Schmidt V. Linville

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conu ST-'ll.:O~\fAI"L s~' 7''YJOR CT\F\':JZl/\SD_ CIY:r .A.C i'JO'\ Dllcl,e:\c. C\'-11-'57 <0. HE'-JRY ~CI-1\~JDT. A.S PLRSC'-.J".L REPR!'.SL!\ L\ Tl\T 01' ;-HE FS'J.-\l'E OF DORO 1HY SC'H\ f!Tl 1. Pbmull' ORDL2. CORT:-<FY U~\-ll:-LE. D 0., .!\1ELA'\!E RAND_ p 0.,_ -; . · / PARK VIEW ADV-Et.;TIS! MEl:liCAL C:C:_'.fi'E~- A:'fl P.-\RKVJE~Y FA\11L\ HEALTH, Defendants Bctore the court i<> the Plaintiffs Motion for Summary Judgment This case arises from the hospitalu.ations and treatment of Dorothy Schmidt prior to her death. Plaintiff Henry Schmidt, as personal repre'>enlA!ivc tOr the estate of' Domthy Sclumdt, has alleged negligence that allegedly led to Mr<- Schmidt'> death. l'hc case has already proceeded throLigh the mandatory prelitigation screening process ao required pursuant to 24 .\1.R S § Plaintitr, Complaint asserts four n~gligence zg~ 1 ct seg. claim-,; Count I i.l a negligence claim against Dr. Courtney Linville, Parkv1ew AdventJol Medical Center ("'PAMC"), and Parh-iew }amily Health ('·PFH''); Count ll is a negligence daim against Dr. Mclame R;md, PAMC, and PFH; 1 Count Ill is a negligence claim against Dr. \1ar+.hew Mtchtenberg and PA__\1C, and Coilllt IV i' a negligence claim agamsl PAMC. Plan,tiff has mo\'ed for ;>ar'ial sununary judgment against 'Dr ~1echtcnhecg is []0\ a named defendant, beca"•' PA \1C )-."-'stipulated ~hat Dr. Me,hlcnherg wa> ib agent octmg tn lh~ course ar.d sccpe of his employment whon ne treated Mrs Schmidt. pt:rsuantl•> \{JZ. Civ P_ S[,o:dl to . h3\~ l11e ent~r~r.· . o!u-; ;:;.retncm ufmaterie.: :'acts adm1lled as p:e_iudic1al to the parties_ rhc Plaintiffs Mo!!on Cor issu~ ~ummary Judgment is itself on t!le narrow of deYiation irom the otandard of care_ I· or the reasons detailed below, the Plamtiifha' not defimtively established that either Dr Rand or PA..'v!C devmted from the standard of care. The court agrees with Plaintiff's argmnent that many o LDr. Rand's responses failed to ~om ply with .'vtaine Rule of Civil Procedure 5 6(11)(2)_ The court nmes, hem-ever, that th1-; action is distinguishable from Doyle r. [Jepi_ of Human Sen•s , as Dr Rand has managed to raise issues of matenal fact through her properly p1-esemed addi Lional statement of material facl>_ 200} ME 61 , ~ 11. 8:::'4 A.2d 4~. Matcnal facts regarding Mrs. Scltnud!'s condition, th~ standard of care, and whether Dr. Rand adhered thereto or hreaclted arc .ltill in conrrovc"'y This is not an action where 11 is practicable or reason<~hle for the c.(}Urt to make th~ type of findings enYisioned hy Rule 56( d) l. FACTIJ.-'.1, BACKGROlf:\10~ From the e>U!SC!. the court IlOlC> that there is sL:h,tantial dispute particubr between the Plam!i tT and P.'\\1C, the tcsurnony offcr~d reg~rding henv~cn the parties_ m the 'elevant facts in !hiS ca.<e. as \VC!l as h; the treatmg phystctans mvolved m thi.< action. The Plaintiff has 2 design~uon :~) \\de the Plob:1ff. '~<pect '0 the trcaLmg :•h:- sic1ans abo appears narrower 'n "'''P" lhJn descrioc'd ~ummmy judgment" not the approprw;~ ume 'n decide \1-hc'tncr c>.pen ••pinion dcs;gnat1 ons. As a r~sult, .lome ,>f the disputed ic<;timony is omitted from this factual background and a discu"'ion of 'aid te>timony is more appropnatc m a later time. The following facts are gathered from th~ parties' statement<, oJ material facts, opposillons, additional 'latements of material facts, and replies that were properly supported by citations to the record.' 