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Whitfield v. Southern Maryland Hospital, Inc.

United States District Court, D. Maryland

March 7, 2014



DEBORAH K. CHASANOW, District Judge.

Presently pending and ready for review in this medical malpractice case are four motions: (1) a motion in limine under Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993), to strike and exclude causation testimony by David H. Goldstein, M.D. filed by Defendants Southern Maryland Hospital, Inc.; Weatherby Locums, Inc.; Edna Ruth Hill, M.D.; Gastrointestinal Associates of Maryland, P.A.; and Lornette Mills, M.D. ("Defendants") (ECF No. 49); (2) a motion for summary judgment filed by Defendants (ECF No. 50); (3) a separate motion for summary judgment filed by Defendant Weatherby Locums, Inc. (ECF No. 44); and (4) a motion filed by Defendants to withdraw certain exhibits that contain personal identifying information and replace those exhibits with redacted versions (ECF No. 56). The issues have been fully briefed, and the court now rules, no hearing being deemed necessary. Local Rule 105.6. For the following reasons, the motion to exclude Dr. Goldstein's testimony will be denied. Defendants' motion for summary judgment will be denied. Defendant Weatherby Locums, Inc.'s motion for summary judgment will be granted. Defendants' motion to withdraw and replace certain exhibits will be granted.

I. Factual Background[1]

A. Pre-Complaint

On September 28, 2008, Plaintiff Holley Whitfield went to the emergency department at Southern Maryland Hospital ("SMH"), complaining of abdominal pain and vomiting blood. Ms. Whitfield was seen by Defendant Dr. Edna Ruth Hill - an employee of SMH and Weatherby Locums[2] - who noted that Ms. Whitfield characterized her abdominal pain as high as nine out of ten. Dr. Hill noted that Plaintiff was suffering from nausea and frequent bloody vomiting, had irregular lab results, and was on birth control pills. (ECF No. 1 ¶¶ 25-28). Dr. Hill reviewed an X-ray taken of Plaintiff and arrived at an initial diagnosis of upper gastrointestinal bleeding. Dr. Hill did not order a computerized tomography scan ("CAT Scan"). ( Id. ¶¶ 31, 33). Dr. Hill consulted with SMH hospitalist Shannon Asko, who was aware of Plaintiff's complaints of extreme pain.

Plaintiff was subsequently admitted to SMH in the early morning hours of September 29, 2008, under the care of SMH Doctor Rasheed Abassi. ( Id. ¶¶ 34, 36-37). Dr. Abassi was aware of Plaintiff's acute pain. ( Id. ¶ 38). At 1:15 P.M. on September 29, 2008, Defendant Dr. Lornette Mills, a gastroenterologist employed by Gastrointestinal Associates of Maryland ("GAM"), first saw and treated Plaintiff.[3] She noted a differential diagnosis of "1. NSAID gastropathy/peptic ulcer disease. 2. Mallory-Weiss tear. 3. Ateriovenous [sic] malformation. 4. Small bowel lesion." ( Id. ¶ 41). That same afternoon, Mills conducted an endoscopy on Plaintiff and noted "upper gastrointestinal bleeding with the source likely beyond the second portion of the duodenum." ( Id. ¶ 42). She updated her differential diagnosis to: "1. Meckel diverticulum. 2. Arteriovenous malformation. 3. Small bowel lesion." ( Id. ). Mills recommended a Meckel scan which indicated "no abnormality is seen to suggest a Meckel's diverticulum." ( Id. ¶ 43). Two days later, on October 1, 2008, Plaintiff underwent a computerized tomography angiography scan ("CTA Scan") on her chest which indicated a small left pleural effusion. Plaintiff's vital statistics were continually irregular and unstable, and she continued to lose blood. ( Id. ¶ 44). SMH Doctor George Okang was consulted, who determined that Plaintiff was to be admitted to the intensive care unit because of her persistently high heart rate. ( Id. ¶ 45).

