Central Georgia Women's Health Center, LLC v. Katherine B. Dean
342 Ga. App. 127
| Ga. Ct. App. | 2017Background
- Mrs. Dean (33) had prior miscarriages and a prior LEEP, raising risk of cervical incompetence; serial ultrasounds showed progressive cervical shortening to 1.9 cm with funneling at 22+ weeks (critical risk for preterm birth).
- On July 31, 2007 Mrs. Dean developed brown discharge and sought ER evaluation; Dr. Davis (on call) spoke by phone, advised bed rest, and ordered discharge without personally examining or ordering diagnostics.
- Early Aug 1 Mrs. Dean’s symptoms worsened; Dr. Davis again advised coming to the office; she was later seen, found in premature labor, delivered by emergency C-section at 23+ weeks, and the infant died of extreme prematurity.
- Plaintiffs sued for medical malpractice alleging Dr. Davis breached the standard of care by failing to examine/diagnose on July 31 and thereby failed to timely arrange cerclage or progesterone, which would likely have prolonged pregnancy and prevented death.
- Trial evidence included expert testimony that cerclage or progesterone at that stage would likely have prolonged pregnancy enough to materially increase survival odds; jury found for plaintiffs, apportioning 50% fault to Davis defendants and awarding over $4 million.
- On appeal Davis defendants argued (1) plaintiffs failed to prove causation to a reasonable medical certainty and (2) trial court erred by allowing cross-examination about a struck August 2 physician note as probative of untruthfulness; court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs proved causation with reasonable medical certainty | Dr. Bottiglieri and Dr. Carter: failure to diagnose/act on July 31 deprived Mrs. Dean of cerclage or progesterone that would probably have delayed delivery to a survivable gestational age | Evidence was speculative; expert testimony insufficient as a matter of law to link deviation to death; Reeves controls | Court: Evidence (experts/statistics) sufficient to let jury decide; causation not so plain as to require directed verdict for defendants |
| Whether Reeves compelled judgment for defendants because consulting a specialist would have led to same outcome | Plaintiffs: Dr. Davis could have performed, arranged, or insisted on cerclage/progesterone; consulting specialist did not preclude acting contrary to specialist | Defendants: plaintiffs’ expert said consultation could satisfy standard and specialist (Dr. Boddy) would not have prescribed cerclage/progesterone, so no causation | Court: Reeves distinguishable; here plaintiff’s expert testified Dr. Davis could take action himself or disagree with specialist; Reeves not controlling |
| Admissibility of evidence about August 2 physician note on cross-examination under Rule 608(b)(1) | Note and subsequent alteration were probative of Dr. Davis’s truthfulness given conflicting nurse records and patient testimony; extrinsic records corroborated falsity | Defendants: Note was innocent mistake, not deliberate deception; admission unfairly prejudicial and irrelevant | Court: Trial court did not abuse discretion; evidence probative of untruthfulness and not substantially outweighed by prejudice; extrinsic records admissible on material issues |
| Whether trial court abused discretion in scope/length of cross-examination about the note | Plaintiffs: inquiry proper because credibility and accuracy of notes central to dispute | Defendants: questioning was excessive and a character attack | Court: No abuse of discretion; scope appropriate given centrality of note and credibility issues |
Key Cases Cited
- Walker v. Giles, 276 Ga. App. 632 (Georgia Ct. App.) (medical-malpractice requires proof of proximate causation as fact and proximate cause)
- Zwiren v. Thompson, 276 Ga. 498 (Ga.) (expert causation standard: reasonable medical probability/certainty)
- Moore v. Singh, 326 Ga. App. 805 (Ga. Ct. App.) (causation usually jury question absent clear, undisputed evidence)
- Reeves v. Mahathre, 328 Ga. App. 546 (Ga. Ct. App.) (consultation-with-specialist testimony can defeat causation when specialist would have recommended same care)