A district judge in Kansas barred an expert physician and nurse from testifying about the Defendants’ deviation from the requisite standard of care.
Facts:
On April 9, 2021, Smoky Hill admitted Arlen Dority, age 82, after a fall at his home on April 6, 2021 and a decline in his ability to care for himself. Dority resided in the COVID-19 isolation unit. On April 10, 2021, Smoky Hill completed a 48 Hour Care Plan Conference Summary and conducted a fall risk assessment for Dority, and concluded that Dority was at high risk for falls. Shortly thereafter, Dority began physical therapy and occupational therapy to improve his balance and decrease the risk for falls. Between April 9 and April 17, 2021, Dority did not have a documented fall at Smoky Hill.
On April 18, 2021, licensed nurse Andrea Stika noted that Dority was found lying on the floor against the wall, mostly on his left side. He was complaining of right hip and knee pain from his fall, and had scraped his elbow & behind his right ear. When touching the right hip, [Dority] yelled out in pain. He stated that he could not move it. Neuros were done, and no obvious injury was noted, besides the scrape behind right ear.
Smoky Hill notified Salina Emergency Medical Services (“EMS”), which arrived at Smoky Hill six minutes after the nurse found Dority, at 1:31 A.M. EMS transferred Dority to Salina Regional Medical Center, where radiographs indicated a fractured right hip. At the hospital, Dority relayed to staff, and personnel recorded, that the fall occurred while Dority was walking down the hallway at full speed. Surgeons conducted an open reduction internal fixation of the fracture.
At 4:07 P.M. on April 19, 2021, one day after his fall, Dority died. His death certificate listed hip fracture due to a fall as the primary cause of death, with congestive heart failure as a contributing cause.
Wrongful Death and Negligence
On July 9, 2022, Keyna Leonard, Dority’s surviving daughter and the administrator of his estate, sued Defendants for wrongful death and negligence.
Plaintiff claimed that Defendants negligently failed to do one or more of the following: (1) include in Dority’s Interim Care Plan fall-related interventions of a bed in the lowest position and a fall mat; (2) create a Comprehensive Care Plan, containing fall-related interventions of a bed in the lowest position and a fall mat; (3) ensure Dority’s bed was in the lowest position and a fall mat in place on the morning of April 18, 2021; (4) adequately supervise and monitor Dority on April 18, 2021; (5) ensure Dority’s safe transfer from one position to the other on April 18, 2021; and (6) ensure Defendants employed sufficient competent staff.
Defendants argued that Plaintiff has not demonstrated a genuine issue of material fact as to whether they breached any alleged duty of care and, if so, whether that breach caused Dority’s injury.
The Plaintiff retained two experts: Dr. John Kirby and Nurse Eleanore Tache. Tache opined on (1) Defendants’ deviations from the standard of care and (2) how those deviations caused Dority’s fall. John Kirby testified about all aspects of negligence and causation.
Internal Medicine Expert Witness
John Kirby is the Associate Professor of Medicine in the Department of Medicine, Cooper Medical School of Rowan University. John Kirby holds an M.D. from the University of Pennsylvania School of Medicine. Prior to that, he completed his undergraduate studies at Yale University, where he obtained a Bachelor of Science in Biology, graduating magna cum laude with distinction in biology. He previously served as a Consultant to the United States Department of Justice.
Nursing Expert Witness
Eleanore Tache has been a registered nurse since 1979. She currently holds a certification as a Director of Nursing in Long Term Care from the National Association of Directors of Nursing Administration Long Term Care. Additionally, she holds an active Nursing Home Administrator licensure since 2007. She is a graduate of Molly College with a Bachelor’s Degree in Nursing.
Discussion by the Court
Eleanore Tache
To begin with, Tache’s expert report stated that she examined whether any deviations from the standard of care “were a probable cause of harm to [Dority].” She broadly concluded that “multiple deviations” occurred, and that they were a “probable cause” of harm to Dority. She criticized Defendants’ documentation practices, but she did not implicate them in Dority’s fall on April 18, 2021. Tache found fault with Defendants’ assessments because a registered nurse did not conduct them, but she likewise expressed no opinion that this shortcoming contributed to his fall.
She opined that Defendants’ care plan was not sufficiently comprehensive or implemented early enough. But Dority took no falls before the one in question, and the record contains no evidence that any such deviation from the standard of care caused Dority’s fall. She stated that Defendants had inadequate staffing on the night in question, but did not suggest how additional staff would likely have prevented the fall. Ultimately, her opinion on causation is that Defendants “failed to prevent an avoidable fall.”
The Court held that her opinion did not create a genuine issue of material fact as to whether any alleged breach of Defendants’ duty of care caused Dority’s injury.
John Kirby
John Kirby opined that (1) given Dority’s medical history, he was at a risk of falling while in Smoky Hill’s care; (2) Smoky Hill’s fall prevention interventions were “inadequate to prevent” Dority’s fall on April 18, 2021; and (3) the trauma of the fall caused a hip fracture, which together with congestive heart failure, caused his death.
Kirby’s expert report established a causal link between Dority’s fall and his death. However, it did not create a genuine issue of material fact regarding whether any alleged deviations in the standard of care were the proximate cause of Dority’s fall. Like Tache, Kirby advanced the conclusory opinion that “[f]all prevention interventions were inadequate to prevent Dority’s 4/18/21 fall.”
Once again, Kirby’s opinion did not create a genuine issue of material fact as to whether Defendants breached a duty of care which resulted in Dority’s fall. Breach of the standard of care cannot be inferred merely from lack of success or an adverse result in treatment.
Held
Under Rule 702 and Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786, 125 L. Ed. 2d 469 (1993), the Court held that expert testimony from Tache and Kirby on the issue of causation would cause confusion and delay. In short, their opinions are based on the incorrect legal premise that failure to prevent an accident is sufficient to find liability, and are tethered to specific evidence about the circumstances of the fall.
Key Takeaways:
Opinions of Eleanore Tache and John Kirby did not create a genuine issue of material fact as to whether Defendants breached a duty of care which resulted in Dority’s fall. Moreover, breach of the standard of care cannot be inferred merely from lack of success or an adverse result in treatment. If the Court were to equate breach with an adverse result, the test would become no different than strict liability; indeed, medical facilities are not responsible each time a resident or patient is injured. Consequently, with or without expert testimony on causation, mere failure to prevent a bad outcome is not sufficient to create a genuine issue of material fact as to liability.
Case Details:
| Case Details: | Leonard V. Hmg Park Manor Of Salina, Llc Et Al |
| Docket Number: | 2:22cv2267 |
| Court Name: | United States District Court, Kansas |
| Order Date: | December 06, 2023 |
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