Med. Ctr. of Cent. Ga., Inc. v. Turner

905 S.E.2d 858

The MEDICAL CENTER OF CENTRAL GEORGIA, INC. et al.

v.TURNER et al.

A24A0378

Court of Appeals of Georgia.

August 21, 2024

John E. Hall Jr., Jacquelyn Smith Clarke, Austin Aaron Atkinson, Pearson Kern Cunningham, Michael Victor Profit, Atlanta, Alexander Collins Vey, Randolph Page Powell Jr., for Appellant.

Tracey Lynn Dellacona, Caleb Frank Walker, Katherine Lee McArthur, Macon, Lindsey Stephens Macon, for Appellee.

Dillard, Presiding Judge.

[1] Allen Turner died due to complications from a surgery to remove a polyp from his intestines. Following his death, his daughter—Norkesia Turner—sued Dr. William Thompson; Dr. Heather Nolan; and their employer, the Medical Center of Central Georgia, for medical malpractice and wrongful death.¹ The case then proceeded to trial, after which the jury rendered a verdict in Turner’s favor, awarding her approximately $9,200,000 in damages—$7,200,000 of which were noneconomic damages for wrongful death. In challenging the jury verdict and denial of several post-trial motions,² the appellants argue (1) the judgment should be reversed because Turner failed to present sufficient evidence of causation; and (2) the jury’s award of $7,200,000 in noneconomic damages for wrongful death improperly exceeded the statutory limits on such damages in violation of OCGA § 51-13-1. For the following reasons, we affirm.³

Viewing the evidence in the light most favorable to the jury’s verdict,⁴ the record shows that in 2017, when he was 69 years old, Allen was referred to Dr. Thompson by another physician for surgery to excise a "polyp in the very distal duodenum." Prior to surgery, Allen underwent an endoscopy, a colonoscopy, and a "small [bowel] follow through series";⁵ but neither a CT scan nor any other type of imaging was conducted on Allen. On March 31, 2017, Drs. Thompson and Nolan performed the operation, during which they unexpectedly discovered a cancerous mass approximately 25 percent larger than a golf ball. As a result, the doctors determined they needed to remove the mass, as well as the polyp. The area of operation, then, became "much larger" with "much higher risk." And according to Thompson, it was not an option to remove only the polyp and leave the cancerous mass to be excised in a subsequent procedure.

As they continued the operation, Drs. Thompson and Nolan also encountered a "large pulsing vessel near the aorta[,]" which was later determined to be the superior mesentery artery (the "SMA")—the primary vessel supplying blood to the intestines. But at the time, the surgeons did not believe the large blood vessel was the SMA because they were operating "far left" of where it is normally located. As it turned out, Allen’s SMA was distorted and "in an abnormal place." Additionally, swelling in Allen’s lymph nodes "affected [the surgeons’] ability to see things, which further complicated [the] surgery." And at some point during surgery, one of the doctors clamped the SMA on both sides and cut it in half.⁶ After that, the "vascular team" aided the surgeons in attempting to repair Allen’s SMA.

Ultimately, Drs. Thompson and Nolan were able to remove the polyp, the cancerous mass, associated lymph nodes, and everything they would need in order for the cancer to be evaluated. And while Allen survived the initial surgery, over the next few weeks, he underwent numerous additional surgeries due to the severance of his SMA. Tragically, despite the additional surgeries, Allen died after suffering "multi-system failure."

Thereafter, Turner sued MCCG, Dr. Thompson, and Dr. Nolan, asserting claims of medical malpractice and wrongful death. Specifically, Turner alleged that Thompson and Nolan’s negligence in treating Allen—which fell beneath their professional standard of care—caused and contributed to his injuries and death. Turner also claimed, inter alia, that a pre-surgery CT scan or MRI of Allen’s abdomen would have revealed the cancerous mass and whether the SMA was in "the zone of their surgery." According to Turner, the proper standard of care required the doctors to identify and protect the SMA. And as required by law, Turner attached an affidavit from a medical expert, Dr. Marvin Evans, to her complaint in support of the allegations.⁷

The appellants filed a joint answer to Turner’s complaint, denying many of its allegations and asserting several affirmative defenses. Discovery then ensued, and the case ultimately proceeded to a jury trial. Following trial, the jury rendered a verdict in favor of Turner, awarding her (1) $618,853.59 for medical and funeral expenses; (2) $1,443,300 for Allen’s pain and suffering; and (3) $7,216,500 in noneconomic damages for wrongful death. The trial court subsequently entered judgment on the verdict, adding $216.00 in favor of Turner for court costs. The appellants then filed a motion and amended motion for a new trial and judgment notwithstanding the verdict. They also filed a motion "to remit and amend the judgment," arguing that—as to her wrongful-death claim—the approximately $7,200,000 awarded for noneconomic damages exceeded the $350,000 cap on such damages in OCGA § 51-13-1. Following Turner’s responses and a hearing on the motions, the trial court denied them all in separate orders. This appeal follows.