1 On .Tune 24. 2009. \1r, Schmidt visited her physician Dr. Cortncy l.im·ille, to be evaluated for a >cooler. (Pl.'s S.M.F. ~ 1. PAMC O.S.-"1.f_ .- 1 ) At that appointment complained of>hortness of breath. (PI "s S.\f.F. '· l: RanJ O.S.M F_ ~ Dr. Linville ordered a number or Lesl< for l\-lrs. Schm1dL (PL 's S.M.F. \1r<; Sclm1idt l; PIL\1C 0 S_\1 F_ ~~ ~ L) ) The labs showed that Mrs. Schmidt's hemoglobm anJ hematocrll levels were low. (PI·, S.\1.F. • J.) After .<he rece1ved the lab rc.<.ul!.<, Dr. Linville noted m Mrs. Schmidt's 'f,"' r~cord "'LMPTCB [left message ' Tnc court 11ote' the PlamtLff an<' IJr. Rand have attompted w mtrodu:e some mcdJcal reomds "irfloul proper autbelltiCa<ion The Plamtdf" < stmemenl that oert,fi.O cuptc> wJII be ~re,em.O at trial 11 Losufftcient ol the summary :uagmcnt stage Where PAMC has opposed the mtroducMn of1h""' rcccrd,, ti>e) arc not acmL<sible a> to PAM C. 'The cour: TIOle> that the addit.onal >I" tern em oftna<~nal laots pre<On<eli O) Dr Rand atld oppo;cd b; the rlain~JIT on I)' apply to Dr. R•tld, not P AMC, and hkewtse •he atJditiunal statement of tnalcna. faot:; presented by P>\ MC and 0r~osed by the Platn!LIT only apply 10 PAMC. not D' Rand p:.;ierll w c·all aJmi;t~e ba~k_! ,,],:~1: ~rk:Jce>:co need; ctcln,ir.- tcJ 'he hospL<!l (pJ.·_, ():, Jui;· 6 :ri!!'J. !-.-!,-, ~-\1.1. • .::_·: Schru~: \\',:J 5.-, fhc· Fnergcnc;. l<oom Rq'<'rt Jdni:tecl w P.\\[( cJJ' C\ akalior:. cha)!nostic inJ:~des c·C>mp!atnl ":JS s; rnpW~1atJC ancmi.1., and J.J'ebriJc_ U"ni ed f.:\ n or chilk wa' 7 t:mt De : i:Adic w·.m'ed Me.< Schr:ucllt'' Coe that at -h~ ~he ''mG t~at derl!c'd <on; fl;l!lk we!l-appe.1rin~. c,he w:>.s ;Jet in l~-ti"f!- ond ~Umined h~r ~nief N urinar) ') mptOlll>. was aml Ii\·~d indq1cnderElv. {Rand A.S.!d_F ~ i Starting at 5:00p.m. on July 6. Dr. 1\lelanic Rand was t)w on-call covering phys!Cmn m l'AMC (PL's S.M F ~(,)Dr. Rand is a Eunily mCd!Cme practit10ner, and 111 2009 she p~rfm111ed both o!Iice primary care as well as in-patient medicine. (Rand 1\.S.M.F_ 'if 1; Pl.'s R_S.M.F. 1! L) She te.<tified that for overnights the on-call covenng physician wnducts the admission and orders appropriate tests, but the physici~m would only respond to re~ults that are critical ~nough to be brought to the <m-eal! physician-s atlention overnight. (Rand .-\ S.Yi.F . .- 5 _) She sratcJ that the hoi pil:ll ist would take over in the morning and manage the patients' hospital re.<:~lts, she J> ancl repol1 rcsull< to the patient.(R.wcl A.S.M.F wiL~ ~ st~y, look up test 5.) She al.<o stated, however, that if the pallent at the ume, or the patient ts a\\ake. she would report the test rcsull' to the patient; under altenmtivc circumsta.Ttee< whether or not sht' wotild relay the results to the patient wouid depend upon the urgency of the situation. (Pl.'s R.S.M.F. ~ 5) Dr . .'v!ark Rohrer, Plaintd"fs expert witness, opined however, thm the ordcrin,: physicmn remains responsible for l"ollov.-'ln¥-UP on test results ancl thercaiter admimstering appropriate treatment (Pl.· s R.S_M_ F. 5.) 4 ~ __ , _ _ _ _ ,_ " ,--i:m''"'"''l'l"-S\f'' • 8: R<>.nd 0 S \!?. ~41.l_~S.Rnd0 ~ 0: J'_\\JC U.S \LF • 8.'1 D1 Rond->rc·\le\\ oi S\-ff''8) \1 Lk D1. !<and"'" .<til: the' on-cal: COHTnc~ ;-thysJClan_ \frs Sclmmll·, nrinc ,;~::tcplc wos collected ur1 JL:h 7" at 1:45 an. and"-'"" receJ\·d at I :53 a_m_ (Pl.'s S M_F_ ~.