Judge: Jon R. Takasugi, Case: 19STCV20912, Date: 2024-04-04 Tentative Ruling

Case Number: 19STCV20912    Hearing Date: April 4, 2024    Dept: 17

Superior Court of California

County of Los Angeles

DEPARTMENT 17

TENTATIVE RULING

            Defendant Cedars-Sinai Medical Center’s motion for summary judgment is DENIED.

On June 14, 2019, Plaintiffs Diannah Meams and Adam Meams, by and through his guardian ad litem, Diannah Meams (“Plaintiffs”), filed suit against defendants Cedars-Sinai Medical Center, Larry Froch, M.D. and Christopher Shepherd, M.D. alleging a single cause of action for medical malpractice wrongful death.  

            On June 20, 2023, this case was transferred to this department from Spring Street Courthouse Department 29 following a determination that this action is complicated “based upon the number of pretrial hearings and/or the complexity of the issues presented.” (6/20/23 Minute Order.)

            On January 26, 2024, Defendant Cedars-Sinai Medical Center (“CSMC” or “Defendant”) filed this instant motion for summary judgment. Plaintiffs filed an opposition and Defendant replied on March 29, 2024.

Legal Standard

Code of Civil Procedure section 437c, subdivision (a) provides that a “party may move for summary judgment in any action or proceeding if it is contended that the action has no merit or that there is no defense to the action or proceeding.” The motion shall be granted if there is no triable issue as to any material fact and the moving party is entitled to judgment as a matter of law. (Code Civ. Proc., § 437c, subd. (c).) Subdivision (p)(2) of the same section provides that where a defendant presents evidence showing one or more elements of a cause of action cannot be established, then the burden shifts to plaintiff to show the existence of a triable issue of material fact. (See Blue Shield of California Life & Health Insurance Co. v. Superior Court (2011) 192 Cal.App.4th 727, 732.) 

A party is also permitted to move for summary adjudication of a particular issue, which can be granted “only if it completely disposes of a cause of action, an affirmative defense, a claim for damages, or an issue of duty.” (Code Civ. Proc., § 437c, subd. (f)(1).) 

The moving party’s burden on summary judgment “is more properly one of persuasion rather than proof, since he must persuade the court that there is no material fact for a reasonable trier of fact to find, and not to prove any such fact to the satisfaction of the court itself as though it were sitting as the trier of fact.” (Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, 850 fn.11, original italics.) 

Factual Background

Plaintiffs’ complaint is based on allegations that Defendants’ negligence caused the death of Willie Meams (“Mr. Meams” or “Decedent”) on June 19, 2018, while he was under Defendants’ care. Plaintiffs are Decedent’s wife and child.

Mr. Meams was admitted to the ICU on June 3, 2018 for dialysis. On June 4, 2018, he was found unresponsive in the bathroom. He had gone into cardiac arrest. Mr. Meams was revived after CPR. However, the incident left Mr. Meams comatose, with evidence of brain injury and seizures. Mr. Meams eventually developed multi-system organ failure, and passed away on June 19, 2018, after another cardiac arrest.

Discussion

            The elements of medical malpractice are: “(1) the duty of the professional to use such skill, prudence, and diligence as other members of his profession commonly possess and exercise; (2) a breach of that duty; (3) a proximate causal connection between the negligent conduct and the resulting injury; and (4) actual loss or damage resulting from the professional's negligence.” (Simmons v. West Covina Medical Clinic (1989) 212 Cal. App.3d 696, 701-702 [citations omitted].) “Both the standard of care and defendants’ breach must normally be established by expert testimony in a medical malpractice case.”  (Avivi v. Centro Medico Urgente Medical Center (2008) 159 Cal.App.4th 463, 467.)

            Defendant CSMC moves for summary judgment on the grounds that CSMC fully complied with the standard of care while looking after Decedent, and no act or failure to act on the part of CSMC was a substantial factor in causing or contributing to Plaintiffs’ injuries. In support of the motion, CSMC submits the expert declaration of cardiologist Daniel Wohlgelernter, M.D. (“Wohlgelernter Decl.”).

