The Arkansas Court of Appeals upheld the dismissal of a medical negligence case alleging a man was permanently paralyzed because of health care providers’ failure to timely diagnose his spinal injuries. The decision centered on two main themes: vicarious liability and failure to establish proximate cause.
Background
On November 17, 2012, Ramon Magrans fell in his bathroom and unknowingly fractured vertebras in his spine. He had a CT angiogram of the spine at Radiologists of Russellville, P.A. (ROR), and the results were read by employee Jeffrey A. Hale, M.D. on December 14, 2012. The angiogram allegedly showed multiple recent compression fractures of the spine, but the abnormalities were not noted in the report. On January 18, 2013, Magrans visited his primary care physician, Edward Lucas Andrada, M.D., complaining of weakness in his legs and difficulty walking. Dr. Andrada prescribed steroid medication and ordered a lumbar MRI for the following week. On January 21, 2013, Magrans was treated in the emergency department at Saint Mary’s Regional Medical Center by Dr. Sarah Robertson, M.D. She called a neurologist at University of Arkansas for Medical Sciences (UAMS) to discuss a potential transfer to a higher level of care but was advised that because the patient had no loss of sensation in his lower extremities and no incontinence issues, he did not warrant neurological intervention or a transfer. Dr. Robertson also ordered an MRI of Magrans’ lumbar spine but before the results came back, Magrans became unable to move his lower extremities. Dr. Robertson called UAMS and Baptist Health Medical Center-Little Rock to request a transfer but neither facility had a bed available. Ultimately, the patient was accepted a day later at Baptist Health, where he underwent imaging of his entire spinal axis which revealed compression fractures and retropulsion of bone causing compression of the spinal cord. Magrans was permanently paraplegic, and he subsequently passed away in 2018.
Multiple actions ensued
In November 2014, the Magrans family filed a medical malpractice action against ROR and Dr. Andrada. The complaint alleged ROR did not have proper procedures and protocols in place and failed, through its directors and physicians, to provide care and treatment that met the applicable standard of care. The Magranses also alleged Dr. Andrada failed to properly evaluate and treat Ramon Magrans’ spinal injuries, resulting in his permanent paralysis. In January 2015, the Magranses amended their complaint, adding ROR’s Dr. Hale, along with Sarah Robertson, M.D. and Sarah Robertson, M.D., P.A., as defendants. The amended complaint alleged the CT angiogram showed multiple compression fractures of Magrans’ spine, and that such findings should have been identified in the report with a suggestion that specific imaging be done to evaluate those fractures. The complaint also alleged Dr. Robertson failed to provide medical evaluation, assessment and treatment that met the applicable standards of care.
Vicarious liability
Dr. Hale moved for summary judgment arguing all claims against him were barred because the statute of limitations had tolled. The Magranses did not oppose summary judgment in favor of Dr. Hale, and the circuit court granted his motion and dismissed him. In response, ROR filed a motion for summary judgment alleging the plaintiffs were precluded from maintaining their vicarious liability claim under state law. The motion was granted.
“It is well-established Arkansas law that when an employee has been released or dismissed (from a lawsuit), and the employer has been sued solely on a theory of vicarious liability, any liability of the employer is likewise eliminated,” The Court of Appeals stated. “Where the agent has no liability, the principal cannot be liable.”
Failure to establish causation
Dr. Robertson and Dr. Andrada subsequently filed for and were granted summary judgment. The court agreed with their argument that the Magranses could not meet their burden of proof because they lacked the requisite expert testimony to prove the doctors’ actions caused the patients’ injuries.
The Magranses appealed, contending that if an MRI of Ramon Magrans’ thoracic spine had been done, it would have revealed the compression fractures and identified a neurologic emergency existed and “more likely than not” would have resulted in an immediate transfer and surgery. If either doctor had complied with the standard of care, they alleged, Magrans would not have become a paraplegic. In response, both Dr. Andrada and Dr. Robertson argued that the Magranses’ experts failed to offer anything beyond speculation that the outcome would have been any different if either of them had ordered a thoracic spine MRI.
To establish negligence, a plaintiff must demonstrate that the defendant breached a standard of care, that damages were sustained and that the defendant’s actions were a proximate cause of those damages.
Two expert witnesses testified on behalf of the Magranses, including Dr. Donald Frey, who stated both doctors should have ordered a full spine MRI. However, Dr. Frey did not opine on proximate cause, and instead indicated that he could not make such a determination. Specifically, when asked at what point in time surgery could have changed Magrans’ outcome, Dr. Frey said he would not testify to a particular time. Further, when asked whether having the thoracic spine MRI results would have prompted either hospital to make a bed available, Dr. Frey said he could not answer with certainty. Dr. Nicholas Theodore, a neurosurgeon, testified that an MRI indicating a spinal cord compression is a “known emergency,” adding, “I think all alarm bells would have gone off, and hopefully he would have been sent to University of Arkansas or whatever tertiary care facility is available with neurosurgical coverage.” But the court said neither expert could confirm this would have happened. Dr. Frey testified that he believed Dr. Robertson provided the information necessary to UAMS to indicate an emergency, even without imaging. And even after Magrans lost feeling in his legs, transfer to a different facility still could not be accomplished. According to the Court of Appeals, “Speculative testimony about what might have happened does not suffice, particularly not when such testimony contradicts the evidence showing that an onset of lower extremity paralysis did not procure an immediate transfer to either facility due to bed unavailability.”
Further, when asked for his expert opinion on when surgery needed to have been performed to save function in Magrans’ legs, Dr. Theodore could not opine on timing and only stated that there likely would have been “some preservation” of function if surgery had occurred the day Magrans was transferred to Baptist Health.
The Court of Appeals affirmed the lower court’s ruling granting summary judgment, holding, “Plaintiff’s experts could not state with a reasonable degree of medical certainty that had the decedent undergone surgery earlier, he would have survived.”
The court also held that testimony from expert witnesses does not prove proximate cause when the testimony only reveals the patient “would have had a better chance” at a favorable outcome if a physician had taken a different course of action.