- •)-iO)_ Lhe unnal; sis rc'S'~lu wouk ha\< heen avadah le in \he clcctrc>nic hours (Pl.-sS.C\!F rnei1~al ,·ecords "1thin one 1G three ~12.) ·r he unnaly'i' revealed that Mrs. Schmidt's llTine was cloudy, pos!l!ve fm nitrates, cm1tained smallleuk esterase, contained occasional sqllamous cells, containc<l m:my bacteria, and had a whn~ blood ccmnt of 10-20/hpf. {PI's S ..\1.F. ~ 13 as quali!ied by Rand O.S.M.} . .- 13_) In addition, the urinaly>is also wa~ negative for blood. negative for glucose, negative for biluubm, negative for ketone. and ther~ were no red hlood cdls. (Rand O.S ..\f F_ <;' 1 13.) A urine culture was also completed f(Jr Mrs. Schmidt. (Pl.'s" S M.F.\! 17_) A urine culture identifies the types of hacteria prc>~nL (T'l.'s S.MT ~ 14 as qlllilified by Rand O.S.!vLF_ ~ 14.) Dr. Rand has testdied that she did not get the lab results, althougl'. she also agreed that the urinal} sis results would have been a•·ailable to her in the electromc medical records within one to three hours (Rand A.S.M f_ ~ 6: 1'1'' R.S ..\1_F ~ 6; PJ.-s S \{f.~· 12_) Dr. Lin>iile, a co- 1vorkcr of D•. Rand·,, .<Clted that at times the hospital m-paticnt lab results would automutically populate thC!r "ntpaticnt de<;ktop and at other times the m-patient lah results were not '1 he cuur. nNe> thM P[alotl'f"s S10lcmen' vf matcnal faCT regard in£ Llr Ran.!'< tn0l1valmn for ordcrJn£ rhe \ICJna~ySll n'IIO> or_ overl} 'P'C'oU'Jai.ve lts'.Jmooy (PI'' S.M,l-. ~ 8) 5 I he urinal~sis rc>ul'-' are •drm,,b;e os w Dr Rand, bui Lhe} are nul adm1>sibk a< to J'AMC (See Rand 0 S.YU ~ I J, PAMC O.S.'.H 113 ) 5 ack_wwl edged rc'cc·lp: '' 1- th~ ~-~s·JlL but <'1e would !~d' e L'oe hos~. t~tli.\l lo mane.ge lc1c' pat:e" '- IR:u,c;-'< S. \'l.l' . .- "-) Dr Rar_c: al '0 ttsL5.cd !hal 1" one of l ,cr \ntien•s '.s re,~lts tha ar~ pc'''·lded tc- hL'L h•_tl 1 he !R<>.nd A. S_\1 F. ~lOS;JiLa'l • l ~d1r.1LkJ pre\\ :des all m- p.11ien1 care ~ <J-J~ ~nd :JoLe-; ~ny res·. :'olio-,, -Lip. f ) : PI.- s R_S !-.- LF _':' .< ). ln th1s Ct. 'e. however. Dr. RanC: was unaware Pi \1' s- Schmidrs urinaly'>l' results until \lr<, 5chmidt returned R.S_M_F 1 Lo L1e hospnal. <oth~ hospital on July 19. 200~ (PI·, 4; Pl.'s S.M_F ""j' 15-16: Rami A S \{F. 11 6.) Dr. Rand's <,hill ended Mauh~w M~chtcnbcrg. Schmidt. (PL"s S.M.F. at~ am on JulY 7. 2009_ (Pi ·,S.M.!" . .- l R_) At that point, Dr. the fuiHimc stall"ho8pitalist for PAMC, took over care for Mrs. ~ 19) Dr 'vlechtenbcrg testified that a hospitalist cares for~ patient from admission w J1 ~charge and then turns the patient hack over to their phy ~ician once they arc Jischarged. (Pl.'s S_M_F_ ~ 20; RanJ A.S.M.l'. 1116_) Dr. RanJ expected Dr. Mcchtenberg to rn·1ew \1rs. SehmiJt'.< le't results when he took over her care. (Pl' _, ~- \1.1'. <: 23_) \\11en he assumed Mrs. SchmiJL', care. Dr_ Mechtenberg was aware that a urinalysis had been perform~d, and he had the hasic urinalysis results available to him on Ju!y 7'h rPJ', S \1.F. ~1124-25). In addition, Dr. Mechtcnberg was aware that the urine haJ heen sent foe a culmrc, hut he did not have the result<> oi"the culture. (PI ·s S.?vl.r. .- 26 as qualified hy I' A. ..\!.C O.S.MY. ~- 26_) Dr. Mechtcnb'-Tg did not ass~.« Mrs. Sclm1iJLto have a symptomatic urinar;.' tract infcc.twn as of Ju])- 7, 2009. (PA_'vfC (J.S.M.F 6 ~ 4~-J Dr. Mcchtenberg was -''S.