Siegel v. Ringer

[Cite as Siegel v. Ringer, 2017-Ohio-6969.]
IN THE COURT OF APPEALS
FIRST APPELLATE DISTRICT OF OHIO
HAMILTON COUNTY, OHIO
DANIEL SIEGEL, : APPEAL NO. C-160659
TRIAL NO. A-0907503
and :
FRANCES B. SIEGEL, Individually :
and as Administratix of the Estate of O P I N I O N.
Jessica Ann Siegel, :
Plaintiffs-Appellants, :
vs. :
ANDREW JOEL RINGER, M.D., :
MAYFIELD CLINIC AND SPINE :
INSTITUTE,
:
TRIHEALTH, INC.,
:
TRIHEALTH INC., TRIHEALTH
LABORATORIES, :
GOOD SAMARITAN HOSPITAL, :
AMIE SMITH, R.N., :
and :
DANIEL R. BECKMAN, M.D., :
Defendants-Appellees. :
Civil Appeal From: Hamilton County Court of Common Pleas
Judgment Appealed From Is: Affirmed
Date of Judgment Entry on Appeal: July 26, 2017
John H. Metz, for Plaintiffs-Appellants,
Trionna & Vollman, LTD., James P. Triona and Paul J. Vollman, for Defendants-
Appellees Joel Ringer M.D. and Mayfield Clinic & Spine Institute,
OHIO FIRST DISTRICT COURT OF APPEALS
Rendigs, Fry, Kiely & Dennis, Thomas M. Evans and Felix J. Gora, for Defendants-
Appellees TriHealth, Inc., TriHealth Laboratories, Good Samartin Hospital, Amie
Smith R.N., and Daniel Beckman, M.D.
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OHIO FIRST DISTRICT COURT OF APPEALS
ZAYAS, Presiding Judge.
{¶1} The death of one’s child is an unimaginable loss. In reviewing this appeal,
we discharge our duty without passion or prejudice, recognizing that this case originates
from the death of Jessica Siegel at the age of 16, and that she is survived by both of her
parents.
{¶2} Plaintiffs-appellants Daniel and Frances B. Siegel (“Siegels”) appeal from
the trial court’s grant of summary judgment in favor of defendants-appellees Andrew
Ringer, M.D., (“Ringer”), Mayfield Clinic and Spine Institute (“Mayfield”), and
TriHealth, Inc., TriHealth Laboratories, Good Samaritan Hospital, Amie Smith, R.N.,
and Daniel R. Beckman, M.D., (collectively referred to as “Good Samaritan”) in a
medical-malpractice case involving the death of Jessica Siegel. We affirm the judgment
of the trial court, because the medical-malpractice claims and wrongful-death claim
were time barred by the statute of limitations, an autopsy-consent form does not create a
contract, and collateral estoppel prohibited the Siegels from relitigating whether Ringer
engaged in fraud and spoliation.
The Basis of the Law Suit
{¶3} When she was nine years old, Jessica Siegel was diagnosed with an
arteriovenous malfunction (“AVM”), a congenital condition which is an abnormal
tangle of blood vessels in the brain. She had undergone several embolizations to
treat the AVM following her diagnosis. On July 28, 2006, Ringer performed an
embolization, and Jessica was released that day. Ringer performed a second
embolization on August 14, 2006. During this procedure, Jessica suffered a small
perforation to a blood vessel, a known potential complication. In recovery, Jessica
complained of severe headaches and was placed in a medically-induced coma to
manage the intracranial pressure. When the pressure became difficult to treat,
Ringer performed a craniotomy, a procedure to remove a portion of the skull to
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OHIO FIRST DISTRICT COURT OF APPEALS
relieve the pressure. On August 23, 2006, a tracheostomy was performed to assist
her breathing. Jessica developed a fever of 108 degrees which led to a lack of heart
function and cardiopulmonary arrest. She died that evening.
{¶4} Following her death, Ringer suggested that Jessica’s father, Daniel Siegel,
consent to an autopsy because he suspected a clot had broken loose or Jessica suffered
from malignant hyperthermia, a rare, hereditary condition that can be triggered by
anesthesia exposure. Daniel consented, and Amie Smith, R.N., who was not present
during the conversation, gave Daniel an autopsy-consent form. After signing the form,
Daniel left the hospital.
{¶5} Smith filled out the signed autopsy form. She initially checked the box for
a brain autopsy, and Ringer explained the autopsy was to determine whether a genetic
marker existed for the malignant hyperthermia and whether a pulmonary embolism had
occurred. Ringer did not need to have the head or brain autopsied because he had
multiple imaging studies that showed the condition of her brain, so Smith corrected the
form.