[2–4] When a jury returns a verdict, it must be affirmed on appeal "if there is any evidence to support it, and the evidence is to be construed in a light most favorable to the prevailing party with every presumption and inference in favor of sustaining the verdict."⁸ Put another way, a jury verdict, "after approval by the trial court, and the judgment thereon will not be disturbed on appeal if supported by any evidence, in the absence of any material error of law."⁹ And we review a denial of a motion for a new trial "according to this same standard."¹⁰ With this deferential standard of review in mind, we turn to the appellants’ specific claims of error.

[5] 1. The appellants first argue the jury’s verdict should be reversed because Turner failed to prove their allegedly negligent failure to perform a pre-surgery CT scan caused Allen’s injuries and death. We disagree.

[6, 7] As our Supreme Court has explained, a person "professing to practice surgery or the administering of medicine for compensation must bring to the exercise of his profession a reasonable degree of care and skill."¹¹ Indeed, any injury resulting from "a want of such care and skill shall be a tort for which a recovery may be had."¹² Importantly, three essential elements to establish liability in a medical-malpractice action have emerged from OCGA § 51-1-27: "(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."¹³

[8] And because medical malpractice is a civil cause of action, a plaintiff "must prove liability (i.e., duty, negligence, proximate cause) by a preponderance of the evidence."¹⁴ In this respect, the Supreme Court of Georgia has explained that "[p]roof by a preponderance simply requires that the evidence show that something is more likely true than not."¹⁵ Similarly, many federal courts—including the Supreme Court of the United States and the Eleventh Circuit—have "explained that the burden of showing something by a ‘preponderance of the evidence’ simply requires the trier of fact to believe that the existence of a fact is more probable than its nonexistence."¹⁶

[9, 10] Additionally, we have held that to recover in a medical-malpractice case based on wrongful death, a plaintiff "must show not only a violation of the applicable medical standard of care but also that the purported violation or deviation from the proper standard of care is the proximate cause of the injury sustained."¹⁷ And significantly, to satisfy this burden, the plaintiff must "use expert testimony because the question of whether the alleged professional negligence caused the plaintiff's injury is generally one for specialized expert knowledge beyond the ken of the average layperson."¹⁸ But questions regarding causation are "peculiarly questions for the jury except in clear, plain, palpable and undisputed cases."¹⁹

[11–14] Particularly relevant here, in Georgia, medical causation must "be proved to a reasonable degree of medical certainty and cannot be based on mere speculation, and the evidence must provide more than a mere or bare possibility that the alleged negligence caused the plaintiff's injury."²⁰ So, the expert’s testimony "must show as an evidentiary threshold that [his or her] opinion regarding causation is based, at the least, on the determination that there was a reasonable probability that the negligence caused the injury."²¹ But a reasonable degree of medical certainty, "while an acceptable means by which an expert may express the confidence he or she has in the conclusion formed and the probability that it is accurate, is not the required standard."²² To the contrary, Georgia law requires only that "an expert state an opinion regarding proximate causation in terms stronger than that of medical possibility, i.e., reasonable medical probability or reasonable medical certainty."²³

[15–18] Put another way, in providing an opinion in a medical-malpractice case, an expert "need not use the magic words reasonable degree of medical certainty, but the facts in the record must be sufficient to meet the legal standard embodied in those ‘magic words.’ "²⁴ Indeed, in presenting an opinion on causation, the expert is "required to express some basis for both the confidence with which his conclusion is formed, and the probability that his conclusion is accurate."²⁵ There must be, then, a "realistic assessment of the likelihood that the alleged negligence caused the injury or death."²⁶ And as we have previously explained, "perhaps nothing in medicine is absolutely certain, but the law intends that if the plaintiff's...