Gobble v. Bristol Gynecology & Obstetrics, P.C.

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BRITTANY S. GOBBLE, et al., Plaintiffs, v. BRISTOL GYNECOLOGY AND OBSTETRICS, P.C., et al., Defendants.

No. 2:22-CV-51

United States District Court, E.D. Tennessee, Greeneville Division

September 17, 2024

MEMORANDUM OPINION AND ORDER

CYNTHIA RICHARDSON WYRICK UNITED STATES MAGISTRATE JUDGE

Before the Court is a Motion for Summary Judgment and a Motion for Partial Summary Judgment filed by Defendants Bristol Gynecology and Obstetrics, P.C., David P. Russell, M.D., and Haley L. Akin, M.D. (“Defendants”). [Docs. 84 88]. Each motion is supported by a brief, referenced documents, and a statement of material facts. [Docs. 85-87 89-90]. Plaintiffs Brittany S. Gobble and Benjamin T. Gobble individually and as parent and next friend of their minor child OLG, (“Plaintiffs”) filed a response in opposition to each motion, along with supporting briefs, referenced documents, a statement of material facts, and a response to Defendants' statement of material facts. [Doc. 92-98, 104]. Defendants filed a reply and response to Plaintiffs' statement of material facts. [Docs. 99, 100]. Defendants' motions are now ripe for resolution. After careful consideration of the issues raised by Defendants in their filings and for the reasons stated below, Defendants' Motion for Summary Judgment [Doc. 84] is DENIED, and Defendants' Motion for Partial Summary Judgment [Doc. 88] is likewise DENIED.

I. FACTUAL BACKGROUND

The dispute in this matter stems from the prenatal care provided in January 2021 to Brittany S. Gobble (“Ms. Gobble”) by David P. Russell, M.D. (“Dr. Russell”) at Bristol Gynecology and Obstetrics, P.C. (“BGO”) and Haley L. Akin, M.D. (“Dr. Akin”). Plaintiffs contend that Defendants failed to properly diagnose and treat Ms. Gobble for severe preeclampsia which developed during her pregnancy and resulted in injuries to her minor child.

Ms. Gobble began prenatal care with Dr. Russell at BGO on June 22, 2020. [Russell Dep. 34:10-20, Doc. 87-8, p. 3]. On January 7, 2021, Ms. Gobble presented to BGO with blood pressure of 143/93 and a 3+ urine dipstick. [Gross Rule 26 Disclosure., Doc. 98-12, p. 3]. Dr. Russell sent Ms. Gobble to Bristol Regional Medical Center (“BRMC”) for further evaluation for preeclampsia. Id.; [Cawyer Dep. 97:15-20, Doc. 98-2, p. 6]. Preeclampsia is described as “a disorder of pregnancy associated with new-onset hypertension” and “often accompanied by new-onset proteinuria.” [Doc. 98-18, p. 1]. Ms. Gobble was not diagnosed with preeclampsia on January 7, 2021. [Gross Rule 26 Disclosure, Doc. 98-12, p. 3]; [Cawyer Dep. 97:15-20, Doc. 98-2, p. 6]. She then visited BGO again on January 11 and 14, 2021, and continued to have proteinuria during those visits but was not diagnosed with preeclampsia on either date. Id.

In the afternoon of January 16, 2021, Ms. Gobble presented to BRMC with elevated blood pressure and a headache. [Docs. 91-8, p. 1; 98-14, p. 1]. At that point, Ms. Gobble was 35 weeks pregnant. [Gross Rule 26 Disclosure, Doc. 98-12, p. 5]. Before arriving, Ms. Gobble called the hospital to report that her blood pressure read 166/108 and that she had a throbbing headache which did not resolve with Tylenol. [Docs. 98-13, p. 2; 98-14, p. 1]. She was then admitted overnight for observation. Gobble's blood pressure was taken every five to ten minutes from 4:00 p.m. to 5:30 p.m.,^[1] at which time the antihypertensive medication labetalol was administered. [Gable Dep. 69:22-25, Doc. 91-7, p. 2]. She was evaluated at the hospital by Dr. Akin, who noted that Ms. Gobble was not resting while her blood pressures were being taken, that she had “no sustained severe range pressures,” and that her blood pressures were in a “mild range.” [Doc. 98-14, p. 1]. It was further noted that Ms. Gobble was given medication that resolved her headache. Id.; [Doc. 9814, p. 2]. However, Ms. Gobble testified in a deposition that her headache improved but did not fully resolve. [Gobble Dep. 98:6-7, Doc. 98-6, p. 12]. While Ms. Gobble was at the hospital, fetal heartrate monitoring was performed and was reassuring. [Doc. 98-14, p. 1-2]. At 5:46 p.m. that evening, a fetal ultrasound was taken and showed calcification of the placenta and an amniotic fluid index of 6.5, which was noted to be below normal. [Doc. 98-14, p. 3].

Ms. Gobble was discharged from BRMC at 4:22 p.m. on January 17, 2021. [Doc. 91-8, p. 1]. Ms. Gobble was diagnosed with preeclampsia without severe features, and Dr. Akin noted that her preeclampsia labs were within normal limits other than an elevated protein/creatinine ratio. [Doc. 98-14, p. 1-2]. Defendants state that Ms. Gobble had normal blood pressure and no headache at discharge. [Doc. 85, p. 3 (citing Thomas Dep. 55 and Akin Dep. 128)]. However, as referenced above, Ms. Gobble contends that her headache never fully resolved. [Gobble Dep. 98:6-7, Doc. 98-6, p. 12] (explaining that her headache did not go away but did get better).

