July 11, 2014
REEVES et al.
MAHATHRE et al
Reconsideration denied July 25, 2014 -- Cert. applied for.
Medical malpractice. Bibb Superior Court. Before Judge Brown.
Tracey L. Dellacona , Adams & Adams, Charles R. Adams III , Gautreaux & Adams, Jarome E. Gautreaux, for appellants.
Commander Pound Butler, Theodore E. G. Pound , Kathleen W. Simcoe , McCall Williams, W. Earl McCall , Jones, Cork & Miller, Carr G. Dodson, for appellees.
DILLARD, Judge. Doyle, P. J., concurs. Miller, J., concurs in judgment only.
In this wrongful-death action premised on medical malpractice, appellants Michael Reeves, Sharon Reeves, and Marcus Reeves, Jr., individually, and Michael Reeves, as executor of the Estate of Jonelle Reeves (collectively, " Appellants" ), sued Dr. Vijay Mahathre and his employer, Ben Hill Emergency Group LLC (collectively, " Dr. Mahathre" ), inter alia, alleging that Dr. Mahathre was negligent in the medical care
he provided to their mother, Jonelle Reeves (" Reeves" ), in the emergency department at Dorminy Medical Center (" DMC" ). Dr. Mahathre, an emergency-room physician, filed a motion for summary judgment, asserting that he did not breach the applicable standard of care when he treated Reeves and, further, that Appellants failed to [328 Ga.App. 547] establish a causal connection between his care of Reeves and her subsequent death. The trial court granted Dr. Mahathre's motion, and Appellants claim that the court erred in doing so. Because we agree that the appellate record fails to establish that a genuine issue of material fact exists as to whether Dr. Mahathre's treatment proximately caused Reeves's death, we affirm.
Viewed in the light most favorable to Appellants as the nonmovants, the record shows that at approximately 6:20 p.m. on May 21, 2008, Reeves, a 71-year-old with a history of diabetes and hypertension, presented at the emergency room in DMC, complaining of nausea and severe pain in her abdomen and right flank. Dr. Mahathre was her attending emergency-room physician. After taking a medical history and conducting a physical examination, Dr. Mahathre ordered a series of tests, including a complete blood count, blood-chemistry analysis, urinalysis, and an upright kidney-ureter-bladder x-ray. He further administered Reeves an intramuscular injection of pain medication and an anti-nausea medicine, and also gave her an oral antibiotic.
Although Reeves's white-blood-cell count was elevated, possibly indicating an infection, both her urinalysis and x-ray were normal. The pain medication provided Reeves some relief and, without offering a formal diagnosis, Dr. Mahathre discharged her in " improved" condition at 8:45 p.m. with an antibiotic prescription and instructions to see her primary-care physician within two days.
The following morning, May 22, 2008, Reeves was seen at her primary-care physician's office by an advanced-practice registered nurse and, later that afternoon, was admitted as an inpatient at DMC with increased abdominal pain, fever, and an elevated white-blood-cell count. Then, at approximately 9:35 p.m., an abdominal CT scan was performed, which showed that Reeves was suffering from a five millimeter kidney stone blocking her right ureterovesical junction.
After discovering Reeves's diagnosis and, consequently, the need to consult a urologist, and given that DMC had no urologist on-call and available, the attending physician called Dr. Robert Gregory [328 Ga.App. 548] Anderson, a urologist from Tift Regional Medical Center, approximately 30 miles away. Dr. Anderson was unable to accept transfer of Reeves that evening because Tift Regional did not have an available bed, but a decision was made to transfer her first thing in the morning and admit her directly into the surgery unit where Anderson could then place a stent to relieve the blockage to her kidney.
Reeves was transferred to Tift Regional by ambulance at approximately 8:00 a.m. the following morning (May 23, 2008). Upon her arrival to Tift Regional, however, Reeves was
in critical condition and it was determined that she was not stable enough to undergo general anesthesia. Consequently, she was not cleared for surgery and Dr. Anderson was unable to place the stent. Tragically, Reeves was in septic shock and, at 1:15 a.m. on May 24, 2008, she was pronounced dead as a result of " urosepsis," an overwhelming infection that developed in her urinary tract due to the blockage caused by the kidney stone.