{¶6} Dr. Beckman, a staff pathologist at Good Samaritan Hospital, conducted
the autopsy. Before performing the autopsy, he called Ringer to discuss Ringer’s
concern and the limited nature of the autopsy. Beckman performed the autopsy and
received the results from the genetic testing on November 12, 2006. The completed
autopsy report was available on December 8, 2006, and a copy was given to the Siegels
shortly thereafter.
{¶7} In April 2007, the Siegels hired an attorney who requested Jessica’s
medical records for purposes of legal review. In January 2008, Daniel met with Ringer
to discuss the autopsy results.
{¶8} In January 2009, the Siegels filed a medical-negligence, wrongful-death,
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and fraud suit against Ringer and Mayfield. The complaint alleged that defendants
interfered with the contract for the autopsy, intentionally altered a medical record to
avoid liability, and committed fraud and spoliation by ordering a medical record to be
altered. In December 2009, the Siegels filed a complaint against Good Samaritan for
medical negligence and fraud, also alleging that defendants failed to obtain a full and
informed consent for the autopsy and made false representations regarding the autopsy.
{¶9} In both cases, the Siegels claimed that the actions were timely because the
event that started the running of the statute of limitations occurred on December 17,
2008. On that date, the Siegels had deposed Smith and discovered that Ringer had
ordered a limited autopsy instead of a complete autopsy.
{¶10} After the cases were consolidated in 2011, Ringer argued that he was
entitled to immunity under R.C. 2743.02(F) and 9.86 because he was an employee of the
University of Cincinnati. The matter was stayed until the immunity issue was resolved
in the Court of Claims.
The Court of Claims Proceeding
{¶11} In the Court of Claims, the Siegels alleged that Ringer was not entitled
to immunity because their claims arose from Ringer’s deceptive and fraudulent
conduct. Specifically, they alleged that Ringer fraudulently changed the autopsy
form to order a limited autopsy instead of a complete autopsy, failed to notify the
coroner to ensure the autopsy was performed by Good Samaritan, deliberately
destroyed evidence of malpractice, and engaged in spoliation. The Siegels further
alleged that Ringer’s conduct was done with malicious purpose, in bad faith, and in a
wanton or reckless manner.
{¶12} After discovery, the court conducted an evidentiary hearing to determine
if Ringer’s conduct in ordering the limited autopsy constituted fraud, and whether he
acted with malicious purpose, bad faith, or in a wanton or reckless manner. The court
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found that Ringer was entitled to immunity based on the following factual findings:
 Dr. Ringer approached Daniel and requested an autopsy to determine
the cause of Jessica’s death.
 Daniel signed an autopsy authorization form that was blank except for
Jessica’s name. As the nurse was completing the form, she checked
the box for a full autopsy. Ringer corrected her, and she crossed out
full autopsy and checked the correct box.
 Ringer’s correction of the autopsy-consent form did not demonstrate
malice because Ringer was assisting Smith to complete the form in
accordance with his orders.
 The coroner’s office was contacted, and the coroner declined to
perform the autopsy as stated in the hospital discharge summary.
 When Daniel signed the consent form, he assumed a full autopsy
would be done.
 If Ringer were trying to mislead or deceive the Siegels, he would not
have requested an autopsy at all. Ringer requested the autopsy
because he genuinely wanted to determine the cause of Jessica’s
death.
 Ringer did not autopsy the brain because he had numerous imaging
studies that showed the condition of her brain at the time, including
multiple CT scans and angiograms.
 Plaintiffs failed to prove Ringer acted with malicious purpose, bad
faith, or in a reckless manner with regard to his treatment and care of
Jessica.
{¶13} The Siegels appealed to the Tenth District Court of Appeals, which
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affirmed the Court of Claims judgment. See Siegel v. Univ. of Cincinnati College of
Medicine, 2015-Ohio-441, 28 N.E.3d 612 (10th Dist.). In reaching its decision, the Tenth
District Court of Appeals explained that the facts relevant to the immunity issues were
“appellant’s allegations of fraud and spoliation of evidence * * *.” Id. at ¶ 26. The court
reiterated that “[a]ppellants chiefly argue that Dr. Ringer’s decision not to order a
complete autopsy bespoke fraud, spoliation, and other conduct sufficient to avoid
immunity.” Id. at ¶ 40. Ultimately, the court concluded that the evidence supported a
finding that Ringer “did not act with malicious purpose, in bad faith, or in a wanton or
reckless manner during his treatment and care of Jessica.” Id. at ¶ 48. The Siegels
timely appealed to the Ohio Supreme Court, and the court declined jurisdiction. On
March 9, 2016, the Ohio Supreme Court denied the Siegels’ motion for reconsideration.
