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King v. VHS San Antonio Partners, LLC

United States District Court, W.D. Texas, San Antonio Division

May 9, 2018




         On this 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

         On 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.

         On July 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. Id.

         On July 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.

         On July 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.

         Plaintiffs 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.

         Plaintiffs 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.

         Plaintiffs 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.

         Plaintiffs 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.

         Ramey 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.

         Plaintiffs 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.

         Plaintiffs 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.

         Plaintiffs 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.

         Plaintiffs 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.

         II. ...

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