Eugene G. Guardia VS Lakeview Regional Medical Center and Nursing Staff of Lakeview Regional Medical Center
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STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT 2008 CA 1369 EUGENE G GUARDIA VERSUS LAKEVIEW MEDICAL CENTER AND NURSING STAFF OF LAKEVIEW REGIONAL MEDICAL CENTER iIONAL RE G Judgment Rendered On 8 2009 MAY Appeal from the Twenty Second Judicial District Court In and For the Parish of St Tammany State of Louisiana Docket No 2005 11807 Honorable VG Reginald T Badeaux III Judge Presiding ff Rykert O Toledano Jr Counsel for Plaintiff Brian G Meissner Eugene G Guardia Carter B Appellant Wright Ernest N Souhlas Covington Louisiana Aldric C Poirier Jr Counsel for Defendant James W Vitrano Lakeview Mandeville Center Louisiana BEFORE tJ WHIPPLE GAIDRY PARRO Regional Appellee Medical LL c McCLENDON AND WELCH JJ McCLENDON J The Guardia Eugene G plaintiff Lakeview Medical Center defendant Lakeview granting Lakeview appeals the judgment LLc d b Lakeview a motion for summary s in favor of the Regional Medical Center For the judgment following and remand reasons we reverse FACTS AND PROCEDURAL HISTORY On March 17 2003 due arthroplasty Mr Guardia was admitted to Lakeview for to bilateral degenerative joint disease right and left knee Following bilateral knee replacement surgery Mr Guardia developed several complications including lethargy and unconsciousness Mr 2003 Guardia breakdown On which April 1 no care after standard of to care to was trial court medical review 2007 to RN 2 2 a skin judgment proving his claim in that he give expert testimony in the were set granted Lakeview as s for areas hearing motion moot Mr Guardia a motion in expert witness asserting that she as an on to which she January 15 200S for summary Judgment was was was not to be offered at which time judgment and thereafter signed on Lakeview from January 30 200S the matter with appealed petition Mr Guardia named as defendants Lakeview and the nursing subsequently stipulated that it would accept responsibility for any negligent employees relative to the treatment of Mr Guardia at issue herein previous or breach of no motion for summary In his A March 19 petition for damages against the Lakeview its on Lakeview had also filed granting the summary judgment and dismissing 1 a unable to meet his burden of Fields dismissed the motion to strike prejudice lCU panel unanimously found Lakeview filed by Lakeview and his damages testify at trial Both matters the unit testify regarding medical causation between the alleged breach of the limine to strike Julia B properly qualified a by Lakeview Mr Guardia filed On November 2S expert care eventually resolved asserting that Mr Guardia had admitted to the intensive was developed pressure ulcers and thereafter sacral decubitus 14 2005 the standard of hospital He motion for summary judgment was ever ruled upon was filed not show that it 2 by Lakeview on staff at Lakeview acts or omissions of June 5 2006 but the record does DISCUSSION In his assignments of granting summary judgment rehearing and trial or new Guardia contends that the trial court erred in Mr error favor of Lakeview and in Mr Specifically Guardia deposition testimony of his expert Ms Fields issues of material fact as to Lakeview s argues that the affidavits and clearly sufficient to create genuine are reviewed de 675 Dillard v 679 writ denied asks the s Dept Store 02 0852 p 5 La App 03 1620 questions same judgment is appropriate whether the mover is 99 1712 3 p judgment is factual a La as La 10 10 03 whether there is any judgment App lOr 9 22 00 procedural 1 Or 5 9 03 court thus whether summary of law Brumfield interrogatories and admissions full scale trial when there is that there is judgment no as a genuine issue as to matter of law Id file on v Gafford no genuine depositions together with any affidavits show material fact and that the 99 1712 at pp and A motion for summary 225 dispute The motion should be granted only if the pleadings answers to 849 So 2d appellate An determining 768 So 2d 223 a criteria genuine issue of material fact as a matter device used to avoid same judgment is appropriate 855 So 2d 350 does the trial court in entitled to under the novo that govern the trial court s consideration of whether summary Duplantis for liability appeal summary judgments On were motion denying his in 3 4 mover is 768 So 2d at 225 entitled to see LSA cc P art 966B The burden of burden of proof