On October 2, 2008, Dr. Okang ordered a CAT Scan due to Plaintiff's persistent abdomen pain. Most relevant for this case, the CAT Scan revealed a superior mesenteric vein thrombosis ("SMVT"). SMVT is a clot of the superior mesenteric vein through which blood leaves the intestine. SMVT, if left untreated, can eventually cause death. Defendants did not administer any anticoagulation medicine. Plaintiffs contend that they did not act with any speed despite the seriousness of Ms. Whitfield's diagnosis. ( Id. ¶¶ 47-49).

Ms. Whitfield's family was informed of her diagnosis and requested a transfer to the Medical College of Virginia ("MCV") in Richmond, Virginia, a facility that was better equipped to handle SMVT. SMH refused to transfer her unless and until a physician from an accepting hospital notified SMH that it would accept Plaintiff. Plaintiff's family worked the phones until they found a physician who arranged the transfer on October 3, 2008. ( Id. ¶¶ 50-53).

Upon arrival at MCV, Plaintiff was diagnosed with acute mesenteric ischemia, or internal bleeding of the mesenteric vein. Plaintiff underwent surgery which resulted in the removal of seventeen inches of her small intestine after it had died from lack of blood. ( Id. ¶¶ 54-55). During her time at SMH and MCV, Plaintiff suffered additional consequences from her acute mesenteric ischemia, including "persistently low hemoglobin levels, rectal bleeding, confusion, agitation, altered mental status requiring medication and psychological consultations, high blood sugar, nausea and vomiting, high pulse rate, rapid shivering and twitching of her jaw, incontinence, inability to talk and/or respond to questions, hospital acquired MRSA [Methicillin-resistant Staphylococcus Aureus], [and] explosive diarrhea." ( Id. ¶ 60). "Plaintiff continues to experience significant and severe physical and mental anguish, pain, suffering, inconvenience, physical impairment, disfigurement, and other injuries, as well as additional medical treatment, bills, and loss of earnings and economic capacity." ( Id. ¶ 63).

B. Complaint

Plaintiffs allege that Defendants provided inadequate care and treatment to Ms. Whitfield from September 29 to October 3, 2008.

The Maryland Health Care Malpractice Claims Act (the "Malpractice Claims Act"), Md. Code Ann., Cts. & Jud. Proc. §§ 3-2A-01 et seq., governs the procedures for medical malpractice claims in the state of Maryland. See, e.g., Carroll v. Kontis, 400 Md. 167, 172 (2007). On September 26, 2011, Plaintiffs filed a Statement of Claim in the Healthcare Alternative Dispute Resolution Office ("HCADRO"). The HCADRO is an administrative body established by the Malpractice Claims Act.

A party can waive arbitration in the HCADRO, which terminates proceedings. See Md. Code Ann., Cts. & Jud. Proc. § 3-2A-06B(a) to (d)(1). The Malpractice Claims Act notes that suit may then be filed in either Maryland Circuit Court or the U.S. District Court. Id. §§ 3-2A-06A(c), 06B(f).

On July 24, 2012, all Defendants filed an election to waive arbitration under the Malpractice Claims Act. On July 27, 2012, HCADRO ordered transfer to this court. Plaintiffs filed their complaint on September 14, 2012. (ECF No. 1).[4] Plaintiffs complaint consists of two claims: first, a claim of medical negligence; specifically, that Defendants owed Plaintiff Holley Whitfield a duty to exercise that degree of skill and care ordinarily possessed and used by health care providers acting in the same or similar circumstances. Plaintiffs allege that Defendants breached this duty in a variety of ways, the result of which directly and proximately caused Plaintiff's economic and non-economic damages. Second, Plaintiffs claim that as a direct and proximate cause of Defendants' negligence, Plaintiffs suffered damage to their marital relationship. (ECF No. 1 ¶¶ 64-71). This court's subject-matter jurisdiction lies in diversity, 28 U.S.C. § 1332, as Plaintiffs are citizens of Virginia and Defendants are citizens of either Maryland or Utah and the amount in controversy exceeds $75, 000. ( Id. ¶ 4).

