants now appeal. For the reasons set forth below, we reverse.
A directed verdict is proper only if there is no conflict in the evidence as to any material issue and the evidence introduced, with all reasonable deductions therefrom, shall demand a verdict. In determining whether a conflict in the evidence exists, the court must construe the evidence most favorably to the party opposing the motion for a directed verdict.
(Footnotes omitted.) Knight v. West Paces Ferry Hosp., 262 Ga.App. 220, 220-221, 585 S.E.2d 104 (2003). See also Hodges v. Vara, 268 Ga.App. 815, 818(1)(a), 603 S.E.2d 327 (2004). We must reverse the trial court's grant of a directed verdict if there was "any evidence" to support the nonmovant's claims. Id. at 818(1)(a), 603 S.E.2d 327. See also Snider v. Basilio, 276 Ga.App. ___, ___(1), 623 S.E.2d 521 (2005).
Mindful of this standard, we turn to the record in the instant case. At the time of the events at issue, Kimberly Walker, a thirty-year-old mother of two children, was fifteen-to-sixteen weeks pregnant. During the course of her pregnancy, Walker saw the obstetricians at Marietta OB-GYN Affiliates, P.A. Walker had been a patient of Marietta OB-GYN during a prior pregnancy and had reestablished her relationship with the physicians there.
Wednesday, June 20, 2001. Viewed in the light most favorable to the nonmovant, at approximately 9:00 a.m. on Wednesday, June 20, 2001, Walker experienced the onset of severe periumbilical pain, vomiting, diarrhea, and a decreased appetite. Because she "was in too much pain," was "doubled over," and "could not drive," Walker had her mother-in-law drive her to Marietta OB-GYN for treatment that afternoon. After she arrived at Marietta OB-GYN, a nurse practitioner evaluated Walker and assessed her as having a viral syndrome which had caused her to become dehydrated.1 As a result, Walker was provided anti-nausea medication and was sent to the Outpatient Infusion Center at Kennestone Hospital for rehydration.
After receiving an infusion of fluids, Walker remained in severe pain and could not walk, requiring that she be transported by wheelchair to the main hospital for admission. Walker was admitted as a patient to the Women's Center at Kennestone Hospital at approximately 6:00 p.m. by Dr. Giles, the treating obstetrician with Marietta OB-GYN who was on call at the hospital that evening. Dr. Giles evaluated Walker, noted that there was mild abdominal tenderness, and diagnosed Walker with viral gastroenteritis, an inflammation of the digestive tract commonly referred to as an "intestinal bug."
Dr. Giles ordered that a complete blood study be done of Walker upon her admission. At approximately 10:00 p.m., the results of the blood study, which included a breakdown of Walker's white blood cell count, were called to Dr. Giles. According to appellants' medical experts, the blood study showed a "shift to the left," which represented an overall increase in a patient's white blood cell count marked by an increase of immature white blood cells called "segs" but a decrease in lymphocytes. Appellants' medical experts later opined that the "shift to the left" shown by the blood study was inconsistent with an initial diagnosis of viral gastroenteritis and instead indicated that Walker had a potential bacterial abdominal infection, particularly when the results were compared to the baseline blood study results from Walker's prior pregnancy found in her office chart that were taken at approximately the same stage of gestation.2 Dr. Giles did not order a follow-up blood study, x-rays, or an abdominal CT scan3 after being notified of the blood study results.
Thursday, June 21, 2001. Dr. Klein, another obstetrician at Marietta OB-GYN, came on call at the hospital on Thursday morning, June 21, and assumed care over Walker until Friday morning. A urinalysis done on Thursday morning showed that Walker was no longer dehydrated. Nevertheless, according to appellants' medical experts, Walker's medical chart from Thursday contained several indicators that were demonstrative of Walker's overall worsening bacterial infection, including complaints of vomiting and trends of decreasing appetite, decreasing blood pressure compared against her baseline pressure during pregnancy, and a rising pulse rate. According to Walker's husband, Walker also continued to complain of stomach pain on Thursday even with pain medication.