\J.f.'--1--l_Pl'<PSl,lJ •c:--1, the ·.L,-'nalnis results o: ' --16 ~s urm~ cLc'ure. ,:f'l. s ';,_\!.:'. • :7: P.-\\JC O_S 1\f.J-. 1 Z7: PA\!C AS \f F_ C]ua:111ed by?'.. "> R.S l\-LF a::tbtotJt; tf'L ·, <;,\ l.F. ' 2~: ~ ~1\·~n 4G) \\l1en _\1rs. Schrn_dt ""' d"charged she was nut RanJ O_S \ l F f 28: P.A_\!C O.S.'v! F_ .- 2R_) On July 9, 2009, Mrs. Schmidt's unnc culture results becAme available, and theo ;howed greater than 100,000 CFU/mlufE. C"li bacteria. (PL.'s S M_F 'If.- lO-ll, Rand O.S.M.F. ';~ 30- 31 .)0 Ivirs_ Schmidt''> doctors, Doctors Linville, Rand, aud \1echtenberg, nc-...er ~on lac ted Mrs. Schmidt 10 relay the (PI ·, S_M.F. tcstdi~d ~.- r~sul!s 32, 37 as ufher urine culture to her and she qualifi~d wru; not notified of the results_ by PAMC 0. S.M.F. 11 3 7: Rand 0 S M_F ~ 37 .) Dr. Linville that followmg \1rs. Schmidt's imual hospitalintion she expected to sec her, and f>he expected LO receive Yfrs. Schmidt's admis>wn hi,tory and physical. any lab rCSlllts, and her -:!11charge do~umentat'1on. (Raml_\._S M_F ~ \0) flr. Lim;ilJe did nol r~call receiving the lab results_ (Jd) l\-lrs. Sclllmdt "'"-'re-admitted to P.\MC 0:1 July 19, 2009. {Pl.'s S_M_F_ ~ 38: Rand O.S.M.F_ 1' 38 J AI the time !\irs. Schmtdt "'"'admitted, Ll:. &-11d 1'-·li.l the covering physician (Jd) \Jr~. Sclmtidt complamed of' lower leb pain, e~oJ; ache' anC chills.' (Jd I Dr. Rand changed her as>c>Smen: to urosepsis after looking at \!rs. Schmidt's lab coli. (Pl.'s S.\1 f_ ~ 4'. Rand O.S.M.F. ' fhc E Coli re_;ults are admineJ "'to Dr PAMC O_S M_F_ 11 I ~ re~u!ts e.nd noting lhe presence of L. 4 ~_):-Jr. Rand testificJ that Vfrs. Sdunidfs UTI had Rand (See Rand O.S.M F ~! 1.} !'he;- arc not adm1<tod as to PAM C. (),e ' Th;, fact is •dmine<! a< to Llr R.,J. but not as to P A'-1C 1-'>-,e Rand 0 .S M F_•, 3~: P>\).1( 0 .S _1.1 F ~ _iS_) 7 P_\\f( 0 ',_\JF "!'l.) \!rs. Sc:umcl' baci >c'?"' ,m luly I'). ~(!~I'J. (Pl.'s S_\-1 F .- 40 as qualiflcci I" P.-\1-,f(' 0 S \l.f_ .- .-1(1.) \1rs. SchonJclt's ell-charge oummar; statts th~t snc' w~s acirniUcci on J-Jlv 19, 20il9 '"th a~ut~ u~osepsis. 'J' .. 's S /-.-LF.\ 4~- Ranci O_S M F.~ 42.) J·oliov.;ing \1rs. Sclmn.!·_ · , 'kuh, the lln"J d i:tgnoses includGd -- · 3~;:-,;, S\ m:ccmk·, gem umrin;,!)·. Gr~m-negmive form, Esch~nclua coli ... (PI·, S \{ F ~ 42; Rand O.S./-.-1.1-., 42.) 'The cause of her >ep>is i.< di~puted_ (Pl 's S_)\,f_F_ ~ 40: PA!\1C O.S./-.-1.!'. ~ 40, Pl.'s R.S.M_F ~ 40_)' A. Expert witness anal~.1i> '1'-'hile Dr. Carling has tcsnticJ that the standard o Ccare ha-;i cally requires that a physician C1thcr ]'())\ow-up on teots or haYe a system for following up on tests. he also stateci the C!rCl1Ill \tan~~' dictme whether u ph} ski an needs to consider the results of a urine culture and follow-up wllh the a phy>~cmn pati~nt, between 'vir-; and that in this ~chmidf s ino;l~nce the lack of evaluation of the urine cnlrurc by discharge from the hosp1tal and her re-admi>sion was good medical practice because he deemed the culture to be o Cno clinical relevance. (Sa Pl.'s S.M_F. 33 as qualified by P_'\'v!C ~ ~ >.'-; P.-'.MC: A.S._li.1.F. •150.) Based upon Mrs Sclunidfs pre-;entlltion on the 6 11 ' anci the 71 Dr. Carling fo~:nd there was no n~eci I'm a physician to follow up on the h, urine culture. (PAMC A_S \IF '1150.) Or. Carling held that the unnal:y'i' re~ults from July 6'" an~ 19'1 provided evidence that Mrs. S~hmicit UiJ not have an innsrv~ urmary tract infection at I ite aforementioneJ '"0 scntcnoe< 1elymg <JPO<l the d tschacgo >umrr.ar, are nn>y odmitted a> Lu Dr Rand (Rand 0 S M F 1 42.) They are "01 wlmt>>Jblc ,_, tc P "-M[ (T' \M( 0.