The Motions for Summary Judgment
{¶14} The case resumed in Hamilton County against Mayfield and Good
Samaritan. Mayfield filed a motion for summary judgment alleging that the claims
were time barred, the Siegels were estopped from arguing that Ringer committed
fraud and spoliation, and the fraud and spoliation claims were medical claims
subject to the one-year statute of limitations. Good Samaritan filed a motion and
supplemental motion for summary judgment alleging that the claims were time
barred, Smith and Beckman did not commit any fraudulent conduct, the Siegels were
estopped from arguing that Ringer committed fraud and spoliation, and the autopsy-
consent form did not create a contractual obligation.
{¶15} With respect to the statute of limitations, Mayfield alleged that the
cognizable event that started the time running was the complication, and the statute
of limitations expired on August 23, 2007, one year after Jessica’s death and the
termination of her minority status. Good Samaritan argued the claims accrued when
the Siegels received the autopsy report in December 2006, or, in the alternative,
when the Siegels read the autopsy report in December 2007.
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{¶16} The trial court granted the motions for summary judgment, finding
that the actions were time barred under the statutes of limitations and the
authorization form to complete an autopsy did not create a contractual obligation.
Finally, the court found that collateral estoppel barred the plaintiffs from alleging
fraud and spoliation since the Court of Claims and Tenth District Court of Appeals
had found that Ringer had not committed fraud and had not acted with malicious
purpose, in bad faith, or in a wanton or reckless manner. This appeal followed.
Statute of Limitations
{¶17} In their first assignment of error, the Siegels claim that the trial court
erred in granting summary judgment because there was a factual dispute as to when
the statute of limitations began to run. Specifically, the Siegels claim the cognizable
even occurred on December 18, 2008, the date that they alleged they discovered that
Ringer fraudulently ordered a limited autopsy instead of a complete autopsy.
{¶18} An appellate court reviews the granting of a summary judgment de
novo. Hillyer v. State Farm Mut. Auto. Ins. Co., 131 Ohio App.3d 172, 175, 722
N.E.2d 108 (8th Dist.1999). Summary judgment is appropriate when, looking at the
evidence as a whole (1) there is no genuine issue as to any material fact, (2)
reasonable minds can come to but one conclusion and that conclusion is adverse to
the party against whom the motion for summary judgment is made, and therefore,
(3) the moving party is entitled to judgment as a matter of law. Civ.R. 56(C); Horton
v. Harwick Chem. Corp., 73 Ohio St.3d 679, 686-687, 653 N.E.2d 1196 (1995). If any
doubts exist, the issue must be resolved in favor of the nonmoving party. Murphy v.
Reynoldsburg, 65 Ohio St.3d 356, 358-359, 604 N.E.2d 138 (1992).
{¶19} The Siegels were required to file the wrongful-death action within two
years of Jessica’s death. R.C. 2125.02(D). With respect to the medical-malpractice
claims, the Siegels were required to file the claims within one year after the cause of
action accrued. R.C. 2305.113(A).
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{¶20} Under the discovery rule, a cause of action for medical malpractice
accrues “when the patient discovers, or, in the exercise of reasonable care and
diligence should have discovered, the resulting injury.” Oliver v. Kaiser Community
Health Found., 5 Ohio St.3d 111, 449 N.E.2d 438 (1983), syllabus. To establish when
a person should have discovered the injury, the court must review the facts to
determine (1) when the injured party became aware, or should have become aware,
of the extent and seriousness of his condition; (2) whether the injured party was
aware, or should have been aware, that such condition was related to a specific
professional medical service previously rendered him; and (3) whether such
condition would put a reasonable person on notice of need for further inquiry as to
the cause of such condition. Hershberger v. Akron City Hosp., 34 Ohio St.3d 1, 5-6,
