Barbara Ann Gibson, of the Estate of Bradley Gibson, and on Behalf of the Wrongful Death Beneficiaries of Bradley Gibson v. Spring View Health & Rehab Center, Inc. D/B/A Spring View Health & Rehab Center ( 2022 )

RENDERED: NOVEMBER 18, 2022; 10:00 A.M.
NOT TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2022-CA-0204-MR
BARBARA ANN GIBSON,
EXECUTRIX OF THE ESTATE OF
BRADLEY GIBSON, AND ON
BEHALF OF THE WRONGFUL
DEATH BENEFICIARIES OF
BRADLEY GIBSON APPELLANT
APPEAL FROM GRAYSON CIRCUIT COURT
v. HONORABLE KENNETH H. GOFF, II, JUDGE
ACTION NO. 17-CI-00119
SPRING VIEW HEALTH & REHAB
CENTER, INC. D/B/A SPRING VIEW
HEALTH & REHAB CENTER;
ADVENTIST HEALTH SYSTEM
SUNBELT HEALTHCARE
CORPORATION; ADVENTIST
HEALTH SYSTEMS/SUNBELT, INC.;
PAMELA GRAY; AND SUN BELT
HEALTH CARE CENTER, INC. APPELLEES
OPINION
AFFIRMING
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BEFORE: CETRULO, COMBS, AND GOODWINE, JUDGES.
COMBS, JUDGE: This case arises from a summary judgment entered in a case
alleging medical negligence and wrongful death. Barbara Ann Gibson, as
Executrix of the Estate of Bradley Gibson, appeals the summary judgment of the
Grayson Circuit Court entered in favor of Spring View Health & Rehab Center,
Inc., (“Spring View”); Sunbelt Health Care Center, Inc.; Adventist Health
Systems/Sunbelt, Inc.; Adventist Health System Sunbelt Healthcare Corporation;
and Pamela Gray, in her capacity as administrator of Spring View. Gibson argues
that the circuit court erred by concluding that she failed to show a causal
connection between the decedent’s care at Spring View and his subsequent death
three weeks later. After our review, we affirm.
On August 12, 2016, Bradley Gibson was admitted to the intensive
care unit at Twin Lakes Regional Medical Center (Twin Lakes or the hospital)
upon the recommendation of his home healthcare provider. Bradley was in fragile
health. He was suffering with advanced dementia; sepsis; acute congestive heart
failure; chronic obstructive pulmonary disease (COPD) exacerbations; and renal
failure. He remained hospitalized at Twin Lakes until he was stabilized one week
later. The hospital’s discharge summary indicated that Bradley continued to suffer
with acute renal failure, acute congestive heart failure, COPD, cellulitis, and
dementia; but the sepsis had resolved. Because Bradley required skilled care
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following his discharge from the hospital, he was admitted directly to Spring View,
a nursing facility located in Leitchfield, Kentucky, on August 19, 2016.
On August 31, 2016, Bradley was diagnosed with (likely) aspirational
pneumonia by Dr. Daniel Butler. Dr. Butler prescribed antibiotics Levofloxacin
and Zyvox -- both of which target a variety of bacterial infections. He also ordered
that a sputum sample be obtained and cultured. Medical charts indicated that
nurses administered the prescribed antibiotics but were unable to obtain a sputum
sample. Although Bradley would cough up mucus, he swallowed before a sample
could be collected. Critically significant to this case is the fact that the nursing
facility staff did not advise Dr. Butler that sputum could not be collected and that
no culture would be available for review. Bradley’s condition improved, and he
was discharged from Spring View on September 5, 2016, in a stable condition.
There is no dispute that Bradley cleared the pneumonia that was diagnosed by Dr.
Butler at Spring View.
