189 So. 3d 661
Miss. Ct. App.2015Background
- On Feb. 29, 2012 Della Sumrall had a central venous catheter removed by Nurse Chequita Steele at Ocean Springs Hospital (Singing River). Shortly after removal she became unresponsive and suffered anoxic brain injury.
- The Sumralls sued for medical malpractice, alleging improper central-line removal (upright position) caused an air embolus, cardiopulmonary arrest, and brain injury.
- Plaintiffs presented two experts (a physician and an RN) who testified the accepted nursing standard required educating the patient, Trendelenburg positioning (insertion site at/below heart), a Valsalva maneuver, and application of pressure/occlusive dressing on removal.
- Defendant (Singing River) presented Dr. James Corder, who testified (over objection) that there is no national standard of care for patient positioning during central-line removal and that Della had a stroke; plaintiff objected that these opinions were not disclosed pretrial.
- The trial court (bench trial) found no recognized standard of care for positioning and entered judgment for Singing River. The Court of Appeals reversed and remanded, finding reversible error in admitting Dr. Corder’s testimony beyond his Rule 26 disclosures and that the no-standard finding was against the overwhelming weight of the evidence.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| 1. Expert testimony beyond pretrial disclosure | Sumralls: Dr. Corder offered opinions (no national standard; Della had a stroke) not disclosed — discovery violation; testimony should be excluded. | Singing River: Disclosures covered Corder’s role to contradict plaintiffs’ experts and to opine on standard/causation. | Court: Admission of Corder’s ‘‘no national standard’’ and stroke opinions conflicted with disclosures; allowing them was an abuse of discretion. |
| 2. Existence of a nursing standard of care for positioning during central-line removal | Sumralls: Medical literature and experts establish a standard requiring Trendelenburg (or equivalent) positioning except when patient cannot tolerate it. | Singing River: No uniform national standard; policies vary; positioning may depend on patient condition. | Court: Trial court’s finding that no recognized standard exists is against overwhelming weight of evidence; reversed. |
| 3. Expert causation opinion (stroke vs. air embolus) | Sumralls: Hospital personnel and records point to probable air embolus from upright removal causing collapse/brain injury. | Singing River: Alternative causes (stroke, cardiac event) and air embolus unlikely per Corder. | Court: Corder’s stroke opinion lacked disclosed basis and factual support; trial finding relying on that is not supported by substantial evidence. |
| 4. Weight of evidence / deference to bench trial findings | Sumralls: Trial judge ignored overwhelming expert/literature support for a standard and admitted undisclosed expert opinions. | Singing River: Bench judge entitled to deference; he found patient intolerance of Trendelenburg justified deviation. | Court: While bench findings get deference, allowance of undisclosed expert testimony and the ‘‘no standard’’ conclusion were unsupported; verdict reversed and remanded. |
Key Cases Cited
- City of Jackson v. Brister, 838 So.2d 274 (Miss. 2003) (standards for appellate review of bench-trial factual findings)
- Maldonado v. Kelly, 768 So.2d 906 (Miss. 2000) (deference to trial judge as factfinder)
- City of Jackson v. Lipsey, 834 So.2d 687 (Miss. 2003) (trial judge has sole authority to determine witness credibility in bench trials)
- Barrow v. May, 107 So.3d 1029 (Miss. Ct. App. 2012) (abuse-of-discretion standard for admission of evidence/expert testimony)
- Worthy v. McNair, 37 So.3d 609 (Miss. 2010) (appellate review of evidentiary rulings)
- Canadian Nat’l/Illinois Cent. R.R. v. Hall, 953 So.2d 1084 (Miss. 2007) (Rule 26 expert-disclosure requirements and sanctions for discovery violations)
- Buskirk v. Elliott, 856 So.2d 255 (Miss. 2003) (expert testimony outside discovery disclosures can be reversible error)
- Coltharp v. Carnesale, 733 So.2d 780 (Miss. 1999) (excluding expert testimony that advances undisclosed theories)
- T.K. Stanley, Inc. v. Cason, 614 So.2d 942 (Miss. 1992) (admission of undisclosed expert testimony on new matters is error)
- Palmer v. Biloxi Reg’l Med. Ctr., Inc., 564 So.2d 1346 (Miss. 1990) (elements and burdens in medical-malpractice/negligence actions)