United States District Court, W.D. Texas, San Antonio Division
RODRIGUEZ, UNITED STATES DISTRICT JUDGE
date, the Court considered the status of the above
captioned-case. After careful consideration, the Court GRANTS
Defendant Lonny Ramey's Motion for Summary Judgment
(Docket no. 95), DENIES Defendant VHS San Antonio Partners,
LLC d/b/a Mission Trail Baptist Hospital
(“MTBH”)'s Motion for Partial Summary
Judgment (Docket no. 96), and DENIES MTBH's Motion for
Summary Judgment on Causation (Docket no. 97). In addition,
the Court DENIES various motions to exclude the testimony of
a number of medical professionals (Docket nos. 98, 100, 103,
105, 107, 108, 156, 157, 160 and 161).
I. Factual Background
November 25, 2016, Plaintiffs Carl King and Latanya
Walker-King filed their Complaint with this Court. Docket no.
1. Plaintiffs filed their Amended Complaint on July 18, 2017.
Docket no. 56. Plaintiffs name MTBH, Vikram Durairaj, M.D.,
and Lonny Ramey, P.A., as Defendants and bring negligence
claims against all Defendants and a claim under the Emergency
Medical Treatment and Active Labor Act (“EMTALA”)
against MTBH following medical treatment that Carl King
received at MTBH. Id. at 2.
16, 2015, Carl King presented at Methodist Hospital's
emergency department in San Antonio, Texas, complaining of
persistent right-sided neck pain and difficulty swallowing.
Id. at 4-5. On examination, King was found to have
“right lower cervical paraspinal tenderness to
palpation with muscle spasm that radiated to his trapezius
and rhomboid muscles (neck and upper back muscles).”
Id. at 5. King was diagnosed with cervical
radiculopathy/brachial neuritis, prescribed pain medication,
was told to see his primary care physician, and sent home.
17, 2015, King presented at Northeast Methodist Hospital in
San Antonio, Texas, complaining of persistent severe neck
pain radiating to his right shoulder and numbness of both
arms. Id. On examination, King was reportedly found
to have “right neck tenderness to palpation but no
motor or sensory deficits.” Id. King was
diagnosed with neck muscle spasms, prescribed pain and muscle
spasm medication, instructed “regarding warm compress
to his neck, ” was told to see his primary care
physician, and sent home. Id.
20, 2015, at around 8:47 a.m., San Antonio Fire Department
EMS was called and transported King to MTBH, with the nature
of the call described as “Stroke/CVA, ” and King
arrived at MTBH at around 9:46 a.m. Id. at 6.
Plaintiffs state that the MTBH emergency department's
record begins with a notation stating “not
employed” and “no ins[urance].” King states
that triage nurse Rebecca Krett, R.N., documented,
“This is patient's 3rd visit to an emergency
department for same complaint of neck/upper back pain. States
that now he is unable to walk and arms feel weak and numb.
Patient comes into emergency department for
evaluation.” Id. at 13. At around 10:59 a.m.,
nurse Bradley Marron, R.N., documented, “Muscle
strength: right sided upper and lower extremity weakness. 0/5
on right lower extremity. 1/5 on right upper extremity. There
is right-sided weakness.” Id.
allege that King was then placed on a bed in the hallway,
where he waited for two hours until Dr. Durairaj saw him at
around 11:51 a.m. Id. Dr. Durairaj entered notes
regarding “Neck or Upper Back Injury/Pain” that
included a summary of King complaining of muscular spasms,
neck pain, numbness, and motor deficits to all extremities.
Id. Plaintiffs allege the notes demonstrate that
King's neck was not examined, his reflexes were not
checked, and that no labs, EKG, or X-rays were performed.
Id. at 14. King was diagnosed with muscle spasm and
the notes indicate that “Emergency Medical Condition
stabilized.” Id. Plaintiffs allege that around
11:54 a.m., Dr. Durairaj ordered and King received Toradol
and Norflex. Id. Plaintiffs allege that upon
discharge, his pain was an 8 on a scale of 10, he was given a
prescription for the muscle spasm diagnosis, and the
discharge instructions said to, “follow up with primary
care doctor this week to order MRI if he thinks symptoms
warrant.” Id. King was allegedly discharged
shortly after noon. Id.
allege that during the entirety of this visit, King had a
“large ventral epidural abscess centered at cervical
vertebrae 4 and 5 (C4-5 epidural abscess); i.e., a collection
of pus next to and pressing on the front of the spinal cord
at the level of the 4th and 5th cervical vertebrae.”
