FIFTH DIVISION MCFADDEN, P. J., GOBEIL and LAND, JJ.
NOTICE: Motions for reconsideration must be physically received in our clerk’s office within ten days of the date of decision to be deemed timely filed. https://www.gaappeals.us/rules
January 19, 2023
In the Court of Appeals of Georgia A22A1714. MYFAMILYDOC, LLC et al. v. JOHNSTON et al.
MCFADDEN, Presiding Judge.
Margaret Johnston, the surviving spouse and administrator of the estate of
decedent Wayne Johnston, filed a medical malpractice action against Dr. Ravin
Talati, nurse practitioner Mary Chastain, and MyFamilyDoc, LLC, alleging that the
defendants had breached the standard of care by failing to timely review laboratory
results showing that the decedent was severely anemic, to a degree that constituted
a medical emergency. The defendants filed joint motions for summary judgment and
to exclude expert testimony regarding causation. The trial court denied the motions;
and the defendants brought this appeal, challenging the denial of summary judgment
to Chastain based on the trial court’s finding that there is a question of fact as to whether she owed a duty to the decedent and contesting the court’s admission of the
expert testimony.
We reverse the denial of summary judgment to Chastain because she has
pointed to undisputed evidence showing that she owed no duty of care to the
decedent. But we affirm the trial court’s refusal to exclude the expert testimony
because the court did not abuse its discretion in allowing such testimony.
1. Denial of summary judgment to nurse Chastain.
“Summary judgment is proper if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if any, show that
there is no genuine issue as to any material fact and that the moving party is entitled
to a judgment as a matter of law. OCGA § 9-11-56 (c).” GeorgiaCarry.Org v. Atlanta
Botanical Garden, 306 Ga. 829, 830 (1) (834 SE2d 27) (2019) (citation and
punctuation omitted omitted). On appeal, “[w]e review the grant or denial of a motion
for summary judgment de novo, and we must view the evidence, and all reasonable
inferences drawn therefrom, in the light most favorable to the nonmovant.” In the
Matter of Tapley, 308 Ga. 577 (842 SE2d 36) (2020) (citation and punctuation
omitted).
2 So viewed, the evidence shows that Wayne Johnston began receiving medical
care from Dr. Talati at his MyFamilyDoc practice in July 2017. On August 27, 2018,
Johnston, who had been experiencing fatigue and shortness of breath, was seen by Dr.
Talati at MyFamilyDoc. Dr. Talati recommended that Johnston return the next
morning to have his blood drawn for testing, and a follow-up appointment with Dr.
Talati was scheduled for September 4th. The next morning, August 28th, Johnston
had his blood drawn at MyFamilyDoc and the samples were sent to an outside
laboratory for testing. On August 29th, the laboratory electronically transmitted the
test results, showing that Johnston was anemic, to MyFamilyDoc.
Dr. Talati and nurse practitioner Chastain were the only medical providers at
MyFamilyDoc who were responsible for reviewing patient lab results, but neither of
them looked at Johnston’s lab results when they arrived from the laboratory.
According to Dr. Talati, he would have reviewed the results on the morning of
Johnston’s follow-up visit with him on September 4th. But Johnston died prior to that
appointment and Dr. Talati did not view the test results until after he had been
notified of Johnston’s death. After viewing the test results, Dr. Talati called Margaret
Johnston, offered his condolences, and told her that the laboratory results showed that
her husband had been anemic.
3 In seeking summary judgment, Chastain claims that she had no duty to review
Johnston’s blood test results because he was not her patient. See Herrington v.
Gaulden, 294 Ga. 285, 286 (751 SE2d 813) (2013) (plaintiff in medical malpractice
case must prove that he was a patient of the defendant in order to establish the
defendant’s legal duty); Curmode v. Alsbrooks, ___ Ga. App. ___ (Case No.
A22A0801, decided Oct. 27, 2022) (duty inherent in the medical provider-patient
relationship is an essential element of a medical malpractice action, so there can be
no liability for malpractice in the absence of that relationship). Chastain has pointed
to the absence of evidence in the record showing such a duty arising from a medical
provider-patient relationship between her and Johnston, noting plaintiff Margaret
Johnston’s deposition testimony admitting that although she was present for her
husband’s medical appointments, she had “no idea” if he had ever received treatment
from Chastain.
In addition to the absence of evidence showing a provider-patient relationship,
Chastain has also cited specific evidence demonstrating that Johnston was not her
patient. In her deposition, Chastain testified not only that she had not seen Johnston
at the office, but that she had never even met him. Chastain explained that she and Dr.
