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Collins v. HCA Health Services of Tennessee Inc.

Court of Appeals of Tennessee, Nashville

October 28, 2016

BARBARA T. COLLINS
v.
HCA HEALTH SERVICES OF TENNESSEE, INC., ET AL.

          Session: September 21, 2016

         Appeal from the Circuit Court for Davidson County No. 14C-339 Hamilton V. Gayden, Jr., Judge

          Timothy R. Holton and Carroll C. Johnson, III, Memphis, Tennessee, for the appellant, Barbara T. Collins.

          Dixie W. Cooper and Kim J. Kinsler, Nashville, Tennessee, for the appellees, HCA Health Services of Tennessee, Inc. d/b/a Tristar Summit Medical Center.

          J. Steven Stafford, P.J., W.S., delivered the opinion of the court, in which Arnold B. Goldin and Kenny Armstrong, JJ., joined.

          OPINION

          J. STEVEN STAFFORD, JUDGE

         Background

         Because this case involves the trial court's grant of summary judgment, the facts are largely undisputed. On October 15, 2012, Plaintiff/Appellant Barbara Collins ("Appellant") was transported by ambulance to Defendant/Appellee HCA Health Services of Tennessee, Inc., d/b/a/ Tristar Summit Medical Center ("the Hospital"), located in Hermitage, Tennessee, complaining of dizziness, nausea, chest pain, and headache. After her arrival at the Hospital, Appellant was evaluated and her medical records indicate that she was "alert" and that her speech was "not slurred." According to Appellant's medical records, Appellant had previously been diagnosed with bipolar disorder and obsessive compulsive disorder, and she was taking psychiatric medication at the time.

         Appellant was admitted to the Hospital under Dr. Ronald Rentuza's ("Dr. Rentuza") care.[1] Dr. Rentuza ordered a work-up and neurology consult to determine the cause of her diplopia, [2] dizziness, and hypertension. Based on his examination of Appellant, Dr. Rentuza noted that Appellant was "awake, oriented, and in no distress at rest." As part of the work-up, Dr. Rentuza ordered an MRI of Appellant's head and neck. Dr. Rentuza ordered an increased dosage of Appellant's psychiatric medication as well as other additional medication; however, he limited Appellant's pain medication so the medication would not interfere with Appellant's neurology assessment. Nurses Maranda Coggins ("Nurse Coggins") and Ann Stenson ("Nurse Stenson") assessed Appellant frequently during her stay on October 15 and noted that Appellant was responsive and coherent in response to their questions. Appellant stated she did not have any thoughts of harming herself or others, which Nurse Coggins documented in the medical record. Later that day, Appellant told Nurse Stenson that she was "afraid she was dying and had so much she still want[ed] to do with her life." However, based on Nurse Stenson's assessment, Appellant was aware, responsive, and coherent at all times that they interacted.

         The next day, on October 16, 2012, at 7:47 A.M., Nurse British Sullivan ("Nurse Sullivan") assessed Appellant and noted that she was "Awake/Alert" and oriented to person, place, time, and stimuli. Nurse Sullivan described Appellant's mood as "agitated, " "anxious, " "fearful, " "irritable, " and "tearful." Appellant again reported that she "fe[lt] like she [was] dying" and that her "head belong[ed] to someone else and [wa]s running off without her." At 8:00 A.M., Appellant was still anxious and tearful and stated that she wanted to go home. Dr. Rentuza evaluated Appellant again at 10:32 A.M. and noted that Appellant was awake, alert, oriented, and aware of her surroundings. According to Dr. Rentuza's notes in the medical record, Appellant responded appropriately to questions. At around noon, Appellant communicated that she wished to leave. Nurse Sullivan found Appellant in her room dressed, pulling out her IV, and preparing to leave the Hospital. Appellant was upset that she still had a headache and had been waiting a long time for a neurologist. Appellant stated that she was not "getting any help and c[ould] have a [headache] at home." Nurse Sullivan responded she would page Dr. Rentuza to see if Appellant could be given additional pain medication to address her headache. In response, Dr. Rentuza stated that "we are doing all that we can" and that Appellant "could sign [an against medical advice] form ("AMA form") if [she] wanted [because Dr. Rentuza] did not want to give [Appellant] anything else for [her headache]." Nurse Sullivan "tried to get [Appellant] to stay at least until [the neurologist] came." Appellant, however, "kept repeating over and over that she [wa]s leaving and [that[ no one care[d] about her and no one [wa]s doing anything for her." Despite Nurse Sullivan's pleas, Appellant was "adamant" about walking down the street to her daughter's office. Appellant eventually refused to remain in the hospital or sign an AMA form. Although Nurse Sullivan encouraged Appellant to use the elevator, Appellant insisted on taking the emergency exit stairway from the fourth floor to the Hospital's exit.

