In its opinion filed on September 18, 2017, the Court of Appeals of Tennessee at Knoxville (“Tennessee Appellate Court”) reversed the defense win in a Tennessee health care liability case (i.e., medical malpractice case) involving the death of a twin shortly after birth, holding that the trial court erred in issuing a jury instruction on the sudden emergency doctrine when the defendant physicians had time, while minimal, for reflection and thought before deciding on the best course of action.
The Tennessee Appellate Court further held that this error more probably than not affected the outcome of this case because one of the defendant physicians testified that the underlying facts of the case were an “emergency of all emergencies,” another of the defendant physicians claimed that the plaintiff became a “sudden emergency” at the first sign of bradycardia during delivery of the plaintiff’s premature twin babies, and the record reflects that the defendant physicians repeatedly referred to the sudden and unexpected nature of the event and the need to act immediately to save the second twin’s life.
The Underlying Facts
The plaintiff was 24 weeks pregnant when she went to the hospital with signs of premature labor on February 24, 2011. On February 25, 2011, the plaintiff was taken to the operating room for delivery of her twins. The first baby was delivered vaginally without incident. One of the defendant obstetricians then manually rotated the second baby to a head-down orientation in the birth canal, and labor continued. The fetal monitor later indicated a drop in the second baby’s heart rate, necessitating prompt delivery as a result of bradycardia (slow heart rate).
Another of the defendant obstetricians was paged and arrived moments later. The defendants assessed the situation and then proceeded to attempt an operative vaginal delivery by forceps. One defendant placed the first blade without incident and then placed the second blade while the other defendant held the first blade. There was resistance placing the second blade and it was retracted before attempting placement a second time. When the second attempt also proved unsuccessful, both blades were retracted. The delivery team then prepared for cesarean section delivery.
Approximately five minutes later, the second baby was delivered, who had sustained a skull fracture and a scalp avulsion (his scalp was no longer attached but was hanging loose from the rear of his skull). The second baby was transferred to the NICU, where he died hours later. The immediate cause of death was listed as “hemorrhagic shock” with underlying causes listed as “scalp avulsion with skull fracture” and “birth trauma.”
The plaintiff subsequently filed her Tennessee health care liability (medical malpractice) lawsuit that alleged had the defendant physicians acted in a medically reasonable manner when the fetal monitor indicated bradycardia, they would have proceeded with an emergency cesarean section and avoided the catastrophic skull and scalp injuries that caused the second baby’s death. The defendants argued that they complied with the applicable standard and that they did not proximately cause harm or injury by any alleged errors or omissions.
The Tennessee medical malpractice trial began on August 25, 2015 and lasted six days during which the Tennessee medical malpractice jury was presented with a battle of the parties’ experts. The Tennessee health care liability jury found in favor of the defendants, and the plaintiff appealed, alleging that the trial court committed reversible error by providing a jury instruction on the sudden emergency doctrine.
Sudden Emergency Doctrine
The Tennessee Appellate Court stated that the sudden emergency doctrine recognizes that a person confronted with a sudden or unexpected emergency which calls for immediate action is not expected to exercise the same accuracy of judgment as one acting under normal circumstances who has time for reflection and thought before acting.
While the parties argued whether the emergency must be both sudden and unexpected, the Tennessee Appellate Court stated that the record reflects that the emergent situation presented was a sudden occurrence but was not unexpected, as evidenced by the decision to deliver in the operating room rather than a birthing suite, the presence of an “army” to assist in the delivery, and the advanced preparations made in an attempt to expect the unexpected.
With regard to the application of the sudden emergency doctrine in the present health care liability case, the Tennessee Appellate Court stated that the greater distinction in this case lies in whether the defendant physicians were presented with a sudden or unexpected emergency that called for immediate action as opposed to someone who had time for reflection and thought before acting.
As stated above, the Tennessee Appellate Court held that the trial court erred in issuing a jury instruction on the sudden emergency doctrine in this case where the defendant physicians had time, while minimal, for reflection and thought before deciding on the best course of action, and that this error more probably than not affected the outcome of this case. Therefore, the Tennessee Appellate Court reversed and remanded the case for a new trial.
Source Vandyke v. Foulk, No. E2016-00584-COA-R3-CV
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