Melinda Duncan v. Cheryl L. Ledford MD
W2015-02370-COA-R3-CV
| Tenn. Ct. App. | Aug 24, 2016Background
- On Sept. 7, 2009 Melinda Duncan was injured in an ATV rollover, sustaining a comminuted proximal humerus fracture and a large shoulder abrasion; she was treated in the JMCGH ER where orthopedic surgeon Dr. Cheryl Ledford evaluated her.
- Nursing staff had cleaned the abrasion; Dr. Ledford documented the wound as superficial (no full-thickness skin breaks), advised home wound care, and arranged follow-up with a specialist.
- Duncan developed fever/odors and was diagnosed with cellulitis on Sept. 11; she was admitted, treated with antibiotics, and later transferred to Vanderbilt where necrotic crush injury required multiple surgeries and ultimately shoulder reconstruction.
- Plaintiffs (Melinda and Jeff Duncan) sued Ledford and The Jackson Clinic alleging negligent failure to properly evaluate, clean/debride, diagnose, and treat the initial wound, leading to later severe tissue necrosis and surgeries.
- Plaintiffs’ expert, Dr. Thomas Myers, gave conflicting testimony in discovery and evidentiary depositions about whether Ledford breached the standard of care and conceded the record showed the wound was superficial and that he could not say to a reasonable degree of medical certainty that different treatment would have changed the outcome.
- The trial court granted summary judgment for defendants, finding plaintiffs’ expert testimony equivocal on both deviation and causation; the Court of Appeals affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether trial court’s summary-judgment order stated adequate grounds under Tenn. R. Civ. P. 56.04 | Order failed to identify specific facts relied upon | Order stated legal grounds: no disputed material fact and plaintiffs’ evidence insufficient | Affirmed: Rule 56.04 requires grounds, not detailed factual findings; order was sufficient |
| Whether Dr. Ledford deviated from applicable standard of care on Sept. 7, 2009 | Ledford failed to properly clean/debride the abrasion, causing later infection/complications | Nursing had cleaned wound; Ledford documented superficial abrasion; plaintiffs’ expert conceded wound appeared superficial and that Ledford’s treatment was appropriate if so | Affirmed: Plaintiffs failed to show deviation because expert testimony was contradictory and conceded the wound was superficial, which negated breach |
| Whether Ledford’s care proximately caused injuries (causation) | Initial inadequate care caused infection/necrosis necessitating further surgeries | Expert could not state to reasonable medical certainty that different ER treatment would have changed outcome; infections can occur despite proper care | Affirmed: Plaintiffs failed to establish causation; expert’s opinions were speculative and insufficient as a matter of law |
| Liability of The Jackson Clinic (respondeat superior) | Clinic vicariously liable for Ledford’s alleged negligence | Clinic not liable because plaintiffs failed to prove Ledford’s liability | Affirmed: Clinic summary judgment appropriate because plaintiffs failed to make prima facie case against Ledford |
Key Cases Cited
- Rye v. Women’s Care Ctr. of Memphis, MPLLC, 477 S.W.3d 235 (Tenn. 2015) (summary-judgment standards and movant’s burden in health-care liability cases)
- Kilpatrick v. Bryant, 868 S.W.2d 594 (Tenn. 1993) (causation in medical malpractice must be shown to a reasonable degree of medical certainty; possibility is insufficient)
- Bara v. Clarksville Mem. Health Sys., 104 S.W.3d 1 (Tenn. Ct. App. 2002) (expert must testify to causation to a reasonable degree of medical certainty; gatekeeping role of trial court)
- Church v. Perales, 39 S.W.3d 149 (Tenn. Ct. App. 2000) (definition of legal injury in health-care liability context)
- Smith v. UHS of Lakeside, Inc., 439 S.W.3d 303 (Tenn. Ct. App. 2014) (Rule 56.04 requires trial court to state grounds for summary-judgment rulings to facilitate review)