Monroe v. Rex Hosp. ( 2020 )


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  •                IN THE COURT OF APPEALS OF NORTH CAROLINA
    No. COA 20-27
    Filed: 16 June 2020
    Wake County, No. 18 CVS 3250
    ROBERT E. MONROE, as Administrator of the Estate of NAKA HAMILTON,
    Plaintiff,
    v.
    REX HOSPITAL, INC. d/b/a REX HOSPITAL, REX HEALTHCARE, UNC REX
    HOSPITAL, UNC REX HEALTHCARE, UNC REX HEMATOLOGY ONCOLOGY
    ASSOCIATES and HENRY CROMARTIE, III, M.D., Defendants.
    Appeal by defendant from order entered 24 July 2019 by Judge A. Graham
    Shirley II in Wake County Superior Court. Heard in the Court of Appeals 26 May
    2020.
    Charles G. Monnett III & Associates, by Charles G. Monnett III, and
    Spangenberg Shibley & Liber LLP, by Jeremy A. Tor and Stuart E. Scott, for
    plaintiff-appellant.
    Young Moore and Henderson, P.A., by Madeleine M. Pfefferle and Elizabeth P.
    McCullough, for defendant-appellee.
    YOUNG, Judge.
    This appeal arises out of a medical malpractice claim. Plaintiff failed to show
    causation, and there was no genuine issue of material fact exists. Therefore, the trial
    court properly granted summary judgment. Accordingly, we affirm.
    I.     Factual and Procedural History
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    On 27 April 2016, Naka Hamilton (“Ms. Hamilton”) went to the Rex Hospital
    Emergency Department (“Rex ED”). John Lilley, M.D., (“Dr. Lilley”) was the doctor
    present at Rex ED when Ms. Hamilton arrived. Dr. Lilley called Henry Cromartie,
    III., M.D., (“Dr. Cromartie”). Ms. Hamilton was admitted to Rex and received a
    diagnosis of Thrombotic thrombocytopenic purpura (“TTP”).            TTP can rapidly
    progress and the treatment for it is plasma exchange therapy (“PLEX”). If TTP is left
    untreated, multi-organ failure and death can occur. Without PLEX, the mortality
    rate is 90%. If PLEX is timely administered, the mortality rate is 10%.
    Upon Ms. Hamilton’s TTP diagnosis, Dr. Cromartie recommended a bridge
    therapy treatment be administered to correct her anemia prior to the initiation of
    further treatment. Dr. Cromartie recommended that Dr. Lilley order Ms. Hamilton
    further laboratory tests and believed Ms. Hamilton should receive packed blood cells
    (“PRBC”) and fresh frozen plasma (“FFP”) as her first line of treatment.            Dr.
    Cromartie claims he was not the on-call hematologist on 27 or 28 April 2016, but that
    he agreed to consult on the patient and did not tell Dr. Lilley that he was not on-call.
    After Dr. Cromartie’s conversation with Dr. Lilley, Ms. Hamilton was admitted
    to the Intensive Care Unit (“ICU”) by Rex Hospitalist Ahmed Khan, M.D. (“Dr.
    Khan”). Dr. Cromartie spoke with Dr. Khan at approximately 1:30 a.m. on 28 April
    2016 and provided his recommendations. Dr. Cromartie was not consulted further
    and did not have any further involvement in Ms. Hamilton’s care. Dr. Cromartie
    -2-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    expected transfusions of PRBC and FFP would be completed within five to seven
    hours, which would approximately coincide with shift changes when the morning
    physicians would arrive at the hospital.
    The orders were not entered until 4:40 a.m. on 28 April 2016, the first FFP
    transfusion was not administered until around 9:00 a.m., and the first PRBC was not
    administered until 11:08 a.m. Ms. Hamilton remained at the hospital for more than
    eleven hours after Dr. Cromartie’s conversation with Dr. Khan. She was treated by
    numerous health care providers until she passed on 28 April 2016 at approximately
    2:28 p.m. without receiving PLEX.
    Ms. Hamilton was survived by a one-year-old daughter.         A complaint for
    wrongful death, medical malpractice was filed by Ms. Hamilton’s estate.          The
    complaint named Dr. Cromartie and several other defendants. All defendants except
    Dr. Cromartie have been voluntarily dismissed from the case. Plaintiff called John
    Feigert, M.D. (“Dr. Feigert”) as the only causation expert.
    On 31 May 2019, Dr. Cromartie filed a motion for summary judgment, a motion
    to strike, and a motion to dismiss. The trial court entered an order granting summary
    judgment and dismissed the case based on the defense of superseding negligence.
    Plaintiff filed timely written notice of appeal.
    II.     Standard of Review
    -3-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    “On appeal, the appellate court reviews summary judgments to determine if
    there was a genuine issue as to any material fact and whether the movant is entitled
    to judgment as a matter of law. The standard of review for summary judgment is de
    novo.” Howse v. Bank of Am., N.A., 255 N.C. App 22, 26, 
    804 S.E.2d 552
    , 555 (2017);