is the movant on proof at the trial of the essential elements of the adverse matter But if the movant will not bear the the movant is not party s claim but rather point fails to provide factual evidence sufficient to establish that he will be able summary In at trial there is judgment is properly granted ruling evaluate the on a to determine whether there is a or to if the adverse to party satisfy his genuine issue of material fact and LSA C C P art motion for summary weight of the evidence no negate all out an absence of support for evidentiary burden of proof Thereafter to factual one or more essential elements to required 966C 2 judgment the trial court s role is not to determine the truth of the matter but instead genuine issue of triable fact 3 Hines v Garrett 04 0806 1 p summary 6 25 04 La judgments 876 So 2d 764 favored now are 765 factual inferences evidence must be construed in favor of the must be resolved in the 775 So 2d 1049 12 8 00 determines Richard In by a a be can seen medical Medders v care La 4 23 04 malpractice action against and causal a a 874 So 2d 131 connection between the 0924 10 17 94 643 SO 2d LeBlanc 04 2743 medical p 6 8 p La La App lOr 2 10 06 malpractice action against caused the generally required standard infer a was 564 So 2d 654 to establish the breached to the care a must establish violation of that Pfiffner 1228 928 So 2d 571 Correa v 1233 575 94 Fagan v in Likewise a hospital the plaintiff must prove that the hospital injury when it breached its duty Regional Medical Center for summary alleged negligence and the 5 R 9 2794A 94 0992 La 137 physician the plaintiff See LSA 94 0963 2 p only in light of the substantive law applicable plaintiffs injuries resulting therefrom can material preponderance of the evidence the applicable standard of standard of 00 2507 applicable substantive law that particular fact in dispute is Hall 03 1488 p 5 v Willis Because it is the a reasonably drawn from the party opposing the motion and all doubt favor s 1050 materiality whether judgment purposes case opponent Despite the legislative mandate that Cangelosi 661 La applicable standard of except where the negligence is Our v 1989 care so Lady of the Lake Expert testimony is and whether obvious that negligence without the guidance of expert testimony or not lay person a pfiffner that 94 0924 at pp 9 10 643 So 2d at 1234 In the support of its motion for summary judgment Lakeview submitted deposition of Ms Fields and the affidavit of Dr Scott that Ms Fields admitted in her medical causation give the medical her opinion the Although Ms Fields did cause most for Mr Guardia probable position for two days and that that as a nurse they failed deposition that she not causes s pressure ulcers being turned by the she believed that the Lakeview to turn Mr was state in her of Mr Guardia Sondes unqualified to testify as to deposition that she could she went on to pressure ulcers nurses Further nurses copy of Lakeview asserts s state that were his not in supine Ms Fields testified violated their standard of Guardia every two hours 4 M a care in following surgery especially considering that he notes nurses before he was In was his it documented that the affidavit at Dr not religious beliefs a result of his went into of rehabilitation and wound amount of blood as a significant March 17 2003 blood or Mr Guardia became but he is a Jehovah s products because of his responsive only to pain and extremely low blood pressure and significant postoperative anemia hypovolemia abnormal decrease in blood volume an hypovolemic shock and acute renal failure developed pressure ulcers Guardia received wound by on accept blood transfusions used blood thinner Mr Guardia also and position Covington stated that he reviewed the Mr Guardia lost a On March 18 2003 noted to have director in Regency Hospital of his bilateral knee surgery course Witness and did As Mr Guardia s changed nurses ever the Sondes medical records of Mr Guardia was Fields stated that nowhere in the moved to the ICU management services normal Ms high risk patient was a on care the Being occiput and from the on the Coumadin a As Mr on developed coagulopathy Mr gluteal a result areas commonly Guardia bilaterally physical therapy department while in office visits and home health care upon his Guardia Mr at Lakeview Dr Sondes further discharge stated In Affiant expert medical opinion and unpreventable These wounds s Mr Guardia s wounds expected expected unpreventable