Talati were the only providers at MyFamilyDoc who were qualified to evaluate
4 patients; that they had separate patient schedules, so she saw her patients and Dr.
Talati saw his; that they each reviewed laboratory results for their own patients; and
that she would only review laboratory results for Dr. Talati’s patients if he
specifically asked her to do so or if the laboratory called the office to report critical
test results and she was the first provider available to review them. With regard to
Johnston, Chastain testified that she “never saw him,” that she “didn’t take care of
him,” that she “didn’t order his labs,” that she “never talked to Dr. Talati about him,”
and that she “never discussed [his] care with anybody.” As for Johnston’s last visit
with Dr. Talati on August 27, 2018, the undisputed evidence, including the
depositions of Margaret Johnston and Dr. Talati, shows that Johnston was not seen
by Chastain and that he was seen only by Dr. Talati after a medical assistant had
obtained Johnston’s vital information.
A defendant seeking summary judgment may demonstrate [that there is no genuine issue of material fact and that she is entitled to judgment as a matter of law] by either presenting evidence negating an essential element of the plaintiff’s claims or establishing from the record an absence of evidence to support such claims. Where a defendant moving for summary judgment discharges this burden, the nonmoving party cannot rest on its pleadings, but rather must point to specific evidence giving rise to a triable issue.
5 Montgomery v. Travelers Home & Marine Ins. Co., 360 Ga. App. 587, 588 (1) (859
SE2d 130) (2021) (citation and punctuation omitted).
Because Chastain has presented evidence negating the essential element of duty
arising from a provider-patient relationship and demonstrated the absence of evidence
showing that she owed a duty to the decedent, appellee Margaret Johnston must point
to specific evidence giving rise to a triable issue. In attempting to meet this burden,
she has not argued or cited evidence showing that Dr. Talati specifically asked
Chastain to review Johnston’s test results or that Chastain was the first provider
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FIFTH DIVISION MCFADDEN, P. J., GOBEIL and LAND, JJ.
NOTICE: Motions for reconsideration must be physically received in our clerk’s office within ten days of the date of decision to be deemed timely filed. https://www.gaappeals.us/rules
January 19, 2023
In the Court of Appeals of Georgia A22A1714. MYFAMILYDOC, LLC et al. v. JOHNSTON et al.
MCFADDEN, Presiding Judge.
Margaret Johnston, the surviving spouse and administrator of the estate of
decedent Wayne Johnston, filed a medical malpractice action against Dr. Ravin
Talati, nurse practitioner Mary Chastain, and MyFamilyDoc, LLC, alleging that the
defendants had breached the standard of care by failing to timely review laboratory
results showing that the decedent was severely anemic, to a degree that constituted
a medical emergency. The defendants filed joint motions for summary judgment and
to exclude expert testimony regarding causation. The trial court denied the motions;
and the defendants brought this appeal, challenging the denial of summary judgment
to Chastain based on the trial court’s finding that there is a question of fact as to whether she owed a duty to the decedent and contesting the court’s admission of the
expert testimony.
We reverse the denial of summary judgment to Chastain because she has
pointed to undisputed evidence showing that she owed no duty of care to the
decedent. But we affirm the trial court’s refusal to exclude the expert testimony
because the court did not abuse its discretion in allowing such testimony.
1. Denial of summary judgment to nurse Chastain.
“Summary judgment is proper if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if any, show that
there is no genuine issue as to any material fact and that the moving party is entitled
to a judgment as a matter of law. OCGA § 9-11-56 (c).” GeorgiaCarry.Org v. Atlanta
Botanical Garden, 306 Ga. 829, 830 (1) (834 SE2d 27) (2019) (citation and
punctuation omitted omitted). On appeal, “[w]e review the grant or denial of a motion
for summary judgment de novo, and we must view the evidence, and all reasonable
inferences drawn therefrom, in the light most favorable to the nonmovant.” In the
Matter of Tapley, 308 Ga. 577 (842 SE2d 36) (2020) (citation and punctuation
omitted).
2 So viewed, the evidence shows that Wayne Johnston began receiving medical
care from Dr. Talati at his MyFamilyDoc practice in July 2017. On August 27, 2018,
Johnston, who had been experiencing fatigue and shortness of breath, was seen by Dr.
Talati at MyFamilyDoc. Dr. Talati recommended that Johnston return the next
morning to have his blood drawn for testing, and a follow-up appointment with Dr.
Talati was scheduled for September 4th. The next morning, August 28th, Johnston
had his blood drawn at MyFamilyDoc and the samples were sent to an outside
laboratory for testing. On August 29th, the laboratory electronically transmitted the
test results, showing that Johnston was anemic, to MyFamilyDoc.