Appellants filed the instant wrongful-death lawsuit, alleging medical malpractice against numerous defendants involved in Reeves's care, including Dr. Mahathre. In support of their claims, Appellants presented expert testimony that Dr. Mahathre was negligent in failing to order a CT scan and/or diagnose Reeves's condition prior to discharging her from the emergency room during her initial visit on May 21, 2008. Dr. Mahathre filed a motion for summary judgment denying that he breached a duty of care to Reeves, but asserting that, regardless of his purported negligence, there was no causal connection between his actions and Reeves's tragic death. The trial court granted his motion, and this appeal follows.
In order to establish liability in a medical-malpractice action, a plaintiff must prove three essential elements: " (1) the duty inherent in the doctor-patient relationship; (2) the breach of that duty by failing to exercise the requisite degree of skill and care; and (3) that this failure be the proximate cause of the injury sustained."  Significantly, negligence alone is " insufficient to sustain recovery for wrongful death in a medical malpractice action."  Rather, it must be proven [328 Ga.App. 549] that " the death of a patient proximately resulted from such want of care or skill."  And such causation must be established " to a reasonable degree of medical certainty,"  cannot be based upon " mere chance or speculation,"  and when, as here, it falls outside the ken of the normal juror, requires the support of expert testimony.
Assuming, as we must under the standard of review, that Dr. Mahathre
breached the applicable standard of care in failing to order a CT scan on Reeves and/or to diagnose the kidney stone and resulting blockage, the record nonetheless fails to create a jury issue on the question of causation. Indeed, Appellants' own expert, Dr. Richard Braen, an emergency-room physician, testified that, had Dr. Mahathre ordered a CT scan and properly diagnosed Reeves's condition, the standard of care required that he then contact a urologist and follow the urologist's instructions as to her treatment. And had he done so, according to Dr. Braen, Dr. Mahathre would have satisfied his duty of care to Reeves.
In turn, Dr. Mahathre presented the testimony of the urologist who was ultimately consulted to care for Reeves, Dr. Anderson. Dr. Anderson testified that had Dr. Mahathre performed a CT scan and consulted him with the results--i.e., that a five millimeter kidney stone was blocking her right ureterovesical junction--on the night that Reeves presented in the emergency room, he would have advised Mahathre to treat Reeves in the exact fashion that he, in fact, did. [328 Ga.App. 550] Specifically, because Reeves's urine was clear, she had no fever, and she was responding to the pain medicine, Dr. Anderson would " have done nothing differently," in that he would have recommended that Reeves be sent home with pain medication in order to see if she could pass the stone independently and advised her to follow up with him or her primary-care physician in two to three days.
Additionally, Dr. Craig V. Comiter--a urology and causation expert for Appellants--testified that Reeves had " no obvious signs or symptoms of [a urinary] infection at her initial ER presentation [to Dr. Mahathre]," and that it was only when she returned to the hospital for admission that " she was displaying signs and symptoms of infection." And when Dr. Comiter was directly asked whether he had " an opinion [as to] whether or not any act or omission by Dr. Mahathre caused or contributed to the patient's death," he simply responded, " No."
The foregoing testimony goes directly to the issue of causation, and appellants have presented no expert testimony to contradict it. Although one of Appellants' experts--Dr. Julian L. Seifter, a nephrologist--opined generally that the failure of Dr. Mahathre, among various other medical professionals, to correctly diagnose Reeves and relieve the obstruction " ultimately led to the development of ... urosepsis and ... caused her death," this generalized testimony was not sufficient to create a jury question on the issue of causation. [328 Ga.App. 551] Indeed, when causation
is involved, " plaintiff has a more complex dilemma where the defendant has given expert testimony that there was no proximate cause, because to merely show a causal link does not refute the defendant's denial of causation ..., requiring the grant of summary judgment."  And because Dr. Mahathre successfully pierced Appellants' pleadings and demonstrated the absence of evidence supporting the essential element of causation, summary judgment was appropriate in the case sub judice.
Doyle, P. J., concurs. Miller, J., concurs in judgment only.