Singing River Health Sys. v. Brand

380 So.3d 282

SINGING RIVER HEALTH SYSTEM, Appellant

v.Amy BRAND, Individually and as Administratrix of the Estate of Debbie Edwards, Deceased, and on behalf of all Wrongful Death Beneficiaries of Debbie Edwards, Deceased, and April Kattawar, Appellees

NO. 2022-CA-00090-COA

Court of Appeals of Mississippi.

07/18/2023

Rehearing Denied November 7, 2023

JACKSON COUNTY CIRCUIT COURT, HON. FORREST A. JOHNSON JR., JUDGE

ATTORNEYS FOR APPELLANT: BRETT K. WILLIAMS, WILLIAM ROBERTS NORMAN

ATTORNEYS FOR APPELLEES: BENJAMIN NOAH PHILLEY, Ridgeland, NELSON W. WAGAR III, SARA WAGAR HICKMAN

BEFORE CARLTON, P.J., WESTBROOKS AND McCARTY, JJ.

McCARTY, J., FOR THE COURT:

¶1. A patient died from a stomach bleed after she was treated at a hospital. Her family sued the hospital, among others. After a bench trial, the circuit court found the facility breached the standard of care it owed to the patient. Finding no error on appeal, we affirm.

BACKGROUND

¶2. The facts of this case are not contested. Debbie Edwards was admitted to Singing River Hospital in Ocean Springs on May 27, 2018. She was suffering from weakness and passing bloody stool.

¶3. The next day, Debbie underwent a procedure called an esophagogastroduodenoscopy, or EGD, to diagnose and treat problems in her upper gastrointestinal tract. The source of Debbie’s GI bleed was traced to a procedure she had years before called a fundoplication. A fundoplication can be used to curtail acid reflux by wrapping part of the stomach around itself and sewing it into place. This procedure had failed, resulting in what the physicians treating Debbie called a Mallory Weiss tear, a rip in her lower esophagus.

¶4. But the EGD didn’t stop Debbie’s bleeding. Over the next few days at the hospital, several more attempts were made to stop it; all told, she would undergo four EGDs during her ten-day stay at Singing River.

¶5. Dr. John McKee, a gastroenterologist, performed the first EGD on May 28, the day after Debbie arrived at Singing River. This procedure resulted in the diagnosis of the tear at the failed fundoplication site. A few days later, on June 1, Dr. McKee performed a second EGD. He described seeing what he thought was "dried up blood that resembled coffee grounds," meaning there was no active bleeding.

¶6. Unfortunately, the day after, a third EGD revealed the bleeding hadn’t stopped. Dr. Srikrishna Patnana, another gastroenterologist, described a "spurting artery, in the failed fundoplication." The doctor clipped the GI tract at the failed fundoplication site with the hope it would stop the bleeding.

¶7. Although the third EGD appeared to be successful, Debbie was still considered "high risk for bleeding." Indeed, the concern was so steep that Dr. Patnana believed she needed a different type of medical care: "should bleeding reoccur, interventional radiology (IR) would have to be consulted to embolize the spurting artery," while relying on the services of a radiologist. In other words, if the EGD approach to the GI bleed wasn’t working, the hospital should try the IR treatment to stop the bleed.

¶8. Over the next few days, June 4 and 5, Debbie’s health began to fluctuate. After June 4, Dr. Stuart Phillips viewed her condition as improved; he moved her out of intensive care. But around 12:30 a.m. on June 5, Debbie’s bleeding resumed. She began to vomit and pass bloody stool. Her daughter Amy Brand had driven to visit her in the hospital and attempted to comfort her. Brand later described the horror of seeing her mother in such a weakened state. Brand took photographs that showed her mother lying in a puddle of blood spread over the bed.

¶9. The nurses on duty flagged the nocturnist, Dr. Jatinder Singh, at 1:12 a.m. At some point, a blood transfusion was ordered but was not initiated until 4:00 a.m. At 5:15 a.m., Dr. Singh was told that Debbie had a low blood-pressure reading, and saline was ordered. Dr. Singh rotated off duty, and Dr. Stuart Phillips came on duty as the hospitalist.

¶10. At 7:00 a.m., not long after clocking in, Dr. Phillips found that Debbie was unstable. As a result, at 7:41 a.m. the doctor ordered an IR embolization.

¶11. But there was a problem. At 8:20 a.m., the hospital staff realized Singing River’s radiologist was on vacation. No one at Singing River could perform the critical operation to stop Debbie’s GI bleed.

¶12. With the patient now bleeding extensively, she was transferred back to ICU. A general surgical consultation was ordered to address the GI bleed. Nearly fifteen minutes later, at 8:41 a.m., the consultation was canceled. Instead, it was decided a fourth EGD should be performed. At 9:00 a.m., Dr. Phillips decided Debbie needed to be transferred to a facility with IR capability to treat the ongoing bleed in her GI tract.