Dr. Talati and nurse practitioner Chastain were the only medical providers at
MyFamilyDoc who were responsible for reviewing patient lab results, but neither of
them looked at Johnston’s lab results when they arrived from the laboratory.
According to Dr. Talati, he would have reviewed the results on the morning of
Johnston’s follow-up visit with him on September 4th. But Johnston died prior to that
appointment and Dr. Talati did not view the test results until after he had been
notified of Johnston’s death. After viewing the test results, Dr. Talati called Margaret
Johnston, offered his condolences, and told her that the laboratory results showed that
her husband had been anemic.
3 In seeking summary judgment, Chastain claims that she had no duty to review
Johnston’s blood test results because he was not her patient. See Herrington v.
Gaulden, 294 Ga. 285, 286 (751 SE2d 813) (2013) (plaintiff in medical malpractice
case must prove that he was a patient of the defendant in order to establish the
defendant’s legal duty); Curmode v. Alsbrooks, ___ Ga. App. ___ (Case No.
A22A0801, decided Oct. 27, 2022) (duty inherent in the medical provider-patient
relationship is an essential element of a medical malpractice action, so there can be
no liability for malpractice in the absence of that relationship). Chastain has pointed
to the absence of evidence in the record showing such a duty arising from a medical
provider-patient relationship between her and Johnston, noting plaintiff Margaret
Johnston’s deposition testimony admitting that although she was present for her
husband’s medical appointments, she had “no idea” if he had ever received treatment
from Chastain.
In addition to the absence of evidence showing a provider-patient relationship,
Chastain has also cited specific evidence demonstrating that Johnston was not her
patient. In her deposition, Chastain testified not only that she had not seen Johnston
at the office, but that she had never even met him. Chastain explained that she and Dr.
Talati were the only providers at MyFamilyDoc who were qualified to evaluate
4 patients; that they had separate patient schedules, so she saw her patients and Dr.
Talati saw his; that they each reviewed laboratory results for their own patients; and
that she would only review laboratory results for Dr. Talati’s patients if he
specifically asked her to do so or if the laboratory called the office to report critical
test results and she was the first provider available to review them. With regard to
Johnston, Chastain testified that she “never saw him,” that she “didn’t take care of
him,” that she “didn’t order his labs,” that she “never talked to Dr. Talati about him,”
and that she “never discussed [his] care with anybody.” As for Johnston’s last visit
with Dr. Talati on August 27, 2018, the undisputed evidence, including the
depositions of Margaret Johnston and Dr. Talati, shows that Johnston was not seen
by Chastain and that he was seen only by Dr. Talati after a medical assistant had
obtained Johnston’s vital information.
A defendant seeking summary judgment may demonstrate [that there is no genuine issue of material fact and that she is entitled to judgment as a matter of law] by either presenting evidence negating an essential element of the plaintiff’s claims or establishing from the record an absence of evidence to support such claims. Where a defendant moving for summary judgment discharges this burden, the nonmoving party cannot rest on its pleadings, but rather must point to specific evidence giving rise to a triable issue.
5 Montgomery v. Travelers Home & Marine Ins. Co., 360 Ga. App. 587, 588 (1) (859
SE2d 130) (2021) (citation and punctuation omitted).
Because Chastain has presented evidence negating the essential element of duty
arising from a provider-patient relationship and demonstrated the absence of evidence
showing that she owed a duty to the decedent, appellee Margaret Johnston must point
to specific evidence giving rise to a triable issue. In attempting to meet this burden,
she has not argued or cited evidence showing that Dr. Talati specifically asked
Chastain to review Johnston’s test results or that Chastain was the first provider
available to review the critical results after a call from the laboratory. Rather, she
claims that Dr. Talati deposed that Chastain had a duty to review Johnston’s blood
test results, citing his affirmative response to a question indicating that “responsibility
for reviewing these lab results lies with either you or Mary Chastain, but one of the
two of you is required to review completed lab results[.]” But the appellee has
misconstrued Dr. Talati’s testimony, which must be viewed in the context of his
entire deposition. See Forrester v. Ga. Dept. of Human Svcs., 308 Ga. App. 716, 728
(1) (a) (iv) (708 SE2d 660) (2011) (on summary judgment, specific testimony “read
in the context of [the] entire deposition”); Berson v. American Golf Corp., 265 Ga.
6 App. 772, 774-775 (595 SE2d 622) (2004) (considering statements “in the context of
[the] deposition testimony as a whole”).
