Nurse Causation: Adventist v. Mattingly 2
The Baltimore Medical Malpractice Lawyer Blog discusses legal issues in Maryland medical malpractice cases. In part 2 of this Blog post below, I will discuss an issue involving expert testimony on the causation of a nurse’s conduct. The case is the reported opinion by the Court of Special Appeals in Adventist Healthcare, Inc. v. Mattingly, 244 Md. App. 259 (2020).
In part 1, I discussed the defendants’ assertion that a mother’s cremation of her son constituted spoliation of evidence.
Factual Background
The plaintiff died five days after a procedure to reverse his colostomy. Afterward, his mother filed a medical malpractice case in the Circuit Court for Prince George’s County. The plaintiff claimed the defendants failed to diagnose and treat a bowel leak promptly following the surgery. Consequently, these failures led to infection and fatal sepsis. (Op. at 1). This post deals with the issue of nurse causation.
The colostomy reversal procedure is known as an anastomosis. This procedure sews back together the two disconnected sections of the colon. There specifically is a risk of a leak at the point of sewing. (Id. at 4).
During the days following the reversal, the plaintiff appeared to be recovering well. Four nights later, his condition deteriorated, and he was in pain. (Id.). He vomited bile, and his stomach was distended and tender. The doctor ordered an x-ray. By 2 ½ hours, the plaintiff had abnormal vital signs. Almost two more hours later, the plaintiff coded and could not be revived. (Id. at 5). The plaintiff would have to establish that had the nurse responded sooner, causation would have been met.
The state medical examiner declined an autopsy, and the plaintiff’s lawyer arranged for a private one. The autopsy preserved samples in the same fashion as one conducted by the state. (Id. at 9). The plaintiff did not tell the defendants that the autopsy was going to be done, and it was not videotaped. The plaintiff was then cremated. (Id. at 10).
The defense moved for summary judgment, arguing that the plaintiff engaged in spoliation of evidence by conducting the private autopsy and then cremating the body. The circuit court denied the motion. (Id. at 10).
Trial
At trial, the plaintiff called a pathologist who testified that, based on a review of all the materials, the plaintiff died from a failed anastomosis. The failure allowed bowel contents into the peritoneal cavity, causing a fatal infection. The plaintiff also put on expert testimony that the defendants breached the standard of care by not responding to the symptoms earlier.
The jury further heard expert testimony from a nurse who testified as to whether the defendant nurse breached the standard of care by failing to properly escalate the situation with the plaintiff by timely calling the Code Blue Team or Rapid Response Team under the hospital Chain of Command policy. The expert testified that it was her expert opinion that the defendant should have invoked the Rapid Response Team by 8:30 am due to the plaintiff’s shortness of breath, abdominal pain, sweating, and “extremely concerning” vital signs. There was also causation testimony that the plaintiff would have lived if he had earlier surgery. (Id. at 10-13). The plaintiff would contend that this satisfied nurse causation.
The jury returned a verdict of $1,350,000 in favor of the plaintiff, which the court reduced to $740,000 under Maryland’s statutory cap on noneconomic damages. The defendants appealed. (Id. at 13).
Court of Special Appeals
The Court of Special Appeals first held that lawful cremation is not an act of destruction or an intent to destroy evidence for purposes of spoliation. (Id. at 19-20). The CSA also held that the circuit court correctly denied the defense’s request for a jury instruction on spoliation. (Id. at 24).
The CSA then turned to the defendant’s argument that the circuit court erred in denying the defense motion for judgment because the plaintiff failed to present expert testimony on the issue of nurse causation. (Id. at 24).
The nurse expert had testified that the defendant nurse should have invoked the Rapid Response team by 8:30 am. The general surgeon expert testified that the plaintiff would have survived if the defendants had done surgery by 10 am. (Id. at 26). The CSA found that this testimony was more than sufficient to establish causation. (Id. at 27). The jury could reasonably infer that activation of the rapid response team by 8:30 am would have resulted in the plaintiff receiving surgery by 10 am. Accordingly, the circuit court did not err in submitting the claim to the jury. (Id.).
Commentary by the Baltimore Medical Malpractice Lawyer on Nurse Causation
The Court of Special Appeals decided this issue correctly. By its name, the rapid response team would get the plaintiff into surgery in less than 90 minutes. Therefore, the nurse’s breach of standard of care testimony combined with the general surgeon’s causation testimony to satisfy the claim.
However, this case highlights the minutiae that medical malpractice lawyers must be concerned with. The lawyer has to ask questions that meet the legal standards and satisfy the legal burdens. This arises in qualifying experts to testify and the “more likely than not” threshold to provide an opinion. It also comes up in satisfying each element of medical malpractice.
The best practice is to map out every standard the lawyer must meet. Prepare detailed questions to meet every burden. In this case, the plaintiff could have avoided this issue. The lawyer could have asked how long the rapid response team would have taken to get the plaintiff into surgery. In doing so, there would have been an express connection between the nurse’s standard of care testimony and the surgeon’s causation testimony. The jury would not have to infer anything.
Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.