Billie Russell v. Pakkala M.D.

Citation: Not availableDocket: 02A01-9703-CV-00053

Court: Court of Appeals of Tennessee; January 13, 1998; Tennessee; State Appellate Court

Original Court Document: View Document

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Billie J. Russell, as administratrix for the estate of Robert L. Russell, appealed a summary judgment granted to defendants Dr. Y. N. Pakkala and Bolivar Community Hospital (BCH) in a medical malpractice case. The trial court found the affidavits submitted by Russell insufficient to establish a genuine issue of material fact regarding the defendants' alleged negligence. The case stems from a laparoscopic cholecystectomy performed by Dr. Pakkala on August 3, 1993, during which he lacerated Russell's right iliac artery, causing internal bleeding. After efforts to repair the damage during surgery, Russell's condition worsened, leading to a second surgery by another physician, Dr. Harvey Harmon, who successfully repaired the injury.

Russell alleged negligence on the part of Dr. Pakkala for inadequate treatment and on BCH for a lack of necessary medical equipment during the procedure. The defendants moved for summary judgment, supported by Dr. Pakkala’s affidavit, while Russell countered with affidavits from four physicians. The trial court concluded that Russell did not provide adequate expert testimony to demonstrate that Dr. Pakkala failed to meet the community standard of care or to establish causation for her injuries, leading to the summary judgment.

On appeal, Russell contended that the trial court erred in its ruling, asserting that her medical experts had provided testimony sufficient to raise genuine issues of material fact. The appellate court noted that for summary judgment to be granted, the moving party must show no genuine issues of material fact exist and that they are entitled to judgment as a matter of law. If supported by evidence, the burden then shifts to the non-moving party to demonstrate a factual dispute. The court emphasized that it must view the evidence in the light most favorable to the non-moving party and allow reasonable inferences in their favor. The case was remanded for further proceedings.

In Byrd, the Tennessee Supreme Court clarified the burden of proof in summary judgment motions, stating that once the moving party demonstrates an absence of genuine material fact, the nonmoving party must present specific facts through affidavits or discovery materials to establish a dispute warranting a trial. Rule 56.05 emphasizes that reliance on pleadings alone is insufficient. Furthermore, the court noted that trial court conclusions of law are not entitled to a presumption of correctness.

Tennessee Code Annotated, § 29-26-115 outlines the plaintiff's burden in medical malpractice cases, requiring proof of the applicable standard of care, the defendant’s deviation from that standard, and a direct causal link between the negligence and the injuries sustained. The statute mandates that expert witnesses must be licensed in Tennessee or a contiguous state and actively practicing in the relevant field within the year prior to the alleged malpractice, although the court may waive this requirement if necessary.

Expert testimony is essential in establishing negligence and causation in medical malpractice claims, with causation needing to be proven to a reasonable degree of medical certainty. In support of their summary judgment motion, the defendants provided an affidavit from Dr. Pakkala, indicating adherence to the standard of care during the treatment of the plaintiff, Russell. In response, Russell submitted statements from multiple medical experts, including Dr. Harmon, who critiqued Dr. Pakkala's surgical performance related to a perforation during surgery. The court's assessment of the sufficiency of these expert testimonies will be critical in determining the outcome of the summary judgment motion.

Dr. Harmon criticized Dr. Pakkala for not using a quicker method to stop Russell's bleeding, which worsened his condition, although Harmon later successfully repaired the arterial tear. In an affidavit dated September 4, 1996, Dr. Harmon stated he was unfamiliar with the standard of care for general surgeons in Bolivar in 1993 and could not opine on the matter. This acknowledgment was reiterated in his October 25, 1996 deposition, leading the trial court to conclude that his testimony was inadequate to counter the defendants' summary judgment motion, citing relevant case law.

Dr. Mark Josovitz provided a sworn statement on November 15, 1993, asserting that Dr. Pakkala failed to meet a reasonable standard of care by not insufflating the abdomen during surgery, which he claimed led to Russell's artery laceration and permanent disability. However, in a subsequent statement on September 4, 1996, Josovitz admitted he did not perform surgery and was unaware of the applicable standard of care for Dr. Pakkala, deferring to Dr. Harmon on causation. This contradiction invalidated his testimony, leading the trial court to rule it insufficient for opposing summary judgment.

