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Girlinghouse v. Capella Healthcare

United States District Court, W.D. Arkansas, Hot Springs Division

September 28, 2016

WILLIAM GIRLINGHOUSE, et al., PLAINTIFFS
v.
CAPELLA HEALTHCARE, et al., DEFENDANTS

          MEMORANDUM OPINION

          Susan O. Hickey United States District Judge

         Before the Court is Defendants' Motion for Summary Judgment. (ECF No. 47). Plaintiffs have filed a response. (ECF No. 52). Defendants have filed a reply. (ECF No. 55). Plaintiffs have filed a sur-reply. (ECF No. 59). Defendants have filed a response to Plaintiffs' sur-reply. (ECF No. 61). The Court finds this matter ripe for consideration.

         BACKGROUND

         This case arises out of an alleged medical malpractice action. On January 27, 2013, Plaintiff William Girlinghouse (“Mr. Girlinghouse”) was admitted into National Park Medical Center (“NPMC”) in Hot Springs, Arkansas, and was diagnosed with pancreatitis. On January 30, 2013, while at NPMC, Mr. Girlinghouse's oxygen saturation percentage began to decrease, reaching a low of 83 percent. He was moved to the ICU later that evening. On January 31, 2013, Mr. Girlinghouse's oxygenation level declined to the 60s range. He was intubated and put on a ventilator. On February 12, 2013, he was extubated. At this time, Dr. Donald Brady found that Mr. Girlinghouse had “mild to moderate” delirium and had suffered a hypoxic-ischemic insult with acute respiratory failure.[1] On February 20, 2013, he was moved out of ICU and was discharged to inpatient rehabilitation on February 26, 2013.

         On January 28, 2015, Plaintiffs William Girlinghouse and Toni Girlinghouse filed this this lawsuit against Defendants Capella Healthcare, Inc. and NPMC Holdings, LLC, [2] alleging that the NPMC nursing staff did not adequately respond to Mr. Girlinghouse's decreased oxygenation levels and refused to call his physician to address the problem. Plaintiffs argue that if NPMC medical staff had intervened and intubated Mr. Girlinghouse before January 31, 2013, he would not have suffered hypoxic ischemic encephalopathy, [3] causing permanent brain damage. Plaintiffs allege that Defendants' negligence caused severe injury that has resulted in past and future mental anguish, permanent physical impairment, medical expenses, life care expenses, lost earnings, and loss of earnings capacity. Plaintiff Toni Girlinghouse also seeks damages for loss of consortium. Defendants have filed the present Motion for Summary Judgment, arguing that there is no genuine dispute as to any material fact and that they are entitled to judgment as a matter of law.

         STANDARD OF REVIEW

         The standard of review for summary judgment is well established. When a party moves for summary judgment, “[t]he court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact, and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); see also Krenik v. County of LeSueur, 47 F.3d 953, 957 (8th Cir. 1995). This is a “threshold inquiry of . . . whether there is a need for trial-whether, in other words, there are genuine factual issues that properly can be resolved only by a finder of fact because they reasonably may be resolved in favor of either party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986); see also Agristor Leasing v. Farrow, 826 F.2d 732, 734 (8th Cir. 1987). A fact is material only when its resolution affects the outcome of the case. Anderson, 477 U.S. at 248. A dispute is genuine if the evidence is such that it could cause a reasonable jury to return a verdict for either party. Id. at 252.

         In deciding a motion for summary judgment, the Court must consider all the evidence and all reasonable inferences that arise from the evidence in a light most favorable to the nonmoving party. See Nitsche v. CEO of Osage Valley Elec. Co-Op, 446 F.3d 841, 845 (8th Cir. 2006). The moving party bears the burden of showing that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law. See Enterprise Bank v. Magna Bank, 92 F.3d 743, 747 (8th Cir. 1996). The nonmoving party must then demonstrate the existence of specific facts in the record that create a genuine issue for trial. Krenik, 47 F.3d at 957. Genuine issues of material fact exist when “there is sufficient evidence favoring the nonmoving party for a jury to return a verdict for that party.” Anderson, 47 U.S. at 249. A party opposing a properly supported motion for summary judgment “may not rest upon mere allegations or denials . . . but must set forth specific facts showing that there is a genuine issue for trial.” Id. at 256.