Before leaving the hospital, Ms. Gobble was given certain discharge instructions. Dr. Akin testified that she advised Ms. Gobble to continue monitoring her blood pressures at home and to immediately return to the hospital if she had a severe range blood pressure reading, headache, change in fetal movement, or contracting. [Akin Dep. 128, Doc. 87-1, p. 9; Akin Dep. 130, Doc. 98-3, p. 9]. Ms. Gobble testified in her deposition that she did not remember being told to return to the hospital if she experienced these changes. [Gobble Dep. 94-95, Doc. 98-6, p. 10-11]. Additionally, Ms. Gobble was given written instructions on how to count her baby's kicks and what to do if she did not feel fetal movement. [Bowman Dep. 18, 26:18-23, Doc. 87-2, p. 6, 8]; [Doc. 87-10, p. 9]. Brittany Bowman, RN, a labor and delivery nurse at BRMC who was involved in discharging Ms. Gobble, testified that she also told Ms. Gobble how to monitor kick counts. [Bowman Dep. 18:18-25, Doc. 87-2, p. 6].

Ms. Gobble returned to BGO for follow-up on Monday, January 18, 2021, and was seen by Dr. Russell. Prior to that appointment, Dr. Akin and Dr. Russell discussed Ms. Gobble's weekend hospital visit. [Russell Dep. 64:1-7, Doc. 98-4, p. 5]. Dr. Akin advised that she had diagnosed Ms. Gobble with preeclampsia without severe features. [Akin Dep. 129:8-23, Doc. 98-3, p. 8]. Dr. Russell did not recall Dr. Akin mentioning during that conversation that Ms. Gobble had severe range blood pressures or a headache lasting for twelve hours. [Russell Dep. 64:8-25, Doc. 98-4, p. 5]. During Ms. Gobble's appointment on January 18, a non-stress test was performed to evaluate fetal wellbeing, the results of which were reassuring. [Gross Dep. 96-97, Doc. 87-6, p. 5-6]; [Russell Dep. 76:16-18, Doc. 87-8, p. 4]. However, Ms. Gobble had elevated blood pressure despite taking medication that day and a 3+ urine protein dipstick test. [Gross Rule 26 Disclosure, Doc. 98-12, p. 7]. Dr. Russell indicated that while Ms. Gobble was inducible at that time, he decided to wait another week before inducing her. [Russell Dep. 76:5-15, Doc. 87-8, p. 4]; [Gobble Dep. 134:1-7, Doc. 98-6, p. 14]. According to Ms. Gobble, Dr. Russell advised her during this visit that the baby's movements would begin to slow down because she was in the first stages of labor. [Gobble Dep. 41:2-25, 42:1, Doc. 98-6, p. 5-6]. Ms. Gobble testified that during this visit she told Dr. Russell she felt uncomfortable in a way she had not felt in her previous pregnancy, and thought she needed to be induced that day. [Gobble Dep. 133:19-25, 134:2-3, Doc. 98-6, p. 13-14]. Nevertheless, she went home and had no communication with Defendants on January 19, 2021, but did experience lower fetal movement than normal that day. [Gobble Dep. 61, Doc. 873, p. 7].

On January 20, 2021, Ms. Gobble did not feel fetal movement from 7:00 a.m. onward. [Gobble Dep. 44:10-12, Doc. 98-6, p. 7]; see also [Doc. 98-16] (Ms. Gobble's text to her sister that she has not felt OLG move “at all today”). Ultimately, she called BGO at 12:45 p.m. that day, arrived at BRMC at 1:27 p.m., and was admitted to Labor and Delivery at 1:42 p.m. [Docs. 98-13, p. 1; 87-10, p. 12; 91-8, p. 2; 98-16]. Fetal monitoring began at 1:44 p.m., and Dr. Russell delivered OLG at 2:43 p.m. by cesarean section. [Doc. 98-14, p. 5-6]. OLG was born at 35 weeks and 6 days and suffered hypoxic ischemic encephalopathy, a brain injury caused by lack of oxygen to the brain before birth. [Doc. 87-11, p. 7]. OLG will likely experience ongoing developmental delays, abnormal muscle tone, and respiratory difficulties due to her brain injury. [Capal Dep. 60:20-26, 62:1-14, Doc. 98-89, p. 5-6].

II. PARTIES' ARGUMENTS

a. Motion for Summary Judgment

In their Motion for Summary Judgment, Defendants argue that summary judgment is appropriate because Plaintiffs cannot establish causation. [Doc. 85, p. 5-6]. Specifically, they contend that OLG's injuries were not foreseeable to Defendants when the medical care at issue was provided noting that OLG's injuries must have been foreseeable for Plaintiffs to establish causation. Id. at 8-10. Defendants state that Ms. Gobble did not meet the diagnostic criteria for preeclampsia with severe features and that prenatal testing was normal; thus, they deny that OLG's injuries were connected to Ms. Gobble's preeclampsia. Id. at 2. Defendants further argue that for an injury to be foreseeable, it must be probable instead of merely possible, and Defendants must have had some ability to prevent the injury. Id. at 8. They argue that additional fetal monitoring after a non-stress test was performed on January 18, 2021, would not have revealed fetal distress, and they could not have foreseen that there would be a lack of fetal movement on January 20, 2021. Id. at 11-12. Defendants then assert that Plaintiffs have failed to...