~.'-1.f l 42 ) ' -1 he ,uun note> that a fa" am aunt of Dr. Robrcr'> doposttl011 re<ttmony that the P .~mtllt ha.' oltod to ""' nor 1noluied lr. the summary jurigmenr_ rcwrd and therofore coulo not be cun>idcrcd_ 8 d;d r.or'"-''" ;-_ ')nl)'L•'r:lallc cu'nJ.r; tcJ.c·t in!~~Luu ,n-_ Juh 1o. :000 D:_ On'on al"' :ounJ :_h:>:_ \[r; Scl.rnCcl1 d1d not ha\'G J _Ll :· 6-: I I'. \\1 C . \ S. \[ r. liJ not sho\\ 'l~ns ' 5~. ~4.) _\..'l.!\1.1. • 5' -) oympwmotic 'J:·in"-r; tr:1c: inrec·lion ''" I 0:. Or:ion he ~d thJt !\b. Schl'1i di'-; preoelllal iPn U l' arb ic\\ or sy:upK>ms ;b; WOllk indicate 1_P.\MC _\ S.!\1.1·. 1: c_ (P_\~1C J u:·incu;· tract :nfecti.m Lcl a pbys•cJall. D:. Or.Ccm 'ioted the ')'mpto"" ol "')'mptomatcc Jo,wr urin~ry trac' wfection o.s d)·,un<i, pain:-ul unnatwn. frGqucncy. incontinence. and delirium, and nNed :hal an upper unnary tract infection can al'o include fever and pam {R,md A.S.M.F. ":" 15 as qualified by Pl.'s R.S.M.F. ~ 15.) Dr. Carling and Dr_ Onion· s opmions that l\-1rs. Schmidt did not have a symptomatic urinary tra~! mfcction are disputed by Plainti ff"s expen "i Lness, Dr Rohrer. {Pl.'s R. S..\1.F _,:,1 48, 54; PI's R_S_.\1.1-. •; 15.J Dr. Onion opined that a physi~1an mLt>l know the results of a test and mU-sl make a determination whether the patient :;hould he calleJ hased on the kst rcsul!s. (Pl.'s S..\U·. ~ 34.) 0; Omon explained that physicians apply a level of urgency to an ahnonnal test result and then determine how to follow-up (Rand i\..S.M_F_ ~ 14) Dr Omon also testified more specifically that m this case. the standard of care would hJ\'e required that a phj~lcmn l"ollo\\ Lip on the urine culture re,ult' "llhm "- l~w w~eb ai'o Rand A.S.M.F. 34: set also P_\.\[C A.S ..\·1.1'. ,! 55; see D-14.) ,!~ r_PAMC O_S M_F ~ Dr. Onion opined that antib;otic treatment in as;·mptoma'ic urinaJ-y tract infections does not ~hminak Lh~ mkction, prcvcmthc mkc.tion's r~~urrcncc, 9 or diminish symptoms_ CP.\11,1C _\ S MJ·.' ~6: Kand AS./-.1.1 '. :5./ \\c>~lG n·~•il:J.\-c'ma~c Dr ~<:her h·" ,, :tff~r~L:~!Or >L~L~J Dr ! n\ :L~ qu:;E:lc-:1 by PA\!C U.S ..\i.l.' obH~a!cJ w fo'lowup on the 3~: l)-. C>r'con be'ieves :b,; "'nih;,>tic :_reaLn-,enL .<Ldr;cu c»ci!S \'rs. S:~-,·nidt.i:':>.\1( .'.~\utL·U Kc.nd b~orator; liwn :L O.~.l\1J-. Th~ ~ cXpGrl \\'imesses \f_F ~ 'lanJ~rJ 3~.) l~e :~b' '~'ul•__, anU Lhc ~ '~) ofcacc ~~'~ms~ the t:rir.olvs:o fel: Li1aL Dr. Rant! \\as results. (S:a PI_'-; TLS M_F that uc >Undard ofcme ,·egJires ;'ollm< up on bh t"eat:-r.ent. ,:pJ.-, T< S_\;F_ •; -'\ ~ 2.; Dr Rohr~r has otatcd pr~'~np:wn of~pprom~a:e q 1 ~!so had differing opinion< Car;ing believes that the 'ep;i-; "'"-' nOL ~auseJ b~ r~garclmg Mrs_ Schrmdt' s scpsts. Dr. a unnary tracl infection. (P.-'L'v!C A.S.:vt.F_ .- 52.) Dr. Carhng concluded that on Jnly 14" Mrs. Schmidt was septic and bacleremic with E. coli m her hlo"d- and that following a period of improvement 'h~ U10d ot a rclapsc of multi ·organ failure. (Rand A. S \{ F .- 12_} Dr. Rohrer opmcd that 1\-lrs. Schmidt suffered from F_ coli urinary tract infection and E coh bacteremia. \Vhich progressed tCl E. cCJli septicemia. ultimately causing a '} ;temic inllmnmatory response >yndrome resulting in multi-organ fmlure (PI" s R.S .M.F. 0: 5~.) ll.