Id. Plaintiffs allege that other patients who
previously presented at MTBH with similar symptoms that King
showed were provided a full medical screening examination
(“MSE”) to analyze a possible central nervous
system condition. Id. at 15. Plaintiffs allege that
King did not receive a sufficient MSE. Id.
allege that when King was discharged, he could not walk
unassisted from the MTBH emergency department and had to be
lifted into a car. Id. When King's daughter went
back into MTBH to speak to someone, “another
gentleman” allegedly told MTBH staff that King fell
outside, and King was wheeled back into the emergency
department. Id. at 19. For the second time that day,
King was admitted into the MTBH emergency department at
around 1:56 p.m. Id.
allege that King requested an examination and treatment for a
medical condition. Id. At around 2:11 p.m., P.A.
Ramey allegedly began a medical screening examination by
ordering testing on King for pancreatitis, for heart
ischemia, a comprehensive metabolic panel, for blood
clotting, a complete blood count with differential count, an
ECG, and a chest x-ray. Id. P.A. Ramey never saw
King, never examined King, and allegedly did not notify Dr.
Durairaj of the need for a timely examination of King.
Id. Ramey confirms that he ordered these tests and
that he never personally saw King. Docket no. 95 at 2.
alleges these tests were part of King's initial
assessment or initial labs conducted on an emergency patient,
and that he did not conduct an MSE himself. Id. at
7-8. Ramey alleges that, although he cannot recall the actual
exchange with the triage nurse, he now infers from reading
the medical records that he ordered these specific tests
based on a history of weakness and pain identified in
King's records. Id. at 8. Ramey also alleges
that he does not recall being told that King could not move
his arms or legs, and that he does not recall a triage nurse
ever giving him a “Triage Note” that stated that
King could not move his arms or legs. Id. at 8-9.
allege that at around 6:00 p.m., about four hours after King
was re-admitted to MTBH, nurses performed another assessment
of him. Docket no. 56 at 20. The assessment identified
King's reports of pain, numbness, tingling, and a desire
to have more tests done. Id. MTBH alleges that the
nurse's assessment showed that King “was moving all
extremities with symmetry of strength and without involuntary
movements” and that King denied feeling touch but
withdrew to pain. Docket no. 96 at 5.
allege that King saw Dr. Durairaj again at 6:52 p.m., and Dr.
Durairaj completed an “Emergency Physician Record -
Neuro Symptoms/Deficit” form that identified King's
complaint of weakness, summarized his previous complaints and
symptoms, and the results of a physical exam. Docket no. 56
at 21. Dr. Durairaj ordered and reviewed a head, cervical,
lumbar, and thoracic CT for King and concluded the results
were “most consistent with small amount of subdural
hematoma.” Id. Plaintiffs allege that King was
not given the same timely MSEs given to other patients who
displayed similar symptoms. Id. at 24.
allege that at around 9:37 p.m., MTBH providers discussed
with University Hospital in San Antonio King's possible
transfer for a subdural hematoma, and at around 10:18 p.m.,
King was transferred to University Hospital and arrived
around 10:35 p.m. Id. at 26. At around 1:00 a.m. on
July 21, 2015, Plaintiffs state that neurosurgery saw King
for quadriplegia and a possible subdural hematoma.
Id. Despite the subsequent surgery, King was left
with a permanent cervical spinal cord injury that caused
quadriplegia/paresis. Id. at 27.
allege that had Defendants provided King with a proper MSE,
including a timely physical and neurological exam, he would
have received earlier “neurosurgical treatment to
timely relieve/decompress spinal cord compression by his C4-5
epidural abscess and would not have suffered permanent spinal
cord injury causing quadriplegia.” Id.
Plaintiffs allege that King was treated below the applicable
standards of care and disparately from other MTBH emergency
department patients with the same or similar symptoms.
Id. at 28. Plaintiffs allege that MTBH was aware
that King was uninsured, unemployed, and had no apparent
ability to pay when it failed to perform the proper MSEs.
Id. at 29. Plaintiffs allege that MTBH violated
EMTALA by failing to give King an MSE reasonably calculated
to identify his critical medical condition, treating King
differently from other patients with similar symptoms,
failing to stabilize King's emergency medical condition,
and discharging King from MTBH while he was unstable. Docket
no. 56 at 29-34. Plaintiffs allege that Latanya Walker-King,
the wife of Carl King, is entitled to recover damages
available under Texas law based on King's injury for past
and future loss of services, household services, and
consortium. Id. at 33-34, 36, 40.