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Georgia Court of Appeals Affirms Denial of Summary Judgment on Causation – Health Law and Regulation Update Blog Post by Eric Frisch

Health Law and Regulation Update Blog Post by Eric Frisch.

A panel of the Georgia Court of Appeals has affirmed the denial of summary judgment, holding that the plaintiffs presented a jury question on whether the failure to follow chest pain protocols in an emergency department were the proximate cause of the patient’s death from an acute myocardial infarction.

The patient presented to the emergency department on July 26, 2014 by ambulance for complaints of vomiting and chest pain radiating into his left arm. The patient did not complain of chest pain in the ED. A nurse ordered an EKG and troponins. The computer report of the EKG read “borderline,” but the physician over-read was “no ischemic changes.” Likewise, the troponins were within normal limits.

The hospital’s policies and procedures required a provider assign all emergency patients to one of four tracks and the nurses are to follow orders for that track. If the patient has not been assigned to a track, the nurses are supposed to ask a provider to assign a track. Chest pain patients were to be assigned to tracks 1, 2, or 3 if the pain was suspected to be cardiac. For tracks 1, 2, or 3, the protocol called for serial EKGs and enzymes. In this case, the patient was not assigned to a track and the nurses did not request the physician do so.

The physician assessed the patient and discharged him based on the negative results in the ED and the report of a recent negative stress test. Although the patient had risk factors including high cholesterol, COPD, and a family history of coronary artery disease, among other things, the physician discharged the patient. The patient died the following morning at home of an acute myocardial infarction.

The hospital moved for summary judgment on the grounds that the nurse’s alleged negligence was not the proximate cause of the patient’s discharge. The emergency physician testified that he would have discharged the patient even if the nurse had questioned his decision. The trial court denied the motion, ruling that the “totality of the circumstances” surrounding discharge created a fact dispute for the jury. The Court of Appeals affirmed.

The Court held that because plaintiff has presented testimony from a nurse expert that the defendant nurse failed to ensure that the patient was assigned to a track or go up the chain of command, this “caused and/or contributed” to the death. The Court also held that because a physician expert witness testified that the discharge “almost certainly” led to the patient’s death, a jury question was created on proximate cause. The Court distinguished other cases in which the treating physicians testified they would have made the same decision even if they had been given other information because “there is evidence suggesting that the patient warranted care his treating physician did not provide him.” Because there was testimony that if the nurse had done things differently, “that would have made it more likely” for the patient to receive the care he needed from the physician, there was a fact dispute on causation.

Take-home: This is a pretty fact-specific case and without more detail from the opinion, it is hard to pin down specifically why the hospital’s arguments failed other than the general rule that questions of proximate cause are typically jury questions, especially when there is some evidence in the record.

The case is Evans v. The Medical Center of Central Georgia, 2021 WL 2450374 (2021).