- Onion doe• not hehe,·e that Mrs_ Schrmdl died as a resnlt of a urinary tract infection_ {PAMC A.S.Yl.J:_ '. 58.) r: STAl\.DARD OF REVIEW: --~ ummar;· J uJg:ment ;s appropnatc when the record rn·cals no issues of mateial fact in d1sputc. A bet is material if:t bas the potential to affect the Gutcome of the case." Lfpage v_ Rath lr-ar1 Works Carp .. 20•)6 \{F. 130.19,909 A 2d (<'9 (citati''"' •>mitted·,_ T_~e La\\· C ourl ::ta' helU timt '-[ s J·~mmary J uclgrnem " propnl y granted d the iilcts arc not m dispute or. 1fthe defendant has moYed for summary judgment, tb evidence 10 favorin~ the ou:corue · Arrrr.<· Fasruwr Cu Inc r Wrabanlii, jnc 2\>07 \1F 3-t ', ; 7. 917.\.22 ;m;ontro \ crt,·d 'ad' !ron t:1e s1c.c~cncnt o ( nmerd focts t:lat arc' prop~rl; 12~ SLl)'poned. "l.R. Ci' ·. >tatement ofm;J.teriai fActs. SeeM R CiY P 5G(hi(4j ("' rhc court 'hall ha,·e no indepencknt duty to search or ~onsider any pan of the record not <pecifically refercnccJ in the partie<;" separate .ltakmen\ orfacts."'); see also IISBC Bank US'A, ,\'_A_ v. Guhay. 2011 'v!F 101, ~ ]7, 28 A. 3d 115 s_ III. DISCUSSJOJ\ '-' [T]o establish liabihty in a med1eai malpractice case. the plainti fr must show that the defendant's departure from a rccogni.ced standard of care was the proximate cause of the injury. Merriam v Wanger, 2000 ME 159, • ~. 757 A.2d 778 (quoti~g !'hi/lips v Easwrn Maine Med Cl1 _ 565 A 2d 30\;, ~07 (Me. l9g9)j (alterati<'P.S in the onQ.inal). The Lay,. Coutt has held that: A poor result, standing alone, i.< ir.sufficien: w establish liability. [Tjhc plaintiff must pro\t that the poor result was caused either by the defendant\ lack of that degree of1kill and knowledge ordinar;l) ?"·"e:;sed by physician~ m h1 s branch of medicme, or, by his failure to exerci<;e his best judgment in the application ot thal.<kill, Clr, by his failure to me ordinary care in performing the operation or in administering the treatment involved_ Dov.ner L Ve11/eux. 32: A.2d g2, 87 ('vfe 1974). '" rhc phys1cian is not an iruurcr He does not wa,.,-ant fa,·orablc rcsub. l f he ;1ossesses ordmal) 'ki l I, uses ordOnary care, and applies his 11 bc~t ;:Lie·:nent. re io not liob-t ewt~ :'IJr :n:s<ak~s J:,Jll<igiUllt. lJoqnn ;) L 197--lt ( c,.Lc>tins C:)()·n:e< ' J...:;rg, - 01 !!. - i)':' :-,I e. :; 7(>. _; 78. 78 A. : '' s;~:Jces ':le ola;m::"f Ctn (]) t'ne cst~b'isht•g: mc~t ncr bud cr. ur aopwpri~:e starwm;:: OI ~'' >uf "'t':tro .L?h 1',•11/,•;,x_ 3:C:C _\ 46~. 2: S:C_ 86 46')). "'-t•crt mc·,hcal tc-'umnn;· mcdt~~l ~ar~. 12} tC1~ dct~nclanl ;kpartccl froc1 that recogm7ed standmd. ond r)J the conduct in ,-i(dcnion of the standard was ;he proximme cause of the plai :>Li ff' in_iur: _· _,Whether Jn expe·t's testimon; Jccmme ly reflects t!Je ~ppl icable st<mdard A. Dr. Rand Thi> ~a>e has proceeded thmugh the pre-litigation •creening paneL Pur,uant to 24 M.R.S.A. § 2857(\)(C), those findings me now admissible. (24 M.R.S.A § 2857 found unconstitutional on other grounds not applicable here as ~symmetrically applied in Smllh v_ !law/horne, 2006 'viE 19, 892 A.2d 433) \1ainc Law proV!Uts" 11 the Ll!lanunous findmgs of the panel as to ~ithcr occtwn 2855, subsection I or 2. arc in the negative. the claimant must release the claim or claims based on th~ findings \vithout payment or be subject to