Court: Court of Appeals of South Carolina; August 25, 2010; South Carolina; State Appellate Court
The circuit court affirmed the summary judgment favoring Dr. Jennifer Feldman and Columbia Heart Clinic against William and Ann Melton's claims of medical malpractice, negligent misrepresentation, abandonment, and intentional infliction of emotional distress. William Melton, a 74-year-old from Winnsboro, South Carolina, initially sought medical attention in 2002 after experiencing a brief blackout. Although his primary physician, Dr. Manuel Venegas, deemed his heart condition non-serious, he referred Melton to Dr. Feldman for further evaluation. Following a catheterization procedure on June 24, 2002, Melton signed a consent form for the implantation of a Medtronic cardioverter defibrillator (ICD) but did not fully understand the necessity or risks involved.
Post-implantation, Melton experienced unexpected shocks from the ICD, leading to a hospital visit in June 2005. During a routine check, a nurse informed him of a potential defect in the Medtronic ICD's battery, which Dr. Feldman allegedly knew about but could not disclose to patients. Although Melton received a "Device Alert" outlining the defect and replacement options, he felt inadequately informed about his choices. Following concerns regarding another brand, Guidant, Melton attempted to consult Dr. Feldman about alternatives, only to be told she was unavailable due to vacation. The court upheld the summary judgment, indicating no error in the lower court's decision.
Melton alleges that Dr. Feldman expressed frustration over his lack of trust in her decision regarding the insertion of a Guidant device, suggesting he should seek another doctor. Despite Dr. Feldman providing the name of an alternative physician, Melton did not follow up. The appellants initiated legal action against Medtronic, