Harvard et al. v. John D. Archbold Memorial Hospital, Inc.

Facts

In the case of Harvard et al. v. John D. Archbold Memorial Hospital, Inc., the Plaintiff in a medical malpractice lawsuit appealed the trial court’s grant of summary judgment to the Defendants. The trial court ruled that there was no evidence that any delay in medical care proximately caused the patient’s damages. The Court of Appeals affirmed as there was no evidence that a delay in treatment increased the likelihood of hemorrhage.

At 11:00 AM one morning in July 2014, a friend noticed Donna Harvard could not speak. Donna’s husband arrived home one hour later. He took her to the emergency room at John D. Archbold Memorial Hospital, Inc.

The attending physician ordered a CT scan and lab work when she arrived. They then sought a neurology consultation through their telemedicine company, Specialist on Call (SOC). Their protocol involved a nurse consultation confirming medications, vital signs, and symptoms. A neurologist was usually available for a consultation within 30 minutes.

This neurology assessment is necessary to determine whether tissue plasminogen activator (tPA) treatment is appropriate. A doctor can administer the medication up to four and a half hours after a stroke to break up blood clots and restore blood flow to the brain.

While entering the data, the attending physician noted Donna was improving and starting to speak. The nurse used this information to categorize her case as an “immediate concern” rather than a “high priority.” Donna finished her CT scan and lab work at 1:50 PM.

Over the next 30 minutes, Donna lost her speaking ability and became confused. The attending physician contacted SOC immediately and asked them to expedite. A neurologist contacted the hospital within three minutes and recommended tPA. Donna received it at 3:17 PM. Unfortunately, Donna experienced a hemorrhage and did not survive.

Donna’s husband filed a medical malpractice lawsuit on behalf of himself and as the administrator of the estate. He included an expert affidavit from Dr. Arthur Pancioli, who concluded the tPA delay resulted in Donna’s death.

Defendants included the hospital and SOC. Several doctors were initially named, but the trial court dismissed them in the summary judgment order (Plaintiff did not appeal that part of the decision).

Later, the Defendants took Dr. Pancioli’s deposition. His testimony showed:

• Pancioli acknowledged doctors could administer tPA up to four-and-a-half hours after the onset of stroke symptoms.
• The most common risk of tPA is hemorrhage.
• A treatment delay from hour three after a stroke to hour four increased hemorrhage risk by 0.1 percent
• Pancioli conceded Donna had an ever-present hemorrhage risk due to hypertension.
• Pancioli generally concluded the hospital breached the standard of care when they delayed treatment, thus limiting opportunities for an improved outcome.

The Defendants presented their own expert, Dr. Steven Levine. In his deposition, Dr. Levine stated:

• He agreed that the risk increased by 0.1 percent between hour three and hour four after a stroke.
• The percentage was not clinically significant; essentially, the delay had no effect on hemorrhaging.
• Losing the chance for a better outcome was relevant to the treatment’s efficacy, not the hemorrhage risk.
• There was a 99.9 percent chance she would hemorrhage, even if she received the treatment earlier.
• A published study stated waiting three to four-and-a-half hours was not related to a higher hemorrhage rate.
• Only 30 percent of patients treated with tPA obtained a favorable outcome.

The hospital filed a Motion for Summary Judgment, citing Dr. Levine’s deposition testimony. After review, the trial court granted the motion, stating that Dr. Pancioli’s testimony was too vague to express a reasonable degree of medical certainty or probability necessary to support the proximate cause element.

Plaintiff appealed, stating the testimony established a breach in the standard of care. He concluded by saying the delay damaged brain cells, increased hemorrhage risk, and denied any chances of a better outcome.

Issue and Holding

Was there a genuine issue of material fact regarding the cause of the fatal hemorrhage?

No

Reasoning

Even if a medical provider is negligent, a Plaintiff cannot establish a medical malpractice claim unless the Plaintiff establishes by a preponderance of the evidence that the negligence proximately caused or contributed to cause the Plaintiff’s damages. Harvard, 365 Ga. App. at 174. This burden must be met with expert testimony.

The Court of Appeals stated the issue was whether the Plaintiff met his burden to raise a factual question regarding causation. In his appeal, the Plaintiff argued the question was whether Donna lost the chance of a better outcome due to the tPA delay. Even with the argument framed in that manner, the Court of Appeals held that the Defendants were still entitled to summary judgment. Id. at 174-75.

It concluded there was no genuine issue of material fact because none of the Plaintiff’s evidence met the requirements to advance a medical malpractice claim. Specifically, the evidence showed:

• Both experts agreed that Donna died of a hemorrhage that was a potential risk of tPA, regardless of when the tPA was administered.
• Both agreed there was no clinically significant increase in administering the treatment between hours three and four.
• The Plaintiff’s expert, Dr. Pancioli, admitted that Donna was at high risk for hemorrhage due to hypertension.
• Pancioli also admitted that the risk existed even if she received tPA earlier.
• Pancioli made conclusory and speculative conclusions not supported by evidence.
• Levine presented published studies, which the Plaintiff never disputed.
• Levine and the study he cited concluded the 0.1 percent risk was clinically insignificant, and any treatment delay did not impact the likelihood of hemorrhage. Id. at 175-76.

Conclusion

Medical malpractice claims are frequently a battle of experts. While the standard of care is frequently what lawyers immediately focus on when screening a case, it is just as important to analyze causation. Even if a medical provider was negligent, the failure to prove causation can result in the case being dismissed (and even if it is not dismissed a weak causation argument will likely fail before a jury).

When reviewing a medical malpractice case, make sure to analyze all elements, including causation. When finding experts and working it up, make sure that you have strong causation arguments that will both survive a motion for summary judgment and be likely to prevail before a jury.

To learn more about The Champion Firm and the personal injury practice areas we cover, visit our main website here. If you’re an attorney seeking to refer a case or partner with us as co-counsel, please reach out here.

Citation: Harvard et al. v. John D. Archbold Memorial Hospital, Inc., A22A0960 (Ga. Ct. App. Aug. 25, 2022)