    see also Robinson v. Duke Univ. Health Sys., Inc., Inc., 
    229 N.C. App. 215
    , 219, 
    747 S.E.2d 321
    , 326 (2013); N.C. Gen. Stat. § 1A-1, Rule 56 (c)(2019).
    III.   Causation
    Summary judgment is proper when the plaintiff fails to produce sufficient
    evidence of an essential element of a medical malpractice action: applicable standard
    of care, breach of the standard of care, causation, and damages. Weatherford v.
    Glassman, 
    129 N.C. App. 618
    , 621-22, 
    500 S.E.2d 466
    , 468-69 (1998). North Carolina
    courts “rely on medical experts to show medical causation because ‘the exact nature
    and probable genesis of a particular type of injury involves complicated medical
    questions so far removed from the ordinary experience and knowledge of laymen[.]’”
    Day v. Brant, 
    218 N.C. App. 1
    , 11, 
    721 S.E.2d 238
    , 246 (2012) (quoting Azar v.
    Presbyterian Hosp., 
    191 N.C. App. 367
    , 371, 
    663 S.E.2d 450
    , 453 (2008)). To hold a
    defendant responsible for injuries, expert medical testimony is necessary to establish
    that defendant’s negligence was a substantial factor, that is, a proximate cause of the
    particular injuries for which plaintiff seeks recovery. See Lee v. Stevens, 
    251 N.C. 429
    , 433-34, 
    111 S.E.2d 623
    , 626-27 (1959).
    -4-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    In North Carolina, the legal definition of proximate cause is:
    a cause which in natural and continuous sequence,
    unbroken by any new and independent cause, produced the
    plaintiff’s injuries, and without which the injuries, would
    not have occurred, and one from which a person of ordinary
    prudence could have reasonably foreseen that such a
    result, or consequences of a generally injurious nature, was
    probable under all the facts as they existed.
    Adam v. Mills, 
    312 N.C. 181
    , 192-93, 
    322 S.E.2d 164
    , 172 (1984) (quoting Hairston v.
    Alexander Tank & Equipment Co., 
    310 N.C. 227
    , 233, 
    311 S.E.2d 559
    , 565 (1984)).
    The natural and continuous sequence of causation may be interrupted or
    broken by the negligence of a second actor. Muse v. Charter Hosp., 
    117 N.C. App. 468
    , 
    452 S.E.2d 589
     (1995); see also N.C.P.I. Civil 102.65 (2016). In analyzing when
    a subsequent negligent act insulates a defendant’s negligence, the North Carolina
    Supreme Court reasoned, “[s]upposing that if it had not been for the intervention of
    a responsible third party the defendant’s negligence would have produced no damage
    to the plaintiff, is the defendant liable to the plaintiff?   This question must be
    answered in the negative, for the general reason that no causal connection between
    negligence and damage is broken by interposition of independent responsible human
    action.” Butner v. Spease, 
    217 N.C. 82
    , 87, 
    6 S.E.2d 808
    , 811 (1940).
    If a second actor’s conduct creates a “new cause, which intervenes between the
    original negligent act and the injury ultimately suffered” and “breaks the chain of
    causation set in motion by the original wrongdoer”, the second actor becomes “solely
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    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    responsible for the injury.” Muse, 117 N.C. App. at 476, 452 S.E.2d at 595. “The
    doctrine of insulating negligence is an elaboration of a phase of proximate cause.”
    Hampton v. Hearn, __ N.C. App. __, __, 
    838 S.E.2d 650
    , 655 (2020) (internal quotes
    omitted) (citing Clarke v. Mikhail, 
    243 N.C. App. 677
    , 686, 
    779 S.E.2d 150
    , 158 (2015)
    (holding intervening and superseding cause is an extension of proximate cause, which
    the plaintiff bears the burden of establishing). The burden of proof remains on the
    plaintiff to prove the defendant’s conduct was a proximate cause of his injuries and
    the burden is not shifted to the defendant to prove that his negligence, if any, was
    insulated by the negligence of another. Hampton, __N.C. App. at __, 838 S.E.2d at
    655.
    IV.   Intervening and Superseding Cause
    For an intervening cause to insulate an original negligent actor of liability the
    “cause must be an independent force which turns aside the natural sequence of events
    set in motion by the original wrongdoer and produces a result which would not
    otherwise have followed, and which could not have been reasonably anticipated.”
    Muse, 117 N.C. App. at 476, 452 S.E.2d at 595. “The test by which the negligent
    conduct of one is to be insulated as a matter of law by the independent negligent act
    of another, is reasonable unforeseeability on the part of the original actor of the
    subsequent intervening act and resultant injury.” Adams v. Mills, 
    312 N.C. 181
    , 194,
    
