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Methodist Richardson Medical Center v. Cellars

Court of Appeals of Texas, Fifth District, Dallas

December 3, 2019


          On Appeal from the 101st Judicial District Court Dallas County, Texas Trial Court Cause No. DC-18-09173

          Before Justices Pedersen, III, Reichek, and Carlyle



         Methodist Richardson Medical Center appeals from the trial court's order overruling its objections and denying its motion to dismiss under § 74.351 of the Texas Civil Practice and Remedies Code. Methodist contends the trial court erred in concluding Tina Cellars satisfied § 74.351's requirements because her expert reports do not adequately describe how Cellars's injuries were caused by Methodist Richardson's breach of an applicable standard of care. We affirm and, because the legal issues are settled, issue this memorandum opinion. See Tex. R. App. P. 47.4.


         According to her live petition, Cellars received a spinal epidural at Baylor Surgicare in North Garland. Dr. Daniel Sunwoo administered the injection shortly before 1 p.m., after which Cellars soon began experiencing excruciating pain. Dr. David Metz, an anesthesiologist and the Medical Director at Baylor Surgicare, examined Cellars and, in consultation with Dr. Sunwoo, determined Cellars likely developed a spinal epidural hematoma-a collection of blood on the surface of the spinal cord-as a result of the injection.

         Cellars alleged that "the presence of an epidural spinal hematoma on [her] spinal cord was by any reasonable estimation a medical emergency requiring immediate medical treatment." And the only effective treatment was an operation performed by a neurosurgeon. That operation could not be performed at Baylor Surgicare, however, so Drs. Metz and Sunwoo decided to transfer Cellars to Methodist Richardson. An ambulance was called, and emergency responders were informed Cellars likely had an epidural spinal hematoma. The ambulance left Baylor Surgicare around 2:00 p.m.

         Upon arrival at Methodist Richardson, Cellars was evaluated by Dr. Geoffrey Wiss, an emergency physician who is not a neurosurgeon. According to Cellars, hospital records indicate Dr. Metz called ahead and told Dr. "Wiss and/or the staff at Methodist Richardson of the probable diagnosis [of an epidural spinal hematoma] and the need for an immediate CT scan to confirm." Records also indicate Dr. Metz asked Dr. "Wiss and/or the staff at Methodist Richardson about the availability of a neurosurgeon to provide the definitive treatment that Ms. Cellars required." But despite having advance warning of Cellars's presumptive diagnosis, neither Dr. Wiss nor Methodist Richardson treated Cellars's condition as an emergency. Instead, they waited approximately an hour and a half before giving her a CT scan, which confirmed the epidural spinal hematoma. At that point, a neurosurgeon, Dr. Gary Dennis, was contacted for the first time.

         Dr. Dennis ordered both that Cellars be admitted to Methodist Richardson and that she undergo further imaging. Cellars was given an MRI, more than three and a half hours after she arrived at Methodist Richardson, which again confirmed the epidural spinal hematoma. But Dr. Dennis did not arrive at the hospital to perform the required surgery for several more hours. At that point, it had been approximately eight hours since Cellars arrived at Methodist Richardson and nearly eleven hours since she began experiencing symptoms of the epidural spinal hematoma.

         Cellars asserts she suffered permanent nerve damage because of the delay in her treatment, and her petition alleges claims against the various doctors and entities involved in her care. As it relates to this appeal, the petition claims Methodist Richardson was negligent in failing to adopt or otherwise follow appropriate policies and procedures for responding to patients in need of emergency treatment.

         As required by § 74.351 of the Texas Civil Practice and Remedies Code, Cellars timely provided expert reports from Doctors Nancy Epstein, Alan Kaye, and Susan Abookire.[1] Dr. Epstein, a board-certified neurosurgeon, opined on the standard of care applicable to physicians "confronted with a patient who has a presumptive or actual diagnosis of a neurological elective or emergent condition." She explained that a spinal epidural hematoma is "known to cause serious and permanent spinal cord/nerve injury-potentially leading to paralysis or death-if not treated immediately" and that it is "unquestionably a medical emergency which requires immediate treatment by a neurosurgeon." Thus, she opined: "Any physician confronted with a patient who has an actual or presumed spinal epidural hematoma is required by the standard of care applicable to all physicians to treat the patient as requiring immediate neurosurgical care." Yet "none of the doctors responsible for [Cellars's] care treated her condition as an emergency requiring emergent treatment. As a result, the necessary care was delayed until it was too late to avert serious and permanent injury."

         Dr. Epstein further explained that Cellars likely would have recovered if the necessary surgery were performed within the first six hours after the injury; "every hour she suffered without surgery after that increased both the amount and permanence of her neurological injury." Consequently, "the delay in treatment caused by the negligence of [the treating physicians] was the 'proximate cause' of severe and permanent injury to Tina Cellars."

         With respect to the transfer of treatment from Baylor Surgicare to Methodist Richardson, Dr. Epstein noted that records indicated Dr. Metz both informed Methodist Richardson that Cellars likely had a spinal epidural hematoma and "verified neurosurgical call coverage." It was not clear from the record, however, whether Drs. "Metz or Sunwoo communicated the emergent nature of Ms. Cellars' condition to anyone at Methodist Richardson, or that they communicated that Ms. Cellars required immediate care by a neurosurgeon." Further, the record did not indicate whether Dr. Wiss or "anyone else at Methodist Richardson had made any effort to determine whether in fact there was a neurosurgeon available to attend to Tina Cellars at or shortly after her impending arrival." According to Dr. Epstein, Dr. Wiss was required-based on Cellars's presumptive diagnosis-to ensure a neurosurgeon would be available to treat Cellars "before either accepting the transfer or making any assurances to Drs. Metz or Sunwoo." But Dr. Wiss and Methodist Richardson accepted Cellars's transfer without contacting-much less assuring the availability of-a neurosurgeon.

         Dr. Kaye, who is board certified in anesthesiology and pain medicine, has performed injections similar to the one administered to Cellars. He agreed with Dr. Epstein's conclusions concerning the emergent nature of Cellars's condition, its requirement for prompt treatment, and the alleged failings of the various doctors involved in Cellars's care. But Dr. Kaye's report also discusses the policies and procedures ...

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