            In opposition, Plaintiffs argue that CSMC and its staff breached the standard of care by failing to properly monitor Mr. Meams, which was a substantial factor in causing his death. In support of their opposition, Plaintiffs submit the expert declaration of Michael T. Jamison, M.D. (“Jamison Decl.”).

I.                   Breach

CSMC’s expert opined that the care and treatment rendered to Mr. Meams by CSMC and its staff was appropriate and within the standard of care in the community at all times. (Wohlgelernter Decl., ¶ 8(d).)

In opposition, Plaintiffs contend that CSMC breached its duty of care by letting Mr. Meams, a critically ill, high-risk patient go to the bathroom unattended and off all monitoring. (Jamison Decl., ¶ 37.) The record shows that Mr. Meams had told a nurse that he wanted to use the bathroom. The nurse said that she would bring a chair for him but did not come back after 20 minutes, even though Mr. Meams repeatedly pushed the call light. Mr. Meams then took off his EKG leads and was helped into the bathroom by his wife. Minutes later a nurse assistant (CP-clinical partner) came into the room and asked Mr. Meams from outside the bathroom if he was okay. With no response, Mr. Meams’ wife opened the door to find him slumped against the wall. (Jamison Decl., ¶ 26.) Plaintiffs’ expert opined that “[t]he standard of care required that CSMC staff either provide a bed pan and urinal at bedside for use, or slowly assist patient to chair to use bed pan or urinal, while under constant attendance by at least one nurse and while the patient remains on the monitor. . . . The attending nurse should also instruct the patient to let her/him know if he feels faint or lightheaded. . . . In this case, the nurse did not return with a chair for the patient, failed to keep the patient on his monitor and failed to respond quickly to the alarm signifying that the monitor was off.” (Jamison Decl., ¶ 37.)

In reply, CSMC puts forward three arguments. First, CSMC argues that Mr. Meams and Plaintiffs assumed the risk of any liability when they decided to remove the EKG leads and go to the bathroom unassisted. Plaintiff Mrs. Meams is a nursing assistant herself. Second, CSMC contends that it attempted to follow the standard of care described by Dr. Jamison, i.e., “slowly assist patient to chair to use bed pan or urinal” under constant attendance. The nurse told Mr. Meams that she needed to get a chair before he can use the bathroom. Third, CSMC contends that the fact that a clinical partner went to Mr. Meams’ room shortly after he took off his monitors shows that comprehensive monitoring and preventative measures were in place at the hospital.

However, Defendants’ reply fails to address Plaintiffs’ contention that Mr. Meams had waited more than twenty minutes after he told a nurse that he wanted to go to the bathroom and before his wife ended up assisting him to the bathroom. (Jamison Decl., ¶ 26.) Whether the length of time that Mr. Meams had to wait constitutes a breach of duty by CSMC is a triable issue of material fact. Defendants also do not address Plaintiffs’ contention that during those twenty or so minutes, no one came to help Mr. Meams even though he pushed the call light. Moreover, Defendants in their reply do not provide how much time elapsed between when Mr. Meams took off his monitors, which should have caused alarms to go off in his room and at the nursing station, and when the clinical partner came to check on Mr. Meams. Several triable issues of material fact remain.

II.               Causation

Defendant’s expert opined to a reasonable degree of medical probability that nothing CSMC or its staff did, or failed to do, was a substantial factor in causing or contributing to the decedent’s death. (Wohlgelernter Decl., ¶ 8(d).) Rather, the decedent died as a result of risks and complications associated with the progression of his underlying and pre-existing co-morbidities, including chronic kidney disease, diabetes and acute congestive heart failure. (Ibid.)