    322 S.E.2d 164
    , 173 (1984). Therefore, “in order for the conduct of the intervening
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    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    agent to break the sequence of events and stay the operative force of the negligence
    of the original wrongdoer, the intervening conduct must be of such nature and kind
    that the original wrongdoer had no reasonable grounds to anticipate it.” 
    Id.
     North
    Carolina rejects the rule that “subsequent medical treatment is foreseeable as a
    matter of law.” Barber v. Constien, 
    130 N.C. App. 380
    , 384, 
    502 S.E.2d 912
    , 915
    (1998).
    The trial court can declare whether an act was the proximate cause of an injury
    when there is such little evidence as to warrant an inference of proximate cause. Lee,
    
    251 N.C. 433
    -43, 
    111 S.E.2d at 627
     (“We may say with certainty that evidence which
    merely shows it possible for the fact in issue to be as alleged, or which raises a mere
    conjecture that it was so, is an insufficient foundation for a verdict, and should not be
    left to the jury”).
    V.     Analysis
    In this case, there is no evidence that the subsequent negligence was directly
    related to or dependent upon Dr. Cromartie’s alleged negligence. Plaintiff’s only
    causation expert, Dr. Feigert, testified that the negligent delay in administering the
    blood products redirected the natural sequence of events set in motion by Dr.
    Cromartie’s recommendation and produced a result that would not have otherwise
    occurred.
    -7-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    Furthermore, there is no evidence that the negligent delay in the
    administration of blood products was related to or dependent upon Dr. Cromartie’s
    alleged negligent failure to immediately order PLEX or to more adequately convey a
    sense of urgency to Dr. Khan. Dr. Cromartie was entitled to presume and act upon
    the presumption that Ms. Hamilton’s subsequent health care providers would comply
    with their duty to treat her according to the applicable standard of care. See Weavil
    v. Myers, 243 N.C.386, 391, 
    90 S.E.2d 733
    , 737 (1956); Barber, 
    130 N.C. App. at 384
    ,
    
