ISSUE: In this extraordinary California case, the operation was a success, but the patient died! After undergoing renal surgery, a patient was doing so well that when it was learned that there were no beds available in the hospital’s ICU, an order was issued to transfer the patient to the hospital’s cardiac observation unit. When the patient had a heart attack and died, the issue with which California courts were confronted was whether or not the negligence of the hospital staff and the physicians who ordered the transfer were responsible for the patient’s death. Specifically, the issue before the courts was whether or not the case could be decided on the defendants’ motion for summary judgment.
CASE FACTS: 76-year old Carl Elkins was diagnosed with renal carcinoma and possible lung metastasis and anemia. He was admitted to San Dimas Community Hospital in mid-May 2001 for removal of his right kidney. Surgery was performed on the morning of May 16, 2001, by Dr. Ghassan Roumani. Dr. Hasmuk Joshi was the anesthesiologist. Although surgery was completed without any complications, Dr. Roumani wrote an order for the patient to be placed in the Intensive Care Unit (ICU) following the patient’s initial recovery in the post-anesthesia care unit. However, after being advised that there were no available beds in the ICU, and taking into the account the patient’s apparently stable condition, Dr. Joshi authorized the patient to be transferred from the post-anesthesia unit directly to the cardiac observation unit instead of the ICU. The patient arrived in the cardiac observation unit shortly before noon. Approximately four hours later, the patient’s heart rate dropped dramatically. A code was called. The emergency room physician on duty responded, but was unable to resuscitate the patient. The patient was pronounced dead at 4:28 pm. The cause of death was listed as pulmonary embolism. However, there was a question as to whether the patient died as a result of a heart attack. The patient’s surviving spouse and daughter brought suit against the hospital, Dr. Roumani, and Dr. Joshi asserting that the postoperative transfer of the decedent to the cardiac observation unit (with a patient-to-nurse ratio 6:1) rather than the ICU (with a patient-to-nurse ratio of 2:1) following the surgery failed to meet the applicable standard of care and directly contributed to the patient’s death. The Superior Court, County of Los Angeles, granted the defendants’ motion for summary judgment. The plaintiffs appealed the judgment of the court.
COURT’S OPINION: The Court of Appeal of California reversed the judgment of the lower court and remanded the case to the Superior Court for trial. The court held, inter alia, that the plaintiffs had established an issue of material fact as to causation.
LEGAL COMMENTARY: A motion for summary judgment is properly granted only after “all the [evidence] submitted show[s] that there is no triable issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” An Appellate Court reviews the granting of summary judgment de novo and independently decides whether the facts do or do not present a triable issue of fact warranting a trial as a matter of law. The court observed that although one of the expert witnesses stated that he could not be certain that the patient died from a heart attack, neither the hospital nor Dr. Joshi presented any evidence that the plaintiffs did not possess and could not reasonable obtain evidence that the negligence of the hospital and the anesthesiologist, was a significant factor in causing the patient’s death. Accordingly, the court concluded that the defendants failed to meet their burden to show that the plaintiffs could not establish the required elements of their negligence claim. The court observed that even it were to agree that the defendants’ prima facie showing was sufficient to shift the burden to the plaintiff on summary judgment, the trial court erred in concluding that the plaintiff’s expert medical witnesses’s deposition testimony failed to create a triable issue of fact as to causation. The court noted that plaintiffs’ expert witness testified that the patient died as a result of a heart attack and that, to a reasonable medical probability, he would not have suffered the fatal heart attack if he had been in the ICU rather than in the direct observation unit. Early detection would have allowed for diagnoses and treatment. The court observed that while the plaintiffs’ expert initially testified that he could not state to a reasonable degree of medical probability that the patient died as a result of a heart attack, he later testified, “I would say that of all the possible reasons for his death, including pulmonary embolism, and stroke, and heart attack, that most likely with the most probability, is heart attack.” The court noted that the plaintiffs’ expert, on cross-examination by the defendants’ attorney concluded that “… to a reasonable medical probability, it was a myocardial infraction [heart attack].” Thus, the case could not be decided on a motion for summary judgment.