A review of Dr. Talati’s entire deposition reveals that he confirmed that he and
nurse practitioner Chastain saw their own patients, that Johnston was his patient, that
he ordered Johnston’s blood tests, and that he would have reviewed the laboratory
results before Johnston’s follow-up visit with him. While the portion of Dr. Talati’s
testimony cited above acknowledged that either he or Chastain was responsible for
reviewing test results, it did not indicate that both of them bore such a responsibility
or that Chastain had that responsibility in this case. On the contrary, it is apparent
from a review of Dr. Talati’s entire deposition that he, not Chastain, was the medical
provider responsible for reviewing his patient Johnston’s test results. Indeed, “when
the [cited testimony is] viewed in the context of Dr. [Talati’s] entire deposition, it is
readily apparent that [he] was not referring to the specific [duty] that the [plaintiff]
sought to attribute to [nurse Chastain].” Robles v. Yugueros, 343 Ga. App. 377, 386
(2) (b) (807 SE2d 110) (2017) (emphasis omitted).
Margaret Johnston also points to an audit trail indicating that Chastain accessed
the decedent’s chart on the last date he was seen by Dr. Talati. But she has cited no
evidence showing that such access created a provider-patient relationship between
7 Chastain and Johnston or a duty for Chastain to review Johnston’s subsequent
laboratory results. The only cited evidence explaining that audit trail came from
Chastain’s deposition testimony that if she accessed the chart, she did not mean to do
so; that such access would have occurred accidentally while she was scrolling
through the list of patients; and that she never saw anything in Johnston’s chart.
“Accordingly, even though the [audit trail shows that Chastain accessed Johnston’s
chart, it does] not . . . establish that [she] treated [him or contravene the other]
evidence negating an essential element of [Margaret Johnston’s] claim — the
existence of a [provider]-patient relationship[.]” Tomeh v. Bohannon, 329 Ga. App.
596, 599 (765 SE2d 743) (2014).
Given the undisputed evidence establishing that Johnston was never Chastain’s
patient and the appellee’s failure to point to any evidence demonstrating that Chastain
otherwise had a duty to review Johnston’s test results, there is no genuine issue of
material fact and Chastain is entitled to judgment as a matter of law.
The touchstone for negligence cases of this nature, however they are couched, must be the actual existence of a [medical provider]-patient relationship, not some inchoate or nebulous responsibility. We decline thus to take this opportunity to find that a [nurse practitioner] could be held liable to a potential patient with whom [she] has never spoken, seen, met, or been consulted about.
8 Guida v. Lesser, 264 Ga. App. 293, 298 (590 SE2d 140) (2003) (citations omitted).
Accordingly, we reverse the trial court’s denial of Chastain’s motion for summary
judgment. See Pham v. Black, 347 Ga. App. 585, 588 (1) (820 SE2d 209) (2018) (trial
court erred in denying defendant’s motion for summary judgment where there was no
evidence of a doctor-patient relationship).
2. Expert testimony.
“OCGA § 24-7-702 governs the admissibility of expert testimony, and it
requires that the trial court act as gatekeeper to ensure the relevance and reliability
of expert testimony.” Allen v. CFYC Const., 354 Ga. App. 890, 892 (1) (842 SE2d
297) (2020) (citation omitted). In language now codified at OCGA § 24-7-702 (b)
(3),1 a qualified expert may give opinion testimony if, among other things, “[t]he
testimony is the product of reliable principles and methods[.]” Under OCGA § 24-7-
702, the trial court must “ensur[e] that an expert’s testimony both rests on a reliable
foundation and is relevant to the task at hand. Pertinent evidence based on
scientifically valid principles will satisfy those demands.” Daubert v. Merrell Dow
Pharmaceuticals, 509 U. S. 579, 597 (IV) (113 SCt 2786, 125 LE2d 469 (1993). See
1 This same language was previously in subdivision (b) (2) of OCGA § 24-7- 702, which was in effect when the trial court issued its ruling in April 2022, but was moved to subdivision (b) (3) as part of a statutory amendment, effective July 1, 2022.
9 OCGA § 24-7-702 (f) (“in interpreting and applying this Code section, the courts of
this state may draw from the opinion[] of the United States Supreme Court in Daubert
v. Merrell Dow Pharmaceuticals, Inc., 509 U. S. 579 (1993)”). “Whether expert
testimony ought to be admitted under OCGA § 24-7-702 is a question committed to
the sound discretion of the trial court[, so w]e will not disturb the trial court’s
determination absent [an] abuse of discretion.” Allen, supra (citation omitted). Accord
Howell v. Cochran, 365 Ga. App. 80, 84 (877 SE2d 625) (2022).