¶13. Dr. Phillips decided on Ochsner Medical Center, which was relatively nearby in New Orleans. By early afternoon, at 1:05 p.m., Ochsner agreed to admit Debbie but didn’t yet have a bed for her. At 4:46 p.m., Dr. McKee performed the fourth and final EGD on Debbie. But during the procedure, the GI bleed became more and more prominent—and then Debbie’s heart stopped. Singing River revived her and abandoned the procedure shortly after 5:00 p.m.

¶14. Even though efforts had been made hours before to transfer her to Ochsner, an ambulance was not called until 6:20 p.m., nearly five hours later. It arrived at 7:08 p.m. and departed Singing River at 8:16 p.m. With her daughter following behind, Debbie arrived in New Orleans at 9:51 p.m. But after days of bleeding, she slipped into cardiac arrest and died.

PROCEDURAL HISTORY

¶15. Debbie’s daughters filed a lawsuit in their individual capacities, and Brand also acted on behalf of their mother’s Estate and wrongful death beneficiaries. The hospital did not file a motion to dismiss or for summary judgment, and the case proceeded to a bench trial. Over the three-day trial, Debbie’s Estate called six witnesses: both her daughters, treating physicians Dr. Stuart Phillips and Dr. Jatinder Singh, and retained experts Dr. Stephen W. Landreneau and Dr. Kyle Happel.

¶16. Brand was called to testify first and described her mother, who passed away at age 65, as a very outgoing and family-oriented person. Brand testified that on June 5, when she got to the hospital, her mother was "very nauseous and … kept asking for Phenergan because that’s what helped her with the nause[a]." Brand further testified that she witnessed her mother vomit blood, and Debbie was so afraid that she repeatedly pleaded for someone to help her.

¶17. Debbie’s youngest daughter, April Kattawar, testified next. Kattawar testified that she arrived at Ochsner around 10:30 p.m. on June 5. Upon her arrival, her mother was "coding." She testified that once inside, she was met by a doctor who informed her and her sister that their mother was really sick and that her organs were shutting down; there really wasn’t much that could be done to save her.

¶18. Then Dr. Singh testified, stating he had been on duty on June 4, the night before Debbie died. He recounted how he was notified that in the middle of the night Debbie had begun throwing up blood, passed a bloody stool, and experienced a drop in hemoglobin, which had all been documented in the nurses’ notes:

Patient stated that she had started throwing up blood onto the floor. About 10 cc was caught in emesis bag after throwing up on the floor. Emesis was red in color …. Patient had very large bloody bowel movement during emesis spell. Cleaned and new brief applied.

¶19. Dr. Singh testified he gave Debbie "packed" red blood cells because he believed she was bleeding again. However, Dr. Singh did not consult anyone in the radiology department at this point because he believed she was stable, and "there was no reason to escalate care at that point."

¶20. In marked contrast, Dr. Phillips testified that at the beginning of his shift on June 5, he found that Debbie was terribly unstable. So he ordered the IR embolization at 7:41 a.m., and he agreed when asked if it was obvious to him that Debbie was acutely bleeding and unstable. He testified that "during the seven hours … between then and when [he] took over her care, no medical intervention had been undertaken to stop the bleeding[.]" Moreover, "[t]here was no call to the GI service, Dr. McKee, Dr. Patnana, or anybody else to see about an endoscopy to stop the bleeding." He further testified that the request for the procedure was canceled at 8:20 a.m. because the radiologist would not be available until the following week. Dr. Phillips stated it was at this time that he decided to have the fourth EGD performed. He requested a surgery consultation and for Debbie to be transferred back to ICU.

¶21. He further testified that after the consultation, the general surgeon determined Debbie was not a candidate for surgery. At 9:00 a.m., Dr. Phillips decided Debbie needed to be transferred to another facility with IR capabilities. He also testified that an operating room was requested at 9:49 a.m. to perform Debbie’s fourth EGD, though it was not performed until 3:35 p.m. When asked if he agreed with the Estate’s lawyer that "eleven hours is a pretty long time for someone who’s bleeding and hemorrhaging to be transferred," Dr. Phillips agreed.

¶22. The trial court also heard from both of the Estate’s retained experts. The first was Dr. Stephen Landreneau, an associate professor of clinical medicine at the Louisiana State University Health Science Center. Dr. Landreneau is board-certified in gastroenterology and internal medicine. Dr. Landreneau teaches and supervises endoscopy in his capacity as a professor. He explained to the court that "GI bleeding is a major part of [his] practice and [he] care[s] for these patients almost daily in the hospital." Dr. Landreneau was tendered and accepted, without objection, as an expert in the field of gastroenterology and internal medicine.

¶23. To Dr. Landreneau, it wasn’t the care Debbie actually received...