516 N.E.2d 204 (1987).
{¶21} The accrual of the cause of action depends upon the existence of a
“cognizable event.” “A ‘cognizable event’ is the occurrence of facts and circumstances
which lead, or should lead, the patient to believe that the physical condition or injury
of which she complains is related to a medical diagnosis, treatment or procedure that
she previously received.” Flowers v. Walker, 63 Ohio St.3d 546, 549, 589 N.E.2d
1284 (1992), citing Allenius v. Thomas, 42 Ohio St.3d 131, 538 N.E.2d 93 (1989),
syllabus. “Constructive knowledge of facts, rather than actual knowledge of their
legal significance” is sufficient under the discovery rule. Flowers at 549. The
“cognizable event * * * puts the plaintiff on notice to investigate the facts and
circumstances relevant to her claim in order to pursue her remedies.” Id.{¶22} The Siegels contend that the cognizable event did not occur until they
deposed Smith and learned that Ringer ordered a limited autopsy instead of a
complete autopsy. On the record before us, we conclude the trial court did not err
when it found that the cognizable event could have occurred at the time of the
complication on August 14, 2006, or the death on August 23, 2006, when the Siegels
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requested the autopsy, or when they received the report in December 2006. A
reasonable person should have been aware that the complication and death were
related to medical services rendered to Jessica, especially when Ringer requested an
autopsy immediately after her death. Moreover, the Siegels began a “further inquiry”
when they requested a copy of the autopsy and hired an attorney to review Jessica’s
medical records.
{¶23} It is not necessary for purposes of this appeal to pinpoint exactly when
the cognizable event occurred. The Siegels filed their negligence claims in January
2009 against Mayfield and in December 2009 against Good Samaritan. If a
cognizable event occurred before January 2008 and December 2008, respectively,
the complaints were filed after the expiration of the statute of limitations. There is
no question that a cognizable event occurred by December 2006 when the Siegels
obtained the autopsy report. Accordingly, we find that by December 2006, a
cognizable event occurred that was sufficient to put the Siegels on notice of the need
for further inquiry.
{¶24} The Siegels’ negligence claims filed in January 2009 against Mayfield
and in December 2009 against Good Samaritan are barred by the one-year statute of
limitations pursuant to R.C. 2305.11(A). The wrongful-death action against Mayfield
was also time barred because it was filed more than two years after Jessica’s death.
See R.C. 2125.02(D).
{¶25} The trial court properly determined that the complaints were filed
after the expiration of the statute of limitations. The Siegels’ first assignment of
error is overruled.
Contract Claim
{¶26} In their second assignment of error, the Siegels claim that the trial
court erred in concluding that the authorization to perform an autopsy did not create
a contractual obligation for Good Samaritan. This claim is without merit. The
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existence of an enforceable contract is a prerequisite to a contract claim. An
authorization to complete an autopsy did not create a contractual obligation for Good
Samaritan to conduct the autopsy. See Federman v. Christ Hosp., 1st Dist. Hamilton
No. C-120484, 2013-Ohio-5507, ¶ 14. Consequently, we overrule the Siegels’ second
assignment of error.
Collateral Estoppel
{¶27} In their third and fourth assignments of error, the Siegels argue that
the trial court erred in applying collateral estoppel to bar them from relitigating
whether Ringer’s limitation of the autopsy constituted fraud and spoliation, because
Mayfield was not a party in the Court of Claims and the issues of fraud and spoliation
were not litigated.
{¶28} Collateral estoppel, also known as issue preclusion, provides that facts
or issues that were fully, fairly, and necessarily determined in a prior judicial setting
may not be relitigated in a later action, regardless of whether the claims in the two
actions are identical or different. See Ft. Frye Teachers Assn. OEA/NEA v. State
Emp. Relations Bd., 102 Ohio St.3d 283, 2004-Ohio-2947, 809 N.E.2d 1130, ¶
10, citing Krahn v. Kinney, 43 Ohio St.3d 103, 538 N.E.2d 1058 (1989). Collateral
estoppel applies when (1) the party against whom estoppel is sought was a party to
the prior action; (2) there was a final judgment on the merits in the prior action after
a full and fair opportunity to litigate the issue; (3) the issue was decided and was
necessary to the final judgment; and (4) the issue was identical to the issue involved
in the new action. Mitchell v. Internatl. Flavors & Fragrances, Inc., 179 Ohio
App.3d 365, 2008-Ohio-3697, 902 N.E.2d 37, ¶ 14 (1st Dist.).
{¶29} The Siegels first argue that collateral estoppel does not apply because
Mayfield and Good Samaritan were not parties to the Court of Claims action. That
argument is contrary to the application of collateral estoppel, because Mayfield and
Good Samaritan are seeking to assert the doctrine against the Siegels. Therefore, the
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question is whether the Siegels were a party to the prior action, and the Siegels were
parties to the Court of Claims action.