At home, Bradley’s primary care provider and home health care
provider resumed his care. His underlying conditions continued to deteriorate,
however. On September 24, 2016, Bradley became unresponsive. He was
intubated by EMS personnel before being taken by ambulance back to the hospital
in cardiopulmonary arrest. At the hospital, Bradley received cardiopulmonary
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treatment and antibiotic treatment for pneumonia. Life support measures became
necessary. Bradley died within twenty-four hours, never regaining consciousness.
On April 7, 2017, Barbara Ann Gibson, Bradley’s widow, filed a civil
action alleging medical negligence and wrongful death. Gibson alleged that the
failure of Spring View employees to provide appropriate medical care caused
Bradley to suffer an “accelerated deterioration of his health.” To support her
claim, Gibson identified Dr. Thomas Cumbo, an infectious disease expert.
During his deposition, Dr. Cumbo explained that his opinion was
based upon a review of Bradley’s medical records. Dr. Cumbo testified that a
sputum culture “improves patient outcomes if a pathogen is identified and
antibiotics can be tailored.” He explained that a sputum sample should be obtained
“within a day or two. Preferably that day.” He indicated that a culture normally
takes another one or two days. He testified that once a course of antibiotics has
begun, however, “the utility of a sputum sample goes down.”
Dr. Cumbo explained that patients with COPD are more likely than
not to develop multi-drug resistant pathogens -- “It’s common knowledge in
medicine that folks with extensive COPD are chronically colonized with
pseudomonas.” He believed that Dr. Butler had sufficient information based on
Bradley’s medical history and symptoms to select the antibiotics that he prescribed
without ordering a sputum collection and culture. Dr. Cumbo specifically agreed
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that the antibiotics that Dr. Butler prescribed “did cover MRSA [Methicillin-
resistant Staphylococcus aureus] and pseudomonas empirically”; and he agreed
that the decision of Spring View to discharge Bradley on September 5, 2016, was
also appropriate. With respect to events leading to Bradley’s death, Dr. Cumbo
explained that Bradley probably developed severe pneumonia within a day or two
of his subsequent admission to the hospital on September 24, 2016, and that the
pneumonia led to septic shock, then organ failure, and ultimately death.
Dr. Cumbo testified that if an aggressive antibacterial therapy had
been initiated immediately upon Bradley’s arrival at the hospital, it would have
helped:
He probably would have survived the sepsis -- the septic
shock episode, or he had a better chance of surviving the
septic shock episode, I should say. . . . No way to know,
but there’s a much better chance that he would have.
Critical to his opinion, Dr. Cumbo explained that Bradley “was given appropriate
antibiotics [both at Spring View and at the hospital], but he wasn’t given
antibiotics that were appropriate for the organism that he ended up growing, which
likely led to his death.” He testified that “had [the hospital] known that [Bradley]
had a multi-drug resistant pathogen, especially pseudomonas, then different
antibiotics would have been given.” Despite the fact that Bradley arrived at the
hospital intubated and in cardiac arrest, Dr. Cumbo believed that “there would be
ample opportunity within a reasonable time frame of admission to get past medical
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records.” And, if the Spring View staff had collected and cultured Bradley’s
sputum before antibiotics were administered on August 31, 2016, information
relevant to his subsequent care three weeks later would have been available to any
hospital staffer who inquired. Dr. Cumbo admitted that there was no indication
that hospital staff attempted to acquire any such information at any point, however.
On May 13, 2020, Spring View filed a motion for summary judgment.
The circuit court granted the motion in part, concluding as a matter of law that
Gibson could not recover punitive damages, damages resulting from pain and
suffering, or medical expenses. All claims against Adventist Health
Systems/Sunbelt, Inc., and Adventist Health System Sunbelt Healthcare
Corporation were dismissed. However, the court denied the remainder of the
motion, explaining that it was unable to conclude that Spring View was entitled to
judgment as a matter of law with respect to the negligence claims.