         At some point, Appellant found her way to the second floor and either fell or dropped herself to the ground. At her later deposition, Appellant admitted that she had no recollection of her fall or the events leading thereto and did not believe that she was "incompetent" while she was a patient at the Hospital. Appellant's medical record from her later hospitalization at Vanderbilt Medical Center ("Vanderbilt") indicated, however, that Appellant had informed her daughter that the fall occurred when Appellant was accidently locked onto a balcony at the hospital. Apparently believing that she could make the fifteen-foot drop to the ground, Appellant indicated that she "sat down on her bottom to scoot off the ledge because she thought she could make it [fifteen feet]." After she fell, Appellant was transported to Vanderbilt where she was treated for thoracic and lumbar burst fractures she sustained from the fall. Psychiatry consultation at Vanderbilt ruled out a potential suicide attempt.

         On January 27, 2014, Appellant filed a complaint against Dr. Rentuza, Summit Medical Associates, P.C., and the Hospital in Davidson County Circuit Court alleging "negligence and malpractice" and seeking damages of $10, 000, 000.00. On October 7, 2015, the Hospital moved for summary judgment pursuant to Tennessee Rule of Civil Procedure 56.02, arguing that only a physician may order a patient to be detained at a hospital against her will and that the nurses employed by the hospital did not have statutory grounds to detain or involuntarily commit Appellant under Tennessee Code Annotated Section 33-6-401 et seq. Alternatively, the Hospital argued that it was entitled to absolute immunity under Tennessee Code Annotated Section 33-6-407(e).[3] In support of the Hospital's motion, it relied on the statement of undisputed material facts filed simultaneously with the motion, memorandum of law with attached exhibits of portions of Appellant's certified medical records, and portions of various depositions and affidavits from Dr. Rentuza and the nurses who cared for Appellant during her stay at the Hospital. On December 1, 2015, Appellant filed a response to the Hospital's statement of undisputed facts and filed a statement of additional undisputed facts, relying on psychiatrist Dr. John Griffin's affidavit. Dr. Griffin, who reviewed Appellant's medical records, formed the opinion that Appellant was not competent at the time of her admission to the Hospital and met the criteria for emergency involuntary detention pursuant to Tennessee Code Annotated Section 33-6-401 et seq. On December 9, 2015, the Hospital filed a reply memorandum and response to Appellant's statement of additional undisputed facts, attaching Dr. Rentuza's affidavit which clarified a statement in his deposition regarding his intention to visit Appellant again before her departure from the hospital.

         Following a hearing, the trial court entered a memorandum on February 3, 2016, concluding that the Hospital "did not have a duty to detain [Appellant] absent a directive from a physician." On February 12, 2016, the trial court entered an order incorporating the memorandum by reference, granting the Hospital's motion for summary judgment and dismissing the claims against the Hospital with prejudice. The trial court also certified the order as final under Rule 54.02 of the Tennessee Rules of Civil Procedure.

         Issue

         Appellant filed a timely appeal, raising one issue for review: Whether the trial court properly granted summary judgment to the Hospital.

         Standard of Review

         In this case, only the Hospital moved for and was granted summary judgment by the trial court. Summary judgment is appropriate where: (1) there is no genuine issue with regard to the material facts relevant to the claim or defense contained in the motion and (2) the moving party is entitled to judgment as a matter of law on the undisputed facts. Tenn. R. Civ. P. 56.04. Our Supreme Court in Rye v. Women's Care Center of Memphis, MPLLC recently explained the burden-shifting analysis to be employed by courts tasked with deciding a motion for summary judgment:

[I]n Tennessee, as in the federal system, when the moving party does not bear the burden of proof at trial, the moving party may satisfy its burden of production either (1) by affirmatively negating an essential element of the nonmoving party's claim or (2) by demonstrating that the nonmoving party's evidence at the summary judgment stage is insufficient to establish the nonmoving party's claim or defense. We reiterate that a moving party seeking summary judgment by attacking the nonmoving party's evidence must do more than make a conclusory assertion that summary judgment is appropriate on this basis. Rather, Tennessee Rule 56.03 requires the moving party to support its motion with "a separate concise statement of material facts as to which the moving party contends there is no genuine issue for trial." Tenn. R. Civ. P. 56.03. "Each fact is to be set forth in a separate, numbered paragraph and supported by a specific citation to the record." Id. When such a motion is made, any party opposing summary judgment must file a response to each fact set forth by the movant in the manner provided in Tennessee Rule 56.03. "[W]hen a motion for summary judgment is made [and] ... supported as provided in [Tennessee Rule 56], " to survive summary judgment, the nonmoving party "may not rest upon the mere allegations or denials of [its] pleading, " but must respond, and by affidavits or one of the other means provided in Tennessee Rule 56, "set forth specific facts" at the summary judgment stage "showing that there is a genuine issue for trial." Tenn. R. Civ. P. 56.06.

Rye v. Women's Care Ctr. of Memphis, MPLLC, 477 S.W.3d 235, 264-65 (Tenn. 2015) (judicially adopting a summary judgment parallel to the statutory version contained in Tenn. Code Ann. § 20-16-101); see also Tenn. Code Ann. § 20-16-101 (applying to cases filed after July 1, 2011).