The appellants argue that the trial court abused its discretion in denying their
motion to exclude a doctor’s expert opinion that Johnston’s severe anemia was a
proximate cause of his death because the doctor did not base his opinion on a proper
differential diagnosis, “which is a patient-specific process of elimination that medical
practitioners use to identify the most likely cause of an injury from a list of possible
causes.” Hawkins v. OB-GYN Assoc., 290 Ga. App. 892, 893 (1) (660 SE2d 835)
(2008) (citation and punctuation omitted). Using this methodology, “the physician
considers all relevant potential causes of the patient’s symptoms and then eliminates
alternative causes based on a physical examination, clinical tests, and a thorough case
history.” Smith v. Finch, 285 Ga. 709, 711 (1) (681 SE2d 147) (2009) (citation and
punctuation omitted). The appellants acknowledge that the doctor in this case was not
10 required to completely eliminate every possible cause of Johnston’s death, but they
claim that he failed to take account of other potential causes and improperly
dismissed Johnston’s other comorbidities as possible causes of death simply because
it was “not [his] opinion.”
But a review of the doctor’s entire deposition reveals that he did not fail to
consider, or give such dismissive testimony of, other possible causes of death. See
Forrester, supra (considering testimony in context of deposition as a whole); Berson,
supra (same). Rather, the doctor expressly cited Johnston’s various comorbidities
listed on his death certificate, including cardiovascular disease, diabetes,
hypertension, and anemia. He agreed with the certificate identifying cardiovascular
disease as the immediate cause of death, he testified that all of Johnston’s
comorbidities could have caused his death, and he conceded that anemia by itself did
not cause Johnston’s death. The doctor opined, however, that Johnston’s anemia
aggravated the other underlying diseases, that his severe anemia coupled with his
other comorbidities led to his death, and that he probably would not have died when
he did without such severe anemia. He explained that anemia was the only variable
that had changed from an earlier blood test in July 2018 until the test at issue in
August 2018, which showed a significant drop in Johnston’s red blood cells so that
11 proper oxygenation of his heart was not possible at that point. The doctor testified
that Johnston’s other conditions were stable; that he was not having acute symptoms
from them; and that his severe anemia made the other conditions worse, “particularly
his heart disease.”
The appellants cite Guinn v. AstraZeneca Pharmaceuticals, 602 F3d 1245
(11th Cir. 2010) and Shiver v. Ga. & Fla. Railnet, 287 Ga. App. 828 (652 SE2d 819)
(2007) to support their argument that a mere temporal relationship between
Johnston’s anemia and his death does not eliminate alternative causes of death. While
the expert in this case considered such a temporal relationship, he did not base his
opinion solely on that relationship. Rather, as recounted above, he also considered the
severity of Johnston’s anemia, the significant drop in his red blood cells, and how
those factors impacted Johnston’s other relatively stable comorbidities.
Moreover, we note that in his own deposition, defendant Dr. Talati also
acknowledged that Johnston’s severe anemia was life-threatening. He testified that
anemia can be a fatal condition; that he ordered Johnston’s blood work in order to
determine whether, among other things, he was anemic; that the blood test results
showed that Johnston’s anemia was critical and required emergency medical
12 treatment; and that he would have instructed Johnston to report immediately to the
emergency room if he had seen the test results prior to Johnston’s death.
Trial courts must determine whether to allow “expert opinions on a case-by-
case basis.” Freeman v. LTC Healthcare of Statesboro, 329 Ga. App. 763, 765-766
(766 SE2d 123) (2014). Under the circumstances of the instant case, we conclude that
the appellants have “fail[ed] to show how [the expert’s] opinion was not rendered
using a scientifically valid methodology . . . . Accordingly, it was no abuse of
discretion for the trial court to rule [that] the testimony of [the expert] was
admissible.” Fields v. Taylor, 340 Ga. App. 706, 713 (2) (b) (797 SE2d 127) (2017).
See also Emory Univ. v. Willcox, 355 Ga. App. 542, 544 (2) (844 SE2d 889) (2020)
(trial court did not abuse its discretion in denying defendants’ motion to exclude
doctor’s expert opinion).
3. Causation.
In their final enumeration of error, the appellants reason that if the trial court
erred in failing to exclude the expert testimony discussed above, then they would be
entitled to summary judgment because there would be no proof of causation. But
because we held above that the trial court did not err in refusing to exclude the expert
testimony, this enumeration is without merit.
13 Judgment affirmed in part and reversed in part. Gobeil and Land, JJ., concur.