On November 9, 2021, Gibson filed a motion asking the court to
reconsider its conclusions with respect to the damages sought. A final pretrial
conference was held on December 16, 2021. By order entered on February 7,
2022, the circuit court denied Gibson’s motion. Additionally, the court
reconsidered its earlier conclusion that genuine issues of material fact precluded
Spring View’s motion for summary judgment. Reviewing the record, it concluded
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that Gibson could not show a causal connection between Bradley’s care at Spring
View and his subsequent death. It reasoned as follows:
In discussing [Bradley’s] care at Spring View, Dr. Thomas
Cumbo had only one (1) standard of care criticism: the
failure to obtain a sputum culture as ordered, and the
failure to notify the physician that the order was not
completed. After careful review of Dr. Cumbo’s
deposition, the Court finds the following testimony in
support of granting summary judgment on all claims:
1. Dr. Cumbo testified that the pneumonia from
[sic]which [Bradley] succumbed to was a
different pneumonia than the pneumonia
[Bradley] developed, and was treated for, at
Spring View.
2. Dr. Cumbo testified that [Bradley] “clinically
improved” and agreed that [Bradley] was
appropriately discharged [from Spring View].
3. Dr. Cumbo testified that had the sputum sample
been obtained at Spring View, pseudomonas
and staph aureus would “probably” have been
present.
4. Dr. Cumbo agreed that Dr. Butler’s empiric
medication therapy covered the organisms that
he believed would have grown on the culture
had it been obtained. Dr. Cumbo’s opinion was
summarized in his deposition:
Q: I understand that you believe that if a
culture would have resulted from Spring
View, that information would have been
available to Twin Lakes for its use having to
do with what medications would have been
given to [Bradley], fair?
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A: Yes.
However, there is no evidence in the record that anyone at
[the hospital] made any effort to learn if there was any
type of prior culture, including the one that Dr. Cumbo
testified should have been performed at Spring View. Dr.
Cumbo further testified that the standard of care did not
require Dr. Butler to even order a sputum sample, or for
Dr. Butler to order a blood culture of [Bradley].
Dr. Cumbo identified multiple intervening factors that
dilute any possible causal connection between the sputum
sample/culture at Spring View and [Bradley’s] subsequent
care and death at Twin Lakes, were that testimony not
inadmissible speculation. Dr. Cumbo testified that had it
been known “that he [Bradley] had a multi-drug resistant
pathogen, especially pseudomonas, then different
antibiotics would have been given. So he [Bradley]
wouldn’t have been Levofloxacin and Zyvox, once again.
He [Bradley] would have been given something
presumably that the pseudomonas were sensitive to.” (sic).
First, there is no evidence that, had he been notified of the
inability to obtain a sputum sample from [Bradley], Dr.
Butler would have taken any further steps to obtain one at
Spring View. Instead, Dr. Butler testified that had he been
notified, there would have been no new orders. Second,
the record is void of any evidence that anyone at Twin
Lakes made any effort to learn whether there was a prior
sputum culture at Spring View or attempted to contact
[Spring View or Dr. Butler] to learn of any cultures that
might have been performed. Thus, regardless of whether a
sputum sample was obtained and cultured or not, it could
not have had any impact on [Bradley’s] care at Twin
Lakes or on his outcome. Third, even had someone at
Twin Lakes attempted to obtain information regarding
[Bradley’s] prior admission to Spring View, there is no
evidence that they would have done so prior to [Bradley’s]
death. According to Dr. Cumbo, standard of care required
Twin Lakes to contact prior medical providers within 24
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hours of admission, and unfortunately, [Bradley] passed
away within that same timeframe.
Assuming that information consistent with Dr. Cumbo’s
opinions as to the hypothetical results of a sputum culture
at Spring View was provided within the short timeframe
between [Bradley’s] arrival at Twin Lakes in
cardiopulmonary arrest and his death approximately 24
hours later, antibiotics specific to those bacteria could
have been administered. Dr. Cumbo testified this would
have given [Bradley] a better chance of surviving the
septic shock episode, although he could not quantify that
increased chance. He also agreed that such aggressive
antibiotic therapy would have caused a progression in
[Bradley’s] renal failure, possibly requiring him to
undergo dialysis which itself would have lessened his life
expectancy.