C. Post-Complaint

Dr. David H. Goldstein, one of Plaintiffs' expert witnesses, was deposed. Dr. Goldstein testified that based on the symptoms Plaintiff presented upon arrival at SMH, Defendants should have promptly ordered a CAT Scan, and failure to do so promptly violated their standard of care. The CAT Scan would have revealed Plaintiff's SMVT, for which the standard of care was treatment with an anticoagulant such as the drug heparin. Dr. Goldstein contends that Defendants' failure to administer heparin by September 30, 2008 caused Plaintiff's injuries, because if the drug was administered by that date, it was his opinion that it is more likely than not that blood would have returned to her intestines, foregoing the need for surgery which resulted in the removal of seventeen inches of Plaintiff's small intestine. Alternatively, prompt administration of heparin would have reduced the amount of intestine that had to be removed.

II. Procedural Background

On June 7, 2013, Defendant Weatherby Locums, Inc. filed a motion for summary judgment, arguing that it is not liable for Dr. Hill's alleged negligence because Dr. Hill is not its employee, but instead an independent contractor. Additionally, Weatherby Locums argues that Plaintiffs have not demonstrated that Plaintiffs relied upon Weatherby's apparent authority over Dr. Hill when receiving medical care. (ECF No. 44). Plaintiffs filed an opposition on June 24, 2013 (ECF No. 47), to which Weatherby replied on July 9, 2013 (ECF No. 48).

On July 19, 2013, Defendants filed a joint motion in limine to strike and exclude Dr. Goldstein's causation testimony on the ground that it fails to satisfy the requirements for admissibility of expert testimony pursuant to Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993), and its progeny. (ECF No. 49). On the same day, Defendants filed a joint motion for summary judgment, arguing that because Dr. Goldstein was Plaintiffs' only expert who testified about causation, should his testimony be excluded, Defendants will have demonstrated that no genuine issue of material fact exists as to the causation element of Plaintiff's prima facie claim of negligence. (ECF No. 50). Plaintiffs filed oppositions to each motion on August 8, 2013 (ECF Nos. 49 & 50), and Defendants replied to both on August 26, 2013 (ECF Nos. 57 & 58).

Finally, on August 16, 2013, Defendants filed a motion to withdraw certain exhibits to their motion in limine and motion for summary judgment after being alerted by Plaintiffs that they contain personal identifying information. They propose to replace these exhibits with redacted versions. (ECF No. 56). Plaintiffs have not filed a response.

III. Motion to Exclude

A. Standard of Review

Under Federal Rule of Evidence 702, the district court has "a special obligation... to ensure that any and all scientific testimony... is not only relevant, but reliable.'" Kumho Tire Co. v. Carmichael, 526 U.S. 137, 147 (1999) ( quoting Daubert, 509 U.S. at 589). Rule 702 provides,

[i]f scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise, if (1) the testimony is based on sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case.

The United States Court of Appeals for the Fourth Circuit explained Rule 702 as follows:

The first prong of this inquiry necessitates an examination of whether the reasoning or methodology underlying the expert's proffered opinion is reliable - that is, whether it is supported by adequate validation to render it trustworthy. See [ Daubert, 509 U.S.] at 590 n.9. The second prong of the inquiry requires an analysis of whether the opinion is relevant to the facts at issue. See id. at 591-92.

Westberry v. Gislaved Gummi AB, 178 F.3d 257, 260 (4th Cir. 1999).

To be considered reliable, an expert opinion "must be based on scientific, technical, or other specialized knowledge and not on belief or speculation, and inferences must be derived using scientific or other valid methods." Oglesby v. Gen. Motors Corp., 190 F.3d 244, 250 (4th Cir. 1999) ( citing Daubert, 509 U.S. at 592-93). The district court enjoys "broad latitude" in determining the reliability and admissibility of expert testimony, and its determination receives considerable deference. Kumho Tire Co., 526 U.S. at 142 ( citing Gen. Elec. Co v. Joiner, 522 U.S. 136, 143 (1997)). The proponent of the testimony must ...

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