Ruiz v. Tenet Hialeah Healthsystem, Inc., Etc.
2017 Fla. App. LEXIS 11435
| Fla. Dist. Ct. App. | 2017Background
- Maria Elena Espinosa died of exsanguination during surgery to remove a skull tumor; Ruiz (her personal representative) sued for malpractice.
- Dr. Arturo Lorenzo conducted a brief (3–5 minute) pre-anesthesia evaluation, checked boxes on the form, signed as physician and dated it.
- Lorenzo reviewed a blurry EKG that showed abnormalities but did not flag or reconcile it with surgeons; he reviewed only the first page of labs and missed a urine protein result.
- Dr. Guillermo Velazquez later completed the anesthesia evaluation and signed; Velazquez and an internist settled before trial; surgeons Yates and Albanes were found liable by the jury.
- At trial, no expert testified that Lorenzo’s conduct was shown to have more likely than not caused Espinosa’s death; the trial court granted Lorenzo a directed verdict for lack of causation; the appellate majority affirmed.
- Judge Emas dissented, arguing sufficient circumstantial evidence (signature, missed EKG and proteinuria, testimony that surgery would not have proceeded) supported submitting causation to a jury.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether directed verdict was proper for lack of causation | Lorenzo’s signature and failures (not reconciling abnormal EKG, missing proteinuria) likely led to clearance; had surgeon known, surgery would not have occurred, so Lorenzo probably caused death | No competent, substantial evidence links Lorenzo’s brief evaluation to the death; Velazquez completed evaluation and no expert tied Lorenzo’s acts to causation | Majority: Directed verdict affirmed for lack of competent, substantial evidence of causation; Dissent: disputed evidence should go to jury |
| Whether Lorenzo breached standard of care in pre-op evaluation | Lorenzo negligently failed to review all labs and did not pursue/clarify abnormal EKG or order repeat EKG | Lorenzo reasonably interpreted EKG and viewed patient as otherwise healthy; testified the proteinuria would not have affected his anesthetic | Majority found no expert proving breach-causing-death; trial court assumed breach only causation lacking; dissent saw evidence of breach sufficient for jury |
| Whether signing the pre-op form establishes responsibility/liability | Signature indicates responsibility; expert said signature signals anesthesiologist accepted pre-op clearance responsibility | Lorenzo contended he only began evaluation and Velazquez completed it; contemporaneous practice involved multiple providers | Disputed fact—dissent argued signature and admissions created jury issue; majority treated overall record as insufficient for causation finding |
| Whether subsequent providers’ involvement insulates Lorenzo from liability | Surgeon would not have operated if alerted; subsequent actors do not absolve earlier negligent physician | Lorenzo and court relied on Velazquez’s completion and lack of causal proof to break link | Court of Appeals majority held causation not proved as to Lorenzo; dissent invoked case law that subsequent care does not shield prior negligence |
Key Cases Cited
- Hancock v. Schorr, 941 So.2d 409 (Fla. 4th DCA 2006) (standard for directed verdict review and medical-malpractice causation)
- Chaskes v. Gutierrez, 116 So.3d 479 (Fla. 3d DCA 2013) (elements of medical malpractice and causation standard)
- Hurst v. Krinzman, 237 So.2d 333 (Fla. 3d DCA 1970) (directed verdict standard—view evidence most favorably to plaintiff)
- Coba v. Tricam Indus., Inc., 164 So.3d 637 (Fla. 2016) (directed verdict/JNOV granted only when no view of evidence could support verdict for nonmovant)
- Friedrich v. Fetterman & Assoc., P.A., 137 So.3d 362 (Fla. 2013) (directed verdict inappropriate where conflicting evidence on causation exists)
- Gooding v. University Hosp. Bldg., Inc., 445 So.2d 1015 (Fla. 1984) (causation requires showing negligence probably affected outcome)
- Saunders v. Dickens, 151 So.3d 434 (Fla. 2014) (each treating physician’s prudence is individually assessed; subsequent physician testimony cannot automatically insulate prior physician)
- Davidson v. Gaillard, 584 So.2d 71 (Fla. 1st DCA 1991) (foreseeability of negligent medical treatment following original tortfeasor; cited on causation principles)
- Santa Lucia v. LeVine, 198 So.3d 803 (Fla. 2d DCA 2016) (distinguished: no testimony that surgery would not have proceeded after a pre-op consult)