         DISCUSSION

         Plaintiffs allege Mr. Girlinghouse suffered injury as the proximate result of improper medical care provided by NPMC. Specifically, Plaintiffs allege NPMC's nursing staff failed to adequately respond to Mr. Girlinghouse's decreasing oxygenation levels and refused to call Mr. Girlinghouse's physician to address the issue. Defendants argue that, without expert testimony to support these allegations as required by Arkansas law, Plaintiffs' claim fails to set forth a viable cause of action.

         In a suit based on diversity of citizenship jurisdiction, federal courts apply federal law to matters of procedure and the substantive law of the relevant state. Hiatt v. Mazda Motor Corp., 75 F.3d 1252, 1255 (8th Cir. 1996) (citing Erie R.R. Co. v. Tompkins, 304 U.S. 64 (1938)). In this case, Arkansas is the forum state and the alleged conduct happened in Hot Springs, Arkansas. Therefore, the substantive law of Arkansas applies. Under the requirements of Ark. Code Ann. § 16-144-206(a), the plaintiff in a medical malpractice action must prove “the applicable standard of care; that the medical provider failed to act in accordance with that standard; and that such failure was a proximate cause of the plaintiff's injuries.” Ford v. St. Paul Fire & Marine Ins. Co., 339 Ark. 434, 437, 5 S.W.3d 460, 462 (1992). Regarding the third requirement, this statute imposes the “traditional tort standard of requiring proof that ‘but for' the tortfeasor's negligence, the plaintiff's injury or death would not have occurred.” Id., 5 S.W.3d at 462-63.

         Medical malpractice plaintiffs must present proof on the issue of proximate causation in the form of opinion testimony from a qualified medical expert. Ark. Code Ann. § 16-144-206(a)(3); Ford, 339 Ark. at 437, 5 S.W.3d at 463. It is insufficient for an expert to merely opine that negligence was the proximate cause of the injury. Ford, 339 Ark. at 437, 5 S.W.3d at 463. The expert's opinion must be stated with a reasonable degree of medical certainty or probability. Id. Defendants argue that summary judgment is proper in this case because Plaintiffs have failed to establish the essential proximate cause element through expert testimony.

         Plaintiffs offered three experts on the issue of proximate causation: Dr. Donald Brady, a treating neurologist; Dorothy Cooke, RN (“Nurse Cooke”); and Toni Girlinghouse, RN.[4] Dr. Brady expected to testify “that the negligence described by Toni Girlinghouse and delays in addressing [Mr.] Girlinghouse's decompensation on the day in question resulted in a permanent brain injury.” (ECF No. 47-4). Dr. Brady was deposed on May 20, 2016, where he stated that Mr. Girlinghouse's oxygenation saturation percentage never dropped low enough on January 30, 2013 to cause hypoxic ischemic encephalopathy. He also testified that he believes Mr. Girlinghouse suffered a brain injury on January 31, 2013, and that the brain injury was multifactorial, with factors including hypoxic-ischemic insult, renal insufficiency, prolonged sedation, acute narcotic withdrawal, alcohol withdrawal, environmental factors, sepsis, and multi-organ insult. Defendants argue that Dr. Brady's testimony is insufficient to establish the proximate-cause element of Plaintiffs' prima facie case. The Court agrees. Dr. Brady's testimony did not conclusively state that Mr. Girlinghouse's injuries were proximately caused by the acts or omissions of NPMC's nursing staff. Accordingly, the Court finds Dr. Brady's testimony insufficient to prove proximate cause.

         The Court finds that the only remaining expert opinions offered by Plaintiffs on proximate cause are those of Nurse Cooke and Toni Girlinghouse. Plaintiffs initially designated Nurse Cooke to testify as to the applicable nursing standard of care. Nurse Cooke's expert disclosure report and deposition focused on the nursing standard of care, featuring no opinions on proximate cause. On August 27, 2016, Plaintiffs offered an affidavit from Nurse Cooke in which she opined that Mr. Girlinghouse's brain injury was proximately caused by the nursing care he received while at NPMC.

         Plaintiffs designated Toni Girlinghouse as an expert on the applicable nursing standard of care. On August 27, 2016, Plaintiffs offered an affidavit from Toni Girlinghouse, in which she opined that Mr. Girlinghouse's brain injury was ...


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