Dr. Raymond Hawkins, Jr. treated Russell's incisional hernia two years post-surgery and attributed its cause to the extended incision made during Dr. Pakkala's gall bladder surgery. While he indicated that the hernia resulted from Pakkala’s actions, he refrained from declaring Pakkala negligent, noting that perforating the iliac artery during laparoscopic surgery was rare, given his extensive experience with such procedures.

Dr. Hawkins acknowledged that Dr. Pakkala did not insufflate the abdomen during surgery, which is generally considered standard practice to minimize the risk of perforation. He described the omission as dangerous but noted that some practitioners choose not to insufflate. However, Dr. Hawkins did not demonstrate familiarity with the medical standards in Bolivar or assert that Dr. Pakkala's actions deviated from those standards. As a result, his testimony was inadequate to establish negligence under Tennessee Code Annotated, § 29-26-115(a)(1) and (2). While he was competent to testify regarding causation under § 29-26-115(a)(3), his statement alone did not suffice to counter the defendants' motion for summary judgment since it failed to prove negligence.

Dr. J. T. Davis, Jr. provided an affidavit confirming his qualifications as a licensed cardiovascular surgeon familiar with the medical standards in Bolivar, Tennessee, as of 1993. He noted that Dr. Pakkala's perforation of Mrs. Russell’s right iliac artery during a laparoscopic cholecystectomy is a rare complication for that procedure.

Dr. Y.N. Pakkala is opined to have failed to meet the standard of care required of a general surgeon in Bolivar, Tennessee, during the treatment of Billie Russell on August 3, 1993. Key failures include: 

1. Not recognizing Russell's high-risk status due to her medical history (diabetes, coronary disease, obesity) and failing to refer her to a qualified specialist.
2. Neglecting to transport her to a facility equipped to handle high-risk patients.
3. Attempting a laparoscopic cholecystectomy without adequate training or skills, and without having necessary equipment to manage potential complications.
4. Failing to control bleeding from a perforated artery and delaying transport to a vascular surgeon.
5. Ignoring specific directions from a vascular surgeon.
6. Attempting to repair the artery without the requisite expertise or tools.
7. Administering heparin inappropriately given the circumstances.

While Dr. Davis, another physician, acknowledges the standard of care required in 1993 and is licensed to practice in Tennessee, he does not address causation of injury. However, it is established that Russell underwent a second surgery due to Dr. Pakkala's perforation of her artery, indicating injury regardless of complications from that surgery. Testimony indicates that Russell's subsequent incisional hernia was a result of the initial perforation. Dr. Davis outlines specific negligent actions by Dr. Pakkala, especially related to the surgery and post-operative care, but no evidence shows that negligence after the perforation caused further injury. If Russell can prove Dr. Pakkala's negligence in the initial procedure, it could defeat the defendants' summary judgment motion.

To defeat the defendants’ motion for summary judgment, the plaintiff must demonstrate that a negligent act occurred below the accepted medical standard and that this act caused the injury. Negligence can be established through multiple affidavits, with one expert addressing negligence and another addressing causation, as long as both relate to the same act. The plaintiff needs to show a genuine issue of material fact concerning Dr. Pakkala's alleged negligence in perforating an artery during surgery. Dr. Davis’ affidavit raises two ambiguities: it is unclear whether he was licensed in Tennessee during the year before the incident and whether he definitively asserts that Dr. Pakkala's action constituted negligence, despite describing the perforation as a rare complication and criticizing Dr. Pakkala's qualifications for the procedure. The court must view the evidence in favor of the non-moving party and determine if a factual dispute exists. Given the uncertainty about Dr. Davis' licensing status, the court cannot ensure complete justice, warranting a remand to the trial court to clarify this issue. If Dr. Davis was licensed during the relevant period, the previous summary judgment would be deemed improper. The case is remanded for further proceedings, with costs equally shared between the parties.