Dr. Cumbo’s testimony is insufficient to establish a
proximate causal connection between the lack of sputum
sample/culture at Spring View and [Bradley’s] death three
(3) weeks later from a different pneumonia and associated
septic shock. This is the only purported breach of standard
of care that Dr. Cumbo attempted to causally link to any
claimed injury or damages, therefore, this matter must be
dismissed.
(Citations omitted.) The court concluded that Spring View was entitled to
judgment as a matter of law. Spring View’s motion for summary judgment was
granted, and the action against it was dismissed. This appeal followed.
On appeal, Gibson’s arguments focus on the court’s dismissal of her
claims for punitive damages, pain and suffering, and medical expenses. She also
contends that the trial court erred by concluding that she could not show a causal
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connection between the failure of Spring View staff to collect and culture sputum
and Bradley’s subsequent death weeks later at the hospital.
We have reviewed and considered those portions of the record upon
which Gibson relies in support of her contention that she can prove causation, and
we are compelled to conclude that the trial court did not err by granting summary
judgment. Because this conclusion is dispositive of the appeal, we do not address
the separate arguments concerning damages.
Summary judgment is properly granted where “the pleadings,
depositions, answers to interrogatories, stipulations, and admissions on file,
together with the affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment as a matter of
law.” CR1 56.03. Because summary judgment involves only questions of law and
not the resolution of disputed material facts, we do not defer to the trial court’s
decision. Goldsmith v. Allied Building Components, Inc., 833 S.W.2d 378 (Ky.
1992). Instead, we review the decision de novo. Cumberland Valley Contrs., Inc.
v. Bell County Coal Corp., 238 S.W.3d 644 (Ky. 2007).
On appeal, Gibson contends that the trial court erred by concluding
that her expert opinion testimony failed to raise a genuine issue of material fact
with respect to the issue of causation. She argues that issues of fact surround the
1
Kentucky Rules of Civil Procedure.
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question of whether failing to collect and culture a sputum sample at Spring View
likely had an impact on Bradley’s subsequent care at the hospital. Spring View
argues that it was entitled to summary judgment because Gibson presented no
evidence to show that sputum could have been collected from Bradley or that Dr.
Butler would have authorized it to be collected through an unreasonably invasive
means; no evidence that hospital personnel would have requested and obtained, on
a sufficiently timely basis, the results of a culture had one been performed at
Spring View; nor evidence to indicate that had sputum been collected and cultured
as ordered, it would have revealed the same bacteria as the sample cultured after
Bradley’s death.
In order to recover under a claim of negligence, a plaintiff must
establish that the defendant owed him a duty of care; that the defendant breached
that duty of care; and that the breach proximately caused the plaintiff’s damages.
Lee v. Farmer’s Rural Elec. Coop. Corp., 245 S.W.3d 209 (Ky. App. 2007)
(citations omitted). Proximate cause is a necessary element of any medical
malpractice claim. Ashland Hosp. Corp. v. Lewis, 581 S.W.3d 572 (Ky. 2019).
The plaintiff must demonstrate that the medical professional’s breach of the
applicable standard of care was a proximate cause of the claimed injury. Jackson
v. Ghayoumi, 419 S.W.3d 40 (Ky. App. 2012). In order to be a sufficient cause of
an injury, the challenged act or omission must be a substantial factor in causing
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the injury. Bailey v. North American Refractories Co., 95 S.W.3d 868 (Ky. App.
2001). Proximate cause must be shown to a reasonable degree of medical
probability rather than mere possibility or speculation. Ashland Hosp. Corp.,
supra.We agree with Spring View that no genuine issue of material fact
precludes summary judgment in this matter. Gibson cannot show that the failure
of Spring View personnel to collect and culture Bradley’s sputum was the legal
cause of his death at the hospital three weeks later.
