BARBARA T. COLLINS
HCA HEALTH SERVICES OF TENNESSEE, INC., ET AL.
Session: September 21, 2016
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.
W. Cooper and Kim J. Kinsler, Nashville, Tennessee, for the
appellees, HCA Health Services of Tennessee, Inc. d/b/a
Tristar Summit Medical Center.
Steven Stafford, P.J., W.S., delivered the opinion of the
court, in which Arnold B. Goldin and Kenny Armstrong, JJ.,
STEVEN STAFFORD, JUDGE
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
was admitted to the Hospital under Dr. Ronald Rentuza's
("Dr. Rentuza") care. Dr. Rentuza ordered a work-up and
neurology consult to determine the cause of her diplopia,
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.
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.
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.
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). 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.
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.
filed a timely appeal, raising one issue for review: Whether
the trial court properly granted summary judgment to the
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).
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
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).
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. 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.
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.
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.
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 ...