{¶30} Next, the Siegels argue that the only issue adjudicated in the prior
action was whether Ringer was entitled to immunity. In the prior proceeding, the
Siegels argued that Ringer had engaged in fraud and spoliation by limiting the
autopsy, and as a result, was not entitled to statutory immunity. They further argued
that Ringer had acted with malicious purpose, in bad faith, or in a wanton, reckless
manner by changing the autopsy consent form. “Bad faith” is defined as “involving
actual or constructive fraud or a design to mislead or deceive another.” Siegel, 2015-
Ohio-441, 28 N.E.3d 612, at ¶ 31. In order to determine whether Ringer was entitled
to immunity, the court had to decide if Ringer had committed fraud.
{¶31} The premise of the Siegels’ fraud claim is that Ringer altered the
autopsy form to conceal evidence of malpractice. However, both the Court of Claims
and the Tenth District Court of Appeals found that Ringer did not engage in fraud or
spoliation in limiting the autopsy. Both courts concluded that Ringer instructed
Smith to complete the autopsy form in accordance with his orders, the purpose of the
autopsy was to determine the cause of death, Ringer did not mislead or deceive the
Siegels, and Ringer did not act with malicious purpose, in bad faith, or in a wanton or
reckless manner.
{¶32} In order to prove fraud, the Siegels must show “(a) a representation or,
where there is a duty to disclose, concealment of a fact, (b) which is material to the
transaction at hand, (c) made falsely, with knowledge of its falsity, or with such utter
disregard and recklessness as to whether it is true or false that knowledge may be
inferred, (d) with the intent of misleading another into relying on it, (e) justifiable
reliance upon the representation or concealment, and (f) a resulting injury
proximately caused by the reliance.” Wiley v. Good Samaritan Hosp., 1st Dist.
Hamilton Nos. C-030131 and C-030181, 2004-Ohio-763, ¶ 9, quoting Burr v. Stark
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Cty. Bd. of Commrs., 23 Ohio St.3d 69, 491 N.E.2d 1101 (1986), paragraph two of the
syllabus.
{¶33} Because the issue of whether Ringer altered the autopsy form in an
attempt to deceive or mislead the Siegels was directly litigated and decided in the
previous action, the trial court correctly applied collateral estoppel to prevent the
Siegels from relitigating whether Ringer had altered the autopsy form to mislead the
Siegels. Accordingly, we must overrule the Siegels’ third and fourth assignments of
error.
Denial of Motions
{¶34} In their fifth assignment of error, the Siegels claim that the trial court
abused its discretion by denying their motion to compel discovery and their motion
to postpone consideration of the summary-judgment motions to allow for adequate
discovery. Specifically, the Siegels sought additional discovery regarding the
alteration of the autopsy form. We cannot say that the trial court abused its
discretion, because the Siegels were provided ample opportunities for discovery,
including taking depositions of Ringer, Smith, and Beckman.
{¶35} Moreover, the Tenth District Court of Appeals rejected this argument
when the Siegels alleged that the Court of Claims had unreasonably restricted
discovery in that action. The Tenth District found that the Siegels had been allowed
to depose Ringer regarding the allegations of fraud and spoliation. Siegel, 2015-
Ohio-441, 28 N.E.3d 612, at ¶ 26. And, in fact, the Court of Claims afforded the
Siegels “wide berth in seeking information” to support the allegations of fraud and
spoliation by Ringer. Id. Accordingly, we overrule this assignment of error.
Constitutionality of the Immunity Statutes
{¶36} In their sixth and final assignment of error, the Siegels argue that the
immunity statutes unconstitutionally deprived them of the right to a jury trial in the
Court of Claims. The Siegels raised this exact issue in their appeal to the Tenth
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District Court of Appeals. The court overruled the assignments of error, concluding
that the Siegels had waived the issue by failing to request a jury or object to the
statutory scheme in the Court of Claims. Id. at ¶ 20. The court further found that
the Ohio Supreme Court had rejected the Siegels’ arguments in Conley v. Shearer, 64
Ohio St.3d 284, 595 N.E.2d 862 (1992). Id. Because this issue was litigated and
decided by the Tenth District Court of Appeals, the Siegels are collaterally estopped
from relitigating the issue. See Mitchell, 179 Ohio App.3d 365, 2008-Ohio-3697, 902
N.E.2d 37, at ¶ 14. Therefore, we must overrule this assignment of error.
{¶37} The judgment of the trial court is affirmed
Judgment affirmed.
MYERS and MILLER, JJ., concur.
Please note:
This court has recorded its own entry this date.
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