In opposition, Plaintiffs contend that CSMC’s breach of duty caused Mr. Meams’ cardiac arrest and subsequent death. “Since he was not being attended to and monitored by CSMC nurse, as required by the standard of care, and there being a delay by CSMC in responding to the patient being off his monitor, the patient suffered a lengthy (minutes) cardiac arrest and he subsequently died from the ensuing complications. To a reasonable degree of medical probability, CSMC’s breach of the standard of care, as mentioned above, was a substantial factor resulting in the patient’s cardiac arrest and subsequent death.” (Jamison Decl., ¶ 27.)

In reply, CSMC appears to advance three arguments. First, CSMC seems to argue that Plaintiffs’ expert failed to show that CSMC’s breach of duty was the but-for cause of Mr. Meams’ death. (Reply, 5:19-20 [“Dr. Jamison attempts to insinuate that if CSMC accompanied Mr. Meams to the bathroom, it would have prevented Mr. Meams’ cardiac arrest and subsequent death. . . . This approach fails however, because . . .”].) However, CSMC’s cited authority only requires that a breach be the “proximate or legal cause” of the injury. (Reply, 5:16.) CSMC fails to show that causation in fact is a required element of a malpractice claim.

Second, CSMC contends that Dr. Jamison’s opinion on causation is conclusory or speculative. (Reply, 5:28-6:10.) However, Dr. Jamison clearly identified that Mr. Meams died after suffering a “lengthy” cardiac arrest which occurred “since he was not being attended to and monitored by CSMC nurse, as required by the standard of care, and there being a delay by CSMC in responding to the patient being off his monitor.” (Jamison Decl., ¶ 27.)

Lastly, CSMC argues that Dr. Jamison’s declaration does not show that CSMC’s alleged breach of duty was “sufficient of itself” to cause Mr. Meams’ death, or that his death is “more likely than not” the result of CSMC’s conduct. (Bromme v. Pravitt (1992) 5 Cal.App.4th 1487, 1499.) In Bromme, the Court of Appeal for the Third District wrote: “there can be many possible ‘causes,’ indeed, an infinite number of circumstances which can produce an injury or disease. A possible cause only becomes ‘probable’ when, in the absence of other reasonable causal explanations, it becomes more likely than not that the injury was a result of its action.” (Bromme, supra, at p. 1488, citing Jones v. Ortho Pharmaceutical Corp. (1985) 163 Cal.App.3d 396, 402–403; Dumas v. Cooney (1991) 235 Cal.App.3d 1593, 1603; Simmons v. West Covina Medical Clinic (1989) 212 Cal.App.3d 696, 702; Morgenroth v. Pacific Medical Center, Inc. (1976) 54 Cal.App.3d 521, 532–533.) Here, Plaintiffs’ expert seems to suggest that, in addition to CSMC, other co-Defendants were also negligent (see Jamison Decl., ¶ 32 [“By May 30 . . . it was clear that diuresis had failed [but] [d]ialysis was only initiated on June 3”], ¶ 33 [“Patients, such as Mr. Meams . . . are unable to tolerate this rapid, vigorous dialysis”].) Whether CSMC’s alleged breach of duty was sufficient to cause Mr. Meams’ death, independent of potential acts or omissions by doctors who are also named defendants in this case, is a triable issue of material fact.

Accordingly, Defendant Cedars-Sinai Medical Center’s motion for summary judgment is denied.

It is so ordered.

Dated:             April 4, 2024

Hon. Jon R. Takasugi

Judge of the Superior Court

Parties who intend to submit on this tentative must send an email to the court at smcdept17@lacourt.org by 4 p.m. the day prior as directed by the instructions provided on the court website at www.lacourt.org.  If a party submits on the tentative, the party’s email must include the case number and must identify the party submitting on the tentative.  If all parties to a motion submit, the court will adopt this tentative as the final order.  If the department does not receive an email indicating the parties are submitting on the tentative and there are no appearances at the hearing, the motion may be placed off calendar.  For more information, please contact the court clerk at (213) 633-0517.