SOUTHEASTERN PAIN SPECIALISTS, P.C. v. BROWN (Three Cases)

303 Ga. 265
CourtSupreme Court of Georgia
DecidedMarch 5, 2018
DocketS17G0732, S17G0733, S17G0737
StatusPublished
Cited by12 cases

This text of 303 Ga. 265 (SOUTHEASTERN PAIN SPECIALISTS, P.C. v. BROWN (Three Cases)) is published on Counsel Stack Legal Research, covering Supreme Court of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SOUTHEASTERN PAIN SPECIALISTS, P.C. v. BROWN (Three Cases), 303 Ga. 265 (Ga. 2018).

Opinion

303 Ga. 265 FINAL COPY

S17G0732. SOUTHEASTERN PAIN SPECIALISTS, P.C. v. BROWN et al. S17G0733. DOHERTY v. BROWN et al. S17G0737. SOUTHEASTERN PAIN AMBULATORY SURGERY CENTER, LLC v. BROWN et al.

PETERSON, Justice.

These companion appeals raise questions about when a jury considering a

medical malpractice case might also be instructed on issues of ordinary

negligence. Sterling Brown Sr. sued the defendants individually and on behalf of

his wife, Gwendolyn Lynette Brown, after she suffered catastrophic brain

damage, allegedly from oxygen deprivation while undergoing a procedure to

relieve back pain. Mrs. Brown died while this suit was pending, and the

complaint was amended to add a wrongful death claim.1 A trial in which the court

instructed the jury on both ordinary negligence and medical malpractice resulted

in an award of nearly $22 million. A divided Court of Appeals affirmed. We

granted the defendants’ petitions for certiorari to consider their argument that the

Court of Appeals erred by concluding that the evidence supported a claim of

1 For simplicity, we refer to Mr. Brown and his wife’s estate as “the plaintiffs.” ordinary negligence.

The plaintiffs’ case of medical malpractice was very strong. But a very

strong case of medical malpractice does not become a case of ordinary

negligence simply due to the egregiousness of the medical malpractice. The Court

of Appeals erred in concluding that an ordinary negligence instruction was

authorized by evidence that a doctor defendant responded inadequately to medical

data provided by certain medical equipment during a medical procedure. Because

the verdict was a general one such that we cannot determine that the jury did not

rely on this erroneous theory of liability, we reverse with instructions that the

Court of Appeals on remand order a full retrial as to the appellants.

1. Background and procedural history. (a) Background.

The evidence presented at trial was as follows. Dr. Dennis Doherty, an

anesthesiologist and pain management specialist, began treating Gwendolyn

Lynette Brown for chronic back pain in 2008. Dr. Doherty performed two

epidural steroid injection procedures (“ESIs”)2 on Mrs. Brown without incident.

On September 16, 2008, Mrs. Brown arrived at the surgery center that Dr.

2 During an ESI, steroid medication is injected into the epidural space in the spine to reduce inflammation and relieve pain.

2 Doherty had opened in 2006 (“the Surgery Center”) for a third ESI. After her

vital signs were assessed, Mrs. Brown was given a pain reliever and a sedative

and placed face down on a surgical table. Some time later, at about 5:30 p.m., Dr.

Doherty came into the operating room, administered propofol (another, different

sedative), and started the procedure. Mrs. Brown’s blood oxygen saturation level

at this point was recorded at 100 percent.3

Shortly after Dr. Doherty began the procedure, the pulse oximeter4 that was

used to monitor Mrs. Brown’s blood oxygen saturation level sounded an alarm,

indicating a drop in the level of oxygen in her blood. Michelle Perkins, a surgical

technician involved in the procedure, at several points tried to turn up the oxygen,

but each time Dr. Doherty told her to return to the imaging machine she had been

operating. Ann Yearian, a nurse who was assisting, testified that at Dr. Doherty’s

direction she turned up the oxygen being administered to Mrs. Brown. Yearian

began performing a “jaw thrust” — a procedure to open a patient’s airway by

3 The amount of oxygen in a patient’s blood is measured as a percentage of the total amount that red blood cells can carry. Blood carries oxygen to the body’s various organs, including the brain, and inadequate oxygen in the blood ultimately can lead to brain damage or death. 4 A pulse oximeter is a device that clips onto a patient’s finger or toe and measures the patient’s blood oxygen saturation level.

3 repositioning her jaw. But Yearian reported difficulty, so Dr. Doherty paused his

work of administering the epidural and assisted with the jaw thrust. Perkins asked

Dr. Doherty if she should call nursing director Mary Hardwick, but he told her

not to, saying Mrs. Brown was breathing and her airway was good. Perkins

nonetheless tried to summon Hardwick with a surreptitious text message.

When Hardwick arrived, Mrs. Brown was lying face down on the table

with five-inch needles in her back, Dr. Doherty was at the head of the table

holding her jaw to maintain an airway, and the pulse oximeter was sounding an

alarm and registering zero.5 The blood pressure monitor was recycling, inflating

repeatedly without registering a reading. Hardwick grabbed a stretcher so that

Mrs. Brown could be turned on her back to be resuscitated, but Dr. Doherty

would not allow it. Instead, he told Hardwick that the pulse oximeter was

malfunctioning and did not show Mrs. Brown’s true oxygen saturation, and that

Mrs. Brown had a pulse, was breathing, and was fine. Perkins retrieved a second

pulse oximeter at Hardwick’s directive, and Hardwick placed it on Mrs. Brown’s

toe, but it also registered a reading of zero oxygen saturation. Dr. Doherty

5 One of the plaintiffs’ expert witnesses testified, “We like to see levels at 90 percent saturation or above.”

4 continued to insist that everything was fine and resumed the procedure as various

staffers attempted to physically maintain Mrs. Brown’s airway. The procedure

was completed at 5:48 p.m, 18 minutes after it began.

After Dr. Doherty completed the procedure and the needles were removed,

Mrs. Brown was turned onto her back and placed on a stretcher. A pulse oximeter

began registering a blood oxygen level in the low 50-percent range. Mrs. Brown

was given drugs to reverse the effects of some of the drugs she had been given

previously. Dr. Doherty began manually ventilating Mrs. Brown with a bag valve

mask. Within a couple of minutes, her oxygen levels rose to the 90s; she was able

to maintain that level with oxygen being administered. Hardwick asked if she

could call 911, but Dr. Doherty told her not to, saying that Mrs. Brown was just

heavily sedated.

At about 7:30 p.m., when Mrs. Brown had not fully awoken or responded

normally to voice or painful stimuli, she was taken to a hospital by emergency

medical personnel. Dr. Doherty told Mrs. Brown’s daughter-in-law, the

emergency medical technicians who responded to the practice’s 911 call, and the

physician who admitted Mrs. Brown to the hospital that the ESI had gone fine and

Mrs. Brown simply was having complications coming out of the anesthesia

5 slowly; he gave no indication that Mrs. Brown might have experienced

respiratory complications during the procedure. Mrs. Brown arrived at the

hospital in what the admitting physician described as “acute respiratory failure.”

Mrs. Brown remained profoundly cognitively impaired and a quadriplegic for six

years until her death in September 2014. The plaintiffs presented evidence that

Mrs. Brown had suffered a catastrophic brain injury caused by oxygen

deprivation during the ESI and that she died from complications of that injury.

(b) Trial proceedings.

The plaintiffs sued Dr. Doherty, Hardwick, Southeastern Pain Ambulatory

Surgery Center, LLC (“the LLC”), and Southeastern Pain Specialists, P.C. (“the

P.C.”).6 The complaint and subsequent amendment were entitled “Complaint for

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