the admissibility of tho>c Jindmgs tmder salion 2R57, suh,ecLion I. paragraph 8'" 24 M_R_S A § 285R(2) In addition, to detemJining the issues of proximate causation and comparative negligence, the panel JS required to dctcmnnc "\Vhcthcr the act<, ,Jr Oml.I>!Ons complained of consti lute a deviation f~o:n the applicahic <.la'ldard of care h;· the health care practitioner or health care provider charged with that care." 24 'vi.RS.A 9 2855(l)(i\l l() <iww neg Iigence and proximate c~us:uion ;\.t the panel hearing, the plaintiff is required by a prcponJcrancc of the e\ idcnce. § 28~ 5(:') On the !SSUC ol the stand>rrd o:· care pro\'ldeJ h) Dr Rand, the panel found that Dr. Rand had not Jcvmlcd from the 'tandard of care. 12 _,.,,c,_ ~Jr ~ \.Gli,kr) IZ.md ~onl~l";' t!Ja! t'lc p:mel 3 fin:hne:' &.:,;o:ua·_,ca.l; ddeJt Plant' :To :vloti~·n [;,,- _; url gr:lGF ;-,,~ dJUr: :.13"-~'~'" tilot :he p:cnel ti:Jdb?o aulo,no::cc.l~; uc: euL l'l~::niff' _\ :, •uo:1. ~' Jt ocl-J1u" kcl:<~o t:lJt the· pc_rd findiL~> ,,-ld; attelai T".e cot.r1 b a\\J.re tha: tile bct linrle:· is to 'iQ_ '""'~ " m.ncri~' i ~']-''let p~r!orn h~r on tk :act finder own a:wly>i< See _4/,•wnder iHl\\cver. ck ::>and·_, lind;ngs can C>e a pun of1hat cmaly,,; lr: .'omi!h' Hawrlwr-ue. th~ ~ 7- la\\ CJur'_ noted Lh.1t pand iinUm<r' ··were bigl:l;· pwbmi v~ :md rc I"' an; to the _iur;- 's c!eLem1inatior_ of n:cterial qu~st""" !inJmgs m~y of ;~ct:' 2006 \1F I~- • 22.892 .; 2d 133. ~39 A' 1mponam as tO~ P'~"~' prow to a Jur:·, hownw, they ~re not the determinative factor ii>r purposes of th" Motmn_ Th~ t~>timony h~s court Jind' that surrur.al)· judgmen1 cannot he granted to the Plaintiffas the expert confl!cts rcgarc!ing what the standard of care required of Dr Hand. \Vhilc the Plaintiff argued that Dr. Rand violated the standard of ~are by failing to review the test result.< and convey the results to \lrs. Sclumdt. the summary judgment record also fads to e8tablish that it wa.« Dr. ~oursc R~nd- ~onclusively s responsibility to review the urinalysis results and decide upon a oJ treatment \Vitiun a cenain time frame Dr_ R.and co menUs that her treatment of Mrs. Sehnnc!t me~ the standard of care. Dr. Rand ha< outlined her >tandard pracl!tts and responsiCnht1es and has emphasized that the hospitolist is responsible for managing the pmien L She expcctec! D1. _\!cchtcn herg to review 'vfrs. Schmidt's te.<t resab when he took O\"e! her care_ (Pl.'s S.l\LF ~ 23.) Dr 'vle~htenberg·s own testimon\' ind1cme' that as a hospitali.<t his tole\'"-' :o care for the patient from admission to discharge. (PI·, 5.!\1.1'. 'i' 2Ct, RanC A.S.M_F ~ 16.) Dr. Rand did no! m J11ct ,-iewthc lab results \mtil Mr,, 5clu:mdt returned to the ho,pital. 13 ~~hrn~clt Lc.U a wmpwmmic . (]'.>.. \JC .\-~\f. F. • SC:. I Dr ;u:n~n . tc .. c·: Co:lin~ ~nf~Cth ldund tlJ~ ''L 1\, (;·s. Scll!Cl":: · s i:Ji:ia: ho' p1t~l v;s: t "--'' for u:ne c.1lture to c-~ not think t'cJat r, required follow-up. Dr. Omo" cound :ha', in th'ts ol""o clina:al rcle\oncc anJ cl1d c~s~ the <t~ndard of care wou.cl 14; see also PA.\IC A.S.M.F. • 55:·'"" also Rancl A.S.M.F. ,:•. 13-14) The coun i> not allowed to 'elect wh1~h expert's opmion appears to he more cr~Jihle at the summary judgm~nt .<tage. '!be Law Cou•t has held that "Such an asse'"ment of the weight or crcclihilit}· to be given evidence 1S imperm1ssihle on a muuon !"or sumn1ary judgment." Levesque v. Chan. 569 A.2d 600, 602 (Me. 1':.1~0). Dr. Rand has .