         On appeal, this Court reviews a trial court's grant of summary judgment de novo with no presumption of correctness. See City of Tullahoma v. Bedford Cnty., 938 S.W.2d 408, 412 (Tenn. 1997). In reviewing the trial court's decision, we must view all of the evidence in the light most favorable to the nonmoving party and resolve all factual inferences in the nonmoving party's favor. Luther v. Compton, 5 S.W.3d 635, 639 (Tenn. 1999); Muhlheim v. Knox. Cnty. Bd. of Educ, 2 S.W.3d 927, 929 (Tenn. 1999). If the undisputed facts support only one conclusion, then the court's summary judgment will be upheld because the moving party was entitled to judgment as a matter of law. See White v. Lawrence, 975 S.W.2d 525, 529 (Tenn.1998); McCall v. Wilder, 913 S.W.2d 150, 153 (Tenn.1995).

         This case presents an issue of statutory construction, which is a question of law, and questions of law are amenable to disposition by summary judgment. Metro. Dev. & Housing Agency v. Trinity Marine Nashville, Inc., 40 S.W.3d 73, 76 (Tenn. Ct. App. 2000). Questions of law are reviewed de novo, affording no presumption of correctness to the trial court's determination. Maggart v. Almany Realtors, Inc., 259 S.W.3d 700, 703 (Tenn. 2008).

         Discussion

         As we perceive it, the dispositive issue is whether the Hospital had a duty to involuntarily detain Appellant based upon the undisputed facts in the record. Generally, a claim of simple negligence requires the following elements: "1) a duty of care owed by the defendant to the plaintiff; 2) conduct falling below the applicable standard of care amounting to a breach of that duty; 3) an injury or loss; 4) causation in fact; and 5) proximate, or legal, cause." King v. Anderson Cnty., 419 S.W.3d 232, 246 (Tenn. 2013) (citing Giggers v. Memphis Hous. Auth., 277 S.W.3d 359, 364 (Tenn. 2009)). In her complaint, however, Appellant alleged both "negligence and malpractice" and neither party to this appeal makes any distinction between a claim of simple negligence and a claim of medical malpractice or health care liability.[4] Indeed, for purposes of this appeal, we are not required to decide which type of action governs Appellant's claim against the Hospital because the existence of a duty is an essential element to either claim. See Draper v. Wester field, 181 S.W.3d 283, 290 (Tenn. 2005) ("[Health care liability actions] . . incorporate[] the common law elements of negligence."). As such, if the undisputed facts establish that the Hospital did not owe a duty of care to Appellant to prevent her injury by involuntarily detaining her, she cannot prevail in her claim against the Hospital and the trial court correctly granted summary judgment.

         Appellant argues that "hospitals [owe] a duty to protect patients, who, because of physical or mental conditions, lack the capacity to recognize and avoid dangerous situations." In support, she cites three cases in which she asserts Tennessee courts have placed such a duty on hospitals. See Keeton v. Maury Cnty. Hosp., 713 S.W.2d 314, 316 (Tenn. Ct. App. 1986); Rural Ed. Ass'n v. Anderson, 261 S.W.2d 151 (Tenn. Ct. App. 1953); v. St. Thomas Hosp., 211 S.W.2d 450 (Tenn. Ct. App. 1947). We will proceed to discuss each of these cases in turn.

         In Keeton, plaintiff was not provided with a urinal and felt the urge to urinate after his catheter was removed subsequent to a prostate surgery. 713 S.W.2d at 315. Although the hospital staff was aware of plaintiff's vertigo condition and of his need for assistance in getting out of bed, help was not provided when plaintiff sought assistance on several occasions. Id. at 315-16. After a while, plaintiff got out of bed himself and fell on his way back to bed. Id. at 316. The evidence showed that plaintiff's physicians did not leave orders restricting plaintiff from getting out of bed. Id. The trial court ruled that plaintiff was required to show that the hospital staff violated orders left by the doctor in order for the hospital to be liable for negligence; because the plaintiff's physicians did not leave such orders, the trial court dismissed the plaintiff's claim. Id. This Court reversed, holding that it was foreseeable that plaintiff might fall if he went to the bathroom unassisted and that "it is not necessary to prove that hospital personnel violated an order left by plaintiff's physician" in order to find the hospital liable. Id. at 317.

         In Anderson, the decedent was admitted to defendant mental institution ("institution") that held itself out as equipped to care for mental patients. 261 S.W.2d at 212. Decedent's doctor informed the institution that plaintiff "was deranged and there was danger that he might harm himself if not put on the ground floor and properly watched." Id. at 213. However, decedent was put in a bed near a window on the second floor. Id. at 214. While at the hospital, decedent "suffer[ed] from fears and delusions" and "was getting out of bed, walking around, going into rooms of other patients, wandering about-'out in the halls and making a nuisance of himself" Id. After a few hours, he either fell or jumped out the window and died. Id. at 215. This Court held that the circumstances of the case "were sufficient to raise a duty upon [the institution] to use reasonable ...


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