due to the chain of events that occurred during Mr Guardia s hospital stay Specifically Mr Guardia suffered from severe hypovolemic shock resulting in acute renal failure This combined with severe postoperative anemia resulted in multiple physiologic responses designed to preserve internal organ function and ultimately preserve Mr Guardia s life After explaining the body s responses concluded that there pressure ulcer was were and were in a situation such as Mr Guardia He opined that Mr Guardia would have than not developed pressure ulcer breakdown regardless of any and there was pressure ulcers the standard of if any intervention that would have It was Dr care in Dr very little chance that Mr Guardia would not have complications little s their Sondes care opinion that the of Mr Guardia 5 action Sondes developed more probably by Lakeview prevented the formation of the nurses and staff of Lakeview met In Mr judgment attaching Prevention the Guardia filed an response affidavit of Ms Advisory Panel s Fields position statement of the American regarding expert nursing testimony Guardia repositioned even s skin once nursing documentation Ulcer Prevention hours and that Lakeview Sondes and of Legal Nurse Consultants Fields Ms at Lakeview failed to Further Ms Fields she stated that pointed she stressed that Mr Guardia was written out the statement of the National Pressure repositioning schedule be used Post as deep breathe every 2h Since the assessments or x Further which Operative Care Ms issues earlier preventative states 2 h skin color and condition and 3 Note detection measures such such cough a turn Ms Fields concluded Change position frequently of two Fields noted specifically documented to include but not limited to 24 hr not to the Advisory Panel that bed bound patients be repositioned every a a timely and accurately during the first 24 hours following surgery according orders and follow s summary copy of the National Pressure Ulcer affidavit Assessment status to include but not limited to doctor for She further stated that the issue at hand is integrity Nursing Policy P 5 titled s a Association her In nursing issue and that the nursing staff assess Mr 3 motion regarding pressure ulcer prevention points and summary reviewed the affidavit of Dr to the opposition an routine as Mr skin Guardia turning postoperative days it can be reasonably concluded that they were causative factors to his impaired skin integrity It is still my opinion that the nursing staff of Lakeview Regional Medical Center did deviate from the nursing standards of care by NOT assessing or maintaining skin integrity in a postoperative bed bound patient who became at higher risk for developing decubitus ulcers after complications from his surgery not were addressed We agree that where the body or caused first was alleged negligence is similar the two to a amputation of the wrong leg this failure and his condition is first two injuries required physician s leaving to assess his skin This affidavit dated judgment and 11 January again was in 2008 in circumstances opposition sponge in assess by Mr Guardia in to Lakeview 6 s a Therefore a case patient injuries s were regularly The connection complex medical once the burden Fields in this matter opposition motion to strike a condition and involving is the second affidavit of Ms submitted a This is not days following his surgery beyond the province of lay persons to affidavit dated June 17 2006 in this matter Mr Guardia claims that his by the failure of the nursing staff between summary his expert testimony change his position for the 3 in as to Lakeview s The first first motion for shifted to Mr facts Guardia to produce evidence demonstrating genuine issues of material he needed to establish and condition caused his through expert testimony that given his medical history Lakeview breached a specified standard of injuries Mr Guardia contends that he sufficiently did testimony of Ms Fields thereby establishing Lakeview filed a The a motion in limine to strike the argued that Ms Fields did not 702 provides that so i f scientific may testify thereto which was 1123 La of as an expert testimony of Ms Fields in Louisiana is technical or Inc to 03 2658 p a 10 La App 1 Cir 10 29 04 or a education 4 The Daubert standard in State Supreme Court gatekeeping function to evidence admitted is not S Ct at 2795 v Foret 628 So 2d 1116 must rise to a threshold level 702 Terrebonne v B J 906 SO 2d 431 440 set a new standard