Dr. Cumbo’s testimony shows that at Spring View, Dr. Butler had a
sufficient basis upon which to develop a plan of treatment for Bradley. According
to Dr. Cumbo, Dr. Butler’s decision to prescribe antibiotics Levofloxacin and
Zyvox -- aimed at fighting a variety of bacterial infections including MRSA and
pseudomonas -- was appropriate empiric therapy. All agree that Bradley’s
condition improved and that he was properly discharged from Spring View. All
evidence indicates that Bradley cleared the pneumonia. No evidence indicates that
Bradley’s treatment at Spring View was impacted by the failure of staff to collect
and culture sputum. In fact, Dr. Butler indicated unequivocally that if he later
learned that attempts to collect sputum through ordinary means had been
unsuccessful, he would not have ordered that it be collected by a more invasive
means. The course of treatment would not have changed.
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Weeks later, Bradley developed pneumonia again. He quickly
became so ill that he became unresponsive. There was a delay in contacting 911,
and he arrived at the hospital in cardiopulmonary arrest. At the hospital, Bradley
received cardiopulmonary treatment and antibiotic treatment for pneumonia. No
evidence suggests that hospital staff was unaware of Bradley’s underlying
conditions and the likelihood -- given his poor state of health -- that he had
developed multi-drug resistant pathogens. Dr. Cumbo never criticized the
antibiotic treatment ordered at the hospital. Nevertheless, it was his opinion that a
more aggressive antibacterial therapy at the hospital would have given Bradley a
better chance of surviving septic shock. He believed that hospital staff would have
made this choice had sputum been collected and cultured at Spring View weeks
earlier so that the hospital staff could have inquired and received the results of the
sputum culture upon Bradley’s second admission to the hospital. This connection
is based upon a high degree of speculation and falls far short of constituting
proximate cause.
The pertinent facts are undisputed in this matter: without breaching
his duty of care, Dr. Butler diagnosed Bradley with pneumonia and ordered a
course of antibiotic treatment to begin before sputum could be captured or
cultured. The introduction of antibiotics interrupted the ability to gather accurate
information about the bacteria growing in Bradley’s body. Despite the failure of
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Spring View staff to collect sputum for culture and their failure to advise Dr.
Butler of that fact, Bradley was successfully treated for pneumonia. Bradley
developed pneumonia at home weeks later, became unresponsive, and suffered
cardiopulmonary arrest before arriving at the hospital for treatment. Bradley’s
treatment at the hospital was appropriate. However, he died when life support
measures were withdrawn within twenty-four hours of his arrival at the hospital.
It cannot be reasonably inferred from these facts that the alleged
breach of the standard of care by Spring View staff was a substantial factor in
bringing about Bradley’s death. Even if we were to acknowledge that Spring View
staff was negligent in failing to collect and culture the sputum and by failing to
alert Dr. Butler of the issue, the evidence presented nonetheless is insufficient to
show that the lack of a culture report was causally connected with Bradley’s death.
Absence of the report did not play a substantial role in the sad outcome of
Bradley’s hospitalization weeks later. Any nexus between the alleged breach of
duty and damages sustained is insufficiently direct and distinct to provide a basis
for liability as a matter of law. It remains at best a matter of conjecture and
speculation.
Because there is no genuine issue of any material fact, the trial court
did not err by concluding that Spring View was entitled to a judgment as a matter
of law. Therefore, we affirm its entry of summary judgment.
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ALL CONCUR.
BRIEFS FOR APPELLANT: BRIEFS FOR APPELLEE:
Stephen M. Garcia Ryan D. Nafziger
Louisville, Kentucky Joseph M. Effinger
Matthew A. Piekarski
Louisville, Kentucky
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