    502 S.E.2d at 915
    .
    Dr. Cromartie does not dispute that he did not order PLEX upon his initial
    consultation, but rather ordered PRBC and FFP to correct Ms. Hamilton’s anemia,
    nor does he dispute Dr. Feigert opined those actions were a breach of standard of
    care. Rather, Plaintiff is unable to prove that Dr. Cromartie’s alleged negligence
    proximately caused Ms. Hamilton’s death.
    Dr. Feigert expected all orders for Ms. Hamilton to be “STAT” orders based on
    her admission to the ICU. Furthermore, Dr. Feigert’s expected time frame within
    which it would be reasonable for PRBC and FFP to be prepared and transfused is
    consistent with Dr. Cromartie’s expectation and the other Rex physicians. Dr. Feigert
    opined that it was a breach of the standard of care to order blood products as a bridge
    to PLEX, but if bridge therapy was the plan, then it was reasonable to anticipate the
    -8-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    blood products would have been administered within the time frame Dr. Cromartie
    expected.
    Therefore, the evidence shows that the delay in the administration of blood
    products was not reasonably foreseeable to Dr. Cromartie. Dr. Feigert also opined
    the result would have been different if the natural sequence of events had occurred
    according to Dr. Cromartie’s reasonable expectation and no delay in the
    administration of the blood products intervened.           Plaintiff contends that Dr.
    Cromartie’s recommendation would not permit the team to begin to mobilize until
    8:00 a.m. and PLEX not to be initiated until 4 p.m., which is past the point of no
    return. However, this is contrary to the evidence in the record, most importantly the
    testimony of Plaintiff’s only expert witness designated to offer causation opinions.
    Dr. Feigert testified that not only would Ms. Hamilton more likely than not have
    survived if Dr. Cromartie’s expectation had come to fruition, but also that Ms.
    Hamilton more likely than not would have survived if the blood products had been
    administered in a timely fashion.
    Here, the hospital’s failure to administer the ordered blood products was an
    independent force, at least two steps removed from Dr. Cromartie, such that he could
    not have foreseen its occurrence.      Plaintiff’s causation expert opined it was not
    foreseeable to Dr. Cromartie that the blood products ordered by Dr. Khan would not
    be provided and Ms. Hamilton’s death would result.
    -9-
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    North Carolina law clearly establishes that Dr. Cromartie is “not bound to
    anticipate negligent acts or omissions on the part of others”, so he was entitled to
    presume and to act upon the presumption that the individuals caring for Ms.
    Hamilton would perform their duties. Weavil, 
    243 N.C. at 391
    , 
    90 S.E.2d at 737
    . As
    such, it was not reasonably foreseeable that the blood products would not be timely
    and efficiently administered, thereby delaying the initiation of PLEX past the point
    of no return.
    The delay in the administration of blood products redirected the natural
    sequence of events set in motion by Dr. Cromartie’s recommendation. Plaintiff did
    not dispute this. Plaintiff also did not address his own expert’s testimony that the
    delay redirected the sequence of events set into motion by Dr. Cromartie such that
    Ms. Hamilton died, a result that would not have followed.
    Plaintiff failed to establish a prima facie case because he did not prove that Dr.
    Cromartie’s alleged negligence was a proximate cause of Ms. Hamilton’s death. The
    independent and unforeseeable negligent delay in the administration of the blood
    products redirected the natural sequence of events set in motion by Dr. Cromartie’s
    recommendation and caused Ms. Hamilton’s death, which would not have otherwise
    followed. Without proving proximate cause, Plaintiff cannot prove causation, and
    therefore, cannot prove medical malpractice. There is no genuine issue of material
    - 10 -
    MONROE V. REX HOSPITAL, INC.
    Opinion of the Court
    fact. Accordingly, summary judgement was properly granted, and the trial court’s
    order is affirmed.
    AFFIRMED.
    Judges BRYANT and TYSON concur.
    - 11 -
    

Document Info

Docket Number: 20-27

Filed Date: 6/16/2020

Precedential Status: Precedential

Modified Date: 7/29/2024