<hown that at tnal she \vill b~ ahle to present not only her ovm testimony. bm also expert testimony indicating that she did not breach the standard of care \\.'hile the Plamt;ff lms party, Dr. pn"~nted R~nd · ~ and contrar, nirl ence, viewed in the light most fa, orahle to the non-moving th~ expects' 1estimony ratscs genuine issues of material fact for trial, which rrecludc .<Ulmnary Judgment. B. P AJ\.IC As an mi tial rr.ancr, the court acknowledge<; l1mt P .AJvl C disputed the v:.st majority of f'latmifl"< statement' and raised 1mportant evidentiary ohiectic>ns to some of the materials anU t~stimony relied upon by the Plaintiff in thi> Motion, which only served to weaken the Plaintifr s 'vlotion wlth respect w PAMC. 6(>0, fi(Jl r'!\lc. :)1~_19X~ i -, '- l~%1 (<;JNi:Jg !--,,,-,',c, 1 Osieopcilhic Hoy, co; ui.'tim•"'· thc.tth~ _\__:::U lfi_ 17 ·'I 0 lrdman iy, o ptm.:d-! cmc ~ is~nargc ;,, • ., .1rrlen of proof ;"or o: cl~im vl nec•l1 qent •11ed 1ccJ care' ,'n iy bv cx·Jcrt care. 5~2 m~dical rcs.nw·.my ~stc.Jli>hm ~ '_hE ·o ppwpndT t .<tan\\md of mcd ,~CJJ cld encunt de parte.:. ti·om -J-:c standarJ a•1d t!lJt the' negl ige:1t conJuct proximaccl_, c·auoed the ;llanli'l'< 'r_h:ry .. ,,_ PA\1(. stares tbl P1 _intiffs f'wllm does not CO\er the f.d s:andard of care to l\-lrs. lSSll~ _ I nsteod s~hmidt constrtut~d of \\ hdher the physrcian< rJ.ilures to communicate the lab results a departure iicom the standard of care. PA_\1C assert; that the standard of' care question should really be ·'whether Mrs. Schmidt had a symptomatic urinary tract mfedion that shonld have been treated with antibiotics as a re~ult of her admission to Purkview on July 6-7, 2009 "(P A VIC Opp. 6_) Plaintiff asserts that the issue of ~ommunication of the test results i.< the pi,·ota! ISsue, and that both Dr Rand and Dr. 'vlcchtenberg \verc '~'l"m'i ble The for communicating the ~our! ~~-'! results to Mro_ S~hmidt. agrees that Phintiffs Mmion .<eems to cireumsc1ibe the stanJard very narrowly, however. 1t is tumecessary lo reach this Cssue <ince even usmg this narrow standard the Plamtiffs Motion finds that exp~rt wh~ther ~an'lot be gra.'ll~d As already deocribe<:! in the ~onte;..i of Dr. Rand, this cnun PAMC dcv1ated from the sbnd?..rd of car~ 10 dispmcd Cla.sed upon cnn llicting te1timo!lj _ The ~nun notes that PAMC hao al'" raised an ad<iitional factual di,pute that precludes summary judgment in Ucis ca-;e: th~ JOsue of\vhdher Dr. Mcchtenberg discu,~ed the rcsnlt8 of Mrs. Schrmdt'' uri•1alysis k't with !lcr ;nior to her dr,charge from the hospital Plaintiff contends 15 P: -s '>.~1 F ~ :7: P.-\.\;C U.S \LF .- :;: p_'\MC _\_S_l\1 1- _', ..;6 a> qua'JiieJ h) Pl.-, R S \{_f .- i."u" of,iolatwr, o! !he <t,~ndar~ ot ~ar~ i' DE:--.ll:l) as to hotl1Dr. Rand anJ PA \I C. Plmmitr'- .\1ouon for Factual Finding.< al Trial is also DENIFD. The clerk !S clirc~ted to incorporm~ this Order into the docket by l\- la1ne Rule of Civil Pnlced ure 7~( a). / Dated __ _- ----z9lr~ <7 1 1ul> crior Court 16 rct'cr~nce pursuant to .. '-• I' Daniel Rapapor\ Esq PO Box9546 Portland ME 04112 li' ff)ejMtil ~ iVn c/ lJO Co •+nu; ~irw' I I-1 b o Celine Bayle Esq_ P~11l1p PO Box 1H9 """""' PO Box 15215 Porlland Ml 04112 Saco ME 04072 1' p~ Catlin Ill E~q Jl f/;~hYe&<J /Jrrwn/rJJ~ IJ7fllbu &vibJ ~""""

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