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The Fulton-Dekalb Hospital Authority v. Hickson

Court of Appeals of Georgia, Second Division

June 28, 2019


          MILLER, P. J., RICKMAN and REESE, JJ.

          Reese, Judge.

         The Fulton-DeKalb Hospital Authority, o/k/a Grady Memorial Hospital Corporation, d/b/a Grady Memorial Hospital; Emory Healthcare, Inc.; and Emory University; Carl Nee-Kofi Mould-Millman, M.D., and Betsy Kinchen, L.C.S.W. (collectively, "Grady") seek review of an order of the State Court of DeKalb County, denying Grady's motion for summary judgment in this medical malpractice action filed by Denise Hickson, as Guardian of Maximillian McClain, an Incapacitated Adult. On appeal, Grady argues that the trial court erred in finding that, as a matter of law, Grady was not immune from liability for actions it took in good faith compliance with the discharge provisions of Chapter 3 of Georgia's Mental Health Code.[1] For the reasons set forth infra, we affirm.

         Construing the evidence in the light most favorable to Hickson, as the nonmovant, [2] the record shows the following facts. In the early morning hours of January 20, 2013, an ambulance brought McClain to Grady Memorial Hospital's Emergency Department ("ED"). McClain had been going door-to-door through his apartment building, "screaming and banging on doors[.]" 911 was called, and McClain became combative with the EMS crew, going so far as to punch a police officer who was helping the crew. McClain also kicked the interior compartment of the ambulance and attempted to break the ambulance equipment.

         After EMTs administered Versed, a benzodiazepine, to McClain, he managed to communicate that he was "having a mental break," and that he could not "control" himself. McClain also told the EMTs that he had a history of paranoia and bipolar disorder. McClain arrived at the ED at approximately 3:13 a.m. and was triaged within five minutes.

         The triage nurse assessed that McClain was a suicide risk due to statements he made about hurting himself. At 3:30 a.m., a one-on-one sitter was assigned to observe McClain and document her observations every 15 minutes. At approximately 4:29 a.m., Dr. John H. Lloyd was assigned as McClain's attending ED physician. An initial drug screening was negative for drugs and alcohol.

         According to McClain's medical records, McClain reiterated to Dr. Lloyd that he had a history of bipolar disorder and panic attacks, and added that he had become suicidal earlier in the evening and had a plan to end his life. McClain did not articulate his plan, but said that he had aborted it because it would set off a chain reaction of other people killing themselves. Instead of going through with the plan, and even though it was the middle of the night in January, McLain had lain down in the front yard of his apartment complex.

         At 6:46 a.m., Dr. Lloyd signed a Form 1013 certificate for Involuntary Mental Health Evaluation ("1013"), secondary to a "[s]uicidal, bipolar/anxiety" diagnosis, A 6:48 a.m. entry on McClain's medical chart confirmed that Dr. Lloyd involuntarily committed McClain for inpatient treatment on Grady's psychiatric floor. At the shift change 12 minutes later (7:00 a.m.), Dr. Lloyd's shift ended, and Dr. Mould- Millman's shift began. When Dr. Lloyd left, he "did not think that [McClain's] mental status would clear up and that he could be discharged."

         Around the same time as the shift change, McClain was administered a dose of Ativan, a benzodiazephine that has sedating effects, that Dr. Lloyd had prescribed. McClain was not transferred to the psychiatric floor; instead Kinchen, a licensed clinical social worker working for Grady, "intercepted" and reassessed him. Kinchen found McClain to be stable and recommended to Dr. Mould-Millman that he be discharged. At 8:01 a.m., Kinchen entered a note on McClain's chart mentioning her plan to consult with Dr. Mould-Millman.

         Six minutes later, at 8:07 a.m., Dr. Mould-Millman rescinded the 1013. Dr. Mould-Millman noted on McClain's chart that he had "reassessed" McClain and found that he had no current suicidal or homicidal ideations, that he was calm and cooperative, and that he was able to be safely discharged. There is no evidence that either Kinchen or Dr. Mould-Millman contacted Dr. Lloyd before deciding to discharge McClain. Approximately 11 hours later, McClain attempted to commit suicide by jumping off a third-floor balcony, severing his carotid artery and suffering massive brain injuries.

         Hickson, as McClain's guardian, filed suit against Grady and Dr. Lloyd, alleging claims for medical malpractice against the individual defendants and vicarious liability against the other defendants. According to the complaint and supporting affidavits, the individual defendants grossly breached the applicable standard of care by failing to: perform a thorough psychiatric evaluation, thoroughly review McClain's past psychiatric treatment history; consult and/or coordinate care with McClain's treating psychiatrist or, alternatively, more experienced psychologists or psychiatrists; adequately assess McClain's current psychosocial situation; and document a safety plan to prevent the recurrence of suicidal thoughts, plans, or actions.

         The trial court entered a consent order dismissing without prejudice Hickson's claims against Dr. Lloyd. Grady moved for summary judgment, arguing that it was entitled to immunity under OCGA § 37-3-4, because it had discharged McClain in good faith and in compliance with the statutory requirements of Chapter 3 of Title 37.

         The trial court found that Grady was not entitled to summary judgment in light of several material issues of fact: whether placing a medical note reflecting McClain's discharge constituted good faith compliance with the notice provisions of OCGA §§ 37-3-4 and 37-3-43 (c); whether the assessments of McClain by Kinchen and Dr. Mould-Millman were insufficient and inadequate to the extent that any decision made thereon would not be in good faith; and whether Grady failed to meet the applicable standard of care in providing treatment to McClain, for which it would not be immune under OCGA § 37-3-4.

         The trial court entered a certificate of immediate review, and we granted Grady's application for interlocutory appeal. This appeal followed.

[The appellate court's] review of the grant or denial of summary judgment is de novo, and [the appellate court] view[s] the evidence, and all reasonable conclusions and inferences drawn from it, in the light most favorable to the nonmovant. Summary judgment is warranted only where no genuine issue of material fact exists and the movant is entitled to judgment as a matter of law.[3]

         "[I]n construing a statute, we look at its terms, giving words their plain and ordinary meaning, and where the plain language of a statute is clear and susceptible of only one reasonable construction, we must construe the statute according to its terms."[4] "[I]n construing language in any one part of a statute, a court should consider the entire scheme of the statute and attempt to gather the legislative intent from the statute as a whole."[5] Statutory construction is a question of law, which we review de novo.[6]

         With these guiding principles in mind, we turn now to Grady's claims of error.

         1. Grady argues that the trial court erred in concluding that Hickson's allegations of negligence were not "actions in connection with" McClain's discharge, pursuant to OCGA § 37-3-4, and that the court thus erred in failing to find that Grady was immune from liability as a matter of law.

         In 2011, House Bill 343, inter alia, "amend[ed] Chapter 3 of Title 37 of the Official Code of Georgia Annotated, relating to examination and treatment for mental illness, so as to provide for immunity for hospitals in certain circumstances; to provide for related matters; to repeal conflicting laws; and for other purposes."[7] The amendment ...

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