Appellants' medical experts opined that Walker's clinical condition on Thursday was inconsistent with a diagnosis of viral gastroenteritis because the latter condition normally shows early improvement once a patient is properly hydrated. Dr. Klein did not order a follow-up blood study or an abdominal CT scan on Thursday or early Friday morning. Nor is there evidence in the medical chart that Dr. Klein performed an abdominal examination of Walker at any time during this period.4
Friday, June 22, 2001. Walker's medical chart for early Friday morning reflects a continued trend of elevated pulse rate and lowered blood pressure. Walker continued to complain to her husband about stomach pain, information which her husband says that he conveyed to Dr. Klein, who reassured him that Walker only had the "stomach flu" and would be fine "in a couple of days," and who discussed with them the decision that had been reached to discharge Walker later that morning. Appellants' medical experts contended that Walker's condition was not improving during this period based on the notations in her medical chart reflecting decreased appetite, lowered blood pressure, and a rise in pulse rate.
Dr. Gingrey became the on-call treating obstetrician at the hospital on Friday morning, June 22, and assumed care over Walker through the weekend. Walker's husband testified that he did not leave the hospital room on Friday morning and that he never saw Dr. Gingrey come into the room and assess Walker at any time on Friday.5 Although Walker's medical chart contains entries by Dr. Gingrey on Friday morning, the entries regarding Walker's condition could be read as inconsistent with previous information in the nurse notes and medical chart notations, when viewed in the light most favorable to the nonmovant. Dr. Gingrey did not order a blood study or an abdominal CT scan on Friday morning. At approximately 11:00 a.m., Walker was discharged from the hospital under orders of Dr. Gingrey.
Upon her discharge, Walker, who was still "in a lot of pain" according to her husband, went home for approximately 12 hours. During this time, Walker's condition grew increasingly painful. Walker's husband drove her to the emergency room at Kennestone Hospital at approximately 11:00 p.m. on Friday. In the emergency room, Walker presented with severe right upper and lower quadrant abdominal pain, a life-threatening blood pressure of 60/0, a high pulse rate, and blurred vision.
Saturday, June 23, 2001. Shortly after midnight in the early morning hours of Saturday, June 23, Walker was seen by the emergency room physician. The emergency room physician ordered a complete blood study. According to appellants' medical experts, the blood study results indicated a significant worsening of Walker's abdominal bacterial infection when compared with the results of the blood study done on Wednesday. The emergency room contacted Dr. Dennis Smith, the on-call general surgeon, to assess Walker.
At approximately 3:00 a.m. on Saturday, Dr. Smith visited Walker in the emergency room. Dr. Smith conducted a physical examination of Walker and diagnosed her with acute cholecystitis, a bacterial inflammation of the gallbladder, which required the removal of her gallbladder. He informed Walker and her husband that the surgery would be scheduled for Monday morning since he was going out of town for the weekend, but that his partner, Dr. Novak, could perform the surgery earlier if an emergency arose. Dr. Smith then had Walker readmitted to the Women's Center at the hospital. In his orders, Dr. Smith wrote: "Please notify Dr. Gingrey et al. of [patient]'s location."
At or about 9:00 a.m. on Saturday, Dr. Gingrey visited the floor in the Women's Center where Walker's room was located and reviewed her chart. Dr. Gingrey wrote orders on the chart, including one order changing an anti-nausea medication initially prescribed by Dr. Smith. However, Walker's husband, who stated that he remained with Walker all day Saturday, testified that he never saw Dr. Gingrey come into Walker's room on Saturday morning or physically examine Walker at any point that day. Walker's husband further testified that he did not see any doctors visit Walker at any time on Saturday, including Dr. Smith or his partner Dr. Novak.
Sunday, June 24, 2001. At approximately 1:20 a.m. on Sunday, June 24, Dr. Gingrey arrived at the Women's...
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