to assist trial 1174 ensure Company Ltd 143 L Ed 2d 238 1999 analysis established by Daubert is expert testimony that any and all scientific only relevant but reliable In Kumho Tire 119 S Ct 1167 of all fact in issue a evaluating the admissibility of expert testimony and required the district courts perform that the otherwise requires that expert scientific testimony In Daubert the United States courts in or art specialized knowledge will determine in order to be admissible under LSA C E art reliability Martin opinion adopted by the Louisiana Supreme Court 1993 governed by LSA C E other or to in which it testimony expert by knowledge skill experience training in the form of an deposition genuine issue of material fact However assist the trier of fact to understand the evidence qualified with the affidavit and meet the criteria for admission of her admissibility of expert testimony which witness and that this breach care not v Daubert 509 U S Carmichael 526 the United States to be testimony applied at 589 s U 137 Cheairs 113 147 Supreme Court held to determine the just scientific testimony or v admissibility State ex rei Department of Transp and Development 03 0680 p 7 536 541 admissibility of the expert s However the decision in Daubert concerned the opinion based 4 on methodology used and Daubert v Merrell Dow Pharm Inc not on his or her 509 U S 579 7 La 12 3 03 qualification 113 S Ct 2786 861 So 2d as an 125 L Ed 2d 469 expert in 1993 the tendered which area the issue raised in Cheairs and is the was same issue raised herein Thus the court in Cheairs three prong a to inquiry courts give trial comprehensive guidance in determining the admissibility of expert testimony more The admission of to adopted expert testimony is proper only if the testify competently regarding matters the 1 he proposed expert is qualified to intends address 2 the methodology by which the expert reaches his conclusions is sufficiently reliable determined sort of by the the trier of fact inquiry mandated at 542 As or to determine art a The court also witness as an In this matter which she the motion holding a was not hearing was unable to on judgment s The the motion in limine We conclude that it disregard Ms Field was legal was not qualified excluded without 5 as to of the admissibility of the expert expert opinion for a to on hearing test adopted in in the areas about at the same time as parties argued the motion for summary court However the trial court did so without s error for the trial court to fail to consider and to testimony without first conducting ruling a an was set testimony constituted reliable expert testimony the trial court in reflective are satisfy the three prong qualified to render granted by the trial was factors 03 0680 at p 9 filing its motion in limine to strike the testimony of Ms Fields for summary judgment which specialized expertise to understand the evidence or to determine testify at trial The motion was to or testimony Cheairs 03 0680 at p 8 861 So 2d at 541 42 Lakeview asserted that Ms Fields Cheairs and therefore the recognized that experience alone is normally sufficient expert in these assists 3 Cheairs 702 and whether the testimony would assist the trier of fact qualify fact in issue a explained in Cheairs considerations under LSA C E fact in issue and through the application of scientific technical to understand the evidence 861 So 2d in Daubert as as a hearing contemplated the motion for summary to determine if her in Cheairs Although judgment stated that Ms Fields testify regarding the issue of causation hearing and without any evaluation or her testimony was analysis of the relevant When counsel for Lakeview mentioned the motion in limine the trial court ordered that it be dismissed moot 8 factors to Accordingly considered be we conclude in determining the admissibility that summary judgment was of expert testimony 6 premature and therefore improper CONCLUSION For the foregoing reasons the summary and the matter is remanded for further of this judgment appealed from is reversed proceedings consistent with this opinion Costs appeal shall be shared equally by the parties REVERSED AND REMANDED 6 We note that LSA C E the art 104A of provides in pertinent part person to be S 1 eff Jan 1 competency qualification Additionally by Acts 2008 No 787 Paragraph F to provide for a pretrial hearing regarding an or a expert witness 9 a that p reliminary questions concerning shall be determined by the court LSA C C P art 1425 was amended to add witness 2009 the qualifications and admissibility of testimony of EUGENE G GUARDIA NUMBER 2008 CA 1369 VERSUS FIRST CIRCUIT LAKEVIEW REGIONAL COURT OF APPEAL MEDICAL CENTER AND NURSING STAFF OF LAKEVIEW REGIONAL STATE OF LOUISIANA MEDICAL CENTER WELCH J KlJ DISSENTING I believe the trial court therefore I required days his burden to prove failure nurses The to more on La 4 21 95 In his not that his injuries in this to prove not It is well settled that when one within disprove or common and case a Hutchinson So 2d 451 452 v caused two was was by the post operative necessary on the conclusion regarding medical testimony knowledge expert causation 648 were the first position during majority correctly observes that expert testimony 1st Cir 12122 94 App than regularly change medical causation is required judgment the medical causation issue Mr Guardia probable issue of medical causation is summary respectfully dissent satisfy To correctly granted Shah 94 0264 writ denied p 95 0541 3 La 653 So 2d 570 support of its motion for summary judgment Lakeview pointed plaintiff lacked sufficient expert Further mover offered testimony medical evidence on to out that the issue of medical causation disprove causation through the affidavit of Dr Scott Sondes the director of rehabilitation and wound management services at Regency Hospital Dr surgery Mr Guardia lost did accept blood transfusions not surgery Mr Guardia postoperative anemia hypovolemic shock and a significant had As Sondes noted that in the normal a acute or amount blood extremely result of blood and for One products low Dr Sondes blood renal failure and also religious of his reasons day following pressure explained course and the significant Mr Guardia went into developed a coagulopathy as a result of taking a Dr blood thinner Sondes that Mr Guardia opined medical condition caused the formation of pressure ulcers tissues to hypovolemia by shunting to typically responds maintain blood flow major to the great risk for breakdown in all tissues addition Mr Guardia body unable control the to while the worse severe progression anemia added by reducing the body pressure ulcers of tissues Dr Sondes expected and unpreventable ultimately due s the ability Guardia shock Guardia Mr s Guardia renal failure combined with body underwent physiological preserve internal organ function and preserve his life probably than not Mr Guardia would have developed prevented the Once Lakeview pointed plaintiff s out medical causation the burden shifted at to was incumbent that the failure of the nurses to on Ms Fields peripheral wounds s were was suffering severe from postoperative responses designed that opined to more pressure ulcer breakdown was little if any intervention absence of factual support to Mr to reposition In Guardia satisfy his to the provide factual evidence evidentiary burden of proof expert medical testimony him rather than his to satisfy deposition testimony and affidavit of Ms Fields an attempt acknowledged in her deposition that she is 2 on introducing expert opinion disapproving Mr Guardia to offer condition caused the pressure ulcers offered the to establish that he will be able trial Thus it the s formation of the pressure ulcers issue of medical causation in addition sufficient Guardia medical condition Dr Sondes regardless of any action taken by Lakeview and there that would have Guardia complex s hypovolemic anemia Mr to carry oxygen to the doctor observed that because Mr acute at In to pressure development of Specifically causing skin and made the pressure ulcers concluded that Mr to Mr s clotting ability which made his his damage to exposed body peripheral put Mr Guardia those just coagulopathy inhibited s He noted that the of blood away from organs which not complex s not complex medical this burden a nurse qualified plaintiff However to give an expert opinion on the medical admission it is opinion medical causation of on undisputed that more probably than For these reasons not light to render a Mr Guardia did not satisfy his burden establish that he would be able to prove at Ms Fields Accordingly offering expert evidence sufficient trial In of plaintiff cause that the to nurses was s pressure ulcers not qualified substandard I conclude the trial court caused his correctly granted motion for summary judgment and I would affirm that 3 care ruling of this medical injuries Lakeview s
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