Court Reverses $500K Award After Expert Hospitalist Fails to Meet Lost Chance of Recovery Standard

Court: Court of Appeals of MississippiJurisdiction: FederalCase Name: Univ. of Miss. Med. Ctr. v. Leontyne LittletonCitation: 213 So. 3d 525

In this medical malpractice case, the Circuit Court of Hinds County found the University of Mississippi Medical Center (UMMC) liable under the Mississippi Tort Claims Act for the death of a 29-year-old nursing student who died from a hospital-acquired infection. The court awarded the patient’s mother the maximum statutory-damage award of $500,000.

On appeal, UMMC raised issues regarding the adequacy of the causation testimony provided by the plaintiff’s expert hospitalist. UMMC argued that the trial court erred in finding the expert qualified as a hospitalist, that his opinions were speculative, and that his opinions regarding the patient’s cause of death were contradicted by the autopsy reports. The court of appeals found that the trial court erred in relying on the testimony of the expert hospitalist regarding the proximate cause of the patient’s death, and reversed and rendered judgment in favor of UMMC.

Facts

The patient presented to the emergency room complaining of headache, nausea, and dizziness. While in the emergency room, the patient was given pain killers and diagnosed with a migraine headache. Several days later, the patient complained of neck stiffness and an extreme headache. She was admitted to the University of Mississippi Medical Center (UMMC) where she was given IV pain medication. The next day, the patient was pronounced dead.

The surgical pathologist who performed the patient’s autopsy indicated in her initial report that the patient had “meningoencephalitis, partially treated, probably bacterial etiology.” The patient’s cause of death was reported as cerebral edema secondary to bacterial meningitis. However, the causative organism for her meningitis was unknown because both her pre- and postmortem cerebrospinal fluid cultures were negative. Additional tests were ordered.

The CDC gave a verbal report to the surgical pathologist that the brain-tissue samples were negative for the bacteria neisseria (the bacteria that most commonly cause meningitis), but further tests were being performed to rule out certain viral pathogens. The final report submitted by the CDC stated that the cause of death was “probably viral etiology.”

The Hospitalist Expert

The mother of the deceased patient subsequently filed the present medical malpractice lawsuit against UMMC and retained a board-certified emergency room physician to discuss causation. The physician was qualified as an expert in emergency medicine and hospital medicine. In his expert report, the expert testified that the patient’s death was the result of negligence on the part of the nurses and physician at UMMC.

During the trial, UMMC objected to the designation of the expert as a hospitalist, claiming the expert had no regular experience in treating patients on a hospital floor as opposed to the emergency room. The trial court held that the expert was very much qualified to render an opinion as a hospitalist expert and awarded the maximum for statutory-damages to the plaintiff.

The Appeal

UMCC had appealed that the trial court’s decision, alleging that the trial court erred in allowing an emergency room physician to testify about the standard of care for a hospitalist as well as ICU standards of care claiming the expert was not qualified to do so. UMCC further claimed that the expert had only treated an occasional patient with meningitis on the hospital floor, and the majority of his experience was in treating patients with meningitis in the emergency room only before they are sent to the hospital.

Discussion

The court noted that although the expert testified that UMMC physicians’ failure to provide proper care to the deceased caused her death, he did not explain how UMMC failed to provide supportive care. Furthermore, he could not explain how or why the patient’s transfer to the ICU caused or contributed to her death. The expert merely reported that the standard of care for meningitis was to place the patient in the ICU with proper monitoring. The expert claimed that admitting the patient to the ICU would have saved her life from an unknown cause of death. Yet he offered no specifics on the treatment that she would have received or how monitoring would have saved her life. To prove causation, the expert would have needed to testify about the procedures that should have been adopted to save the patient’s life.

Moreover, there was no evidence that the unnamed lifesaving procedures which the expert suggested would have been successful, because the patient may well have died anyway from the unknown underlying cause of the cardiac arrest. Treatment in the ICU does not guarantee survival. It was mere speculation on the part of the expert that ICU care would have changed the outcome for the deceased, much less increased her probability of survival beyond 50%.

Held

The court found that the trial court erred in allowing the emergency medicine expert to testify as an expert hospitalist. The court could not find that the expert’s testimony met the lost chance of recovery standard.

Under the lost chance of recovery theory, the expert did not offer sufficient evidence to show that, absent malpractice, there was a greater than a 50% chance that a substantially better result would have occurred had the patient been admitted to the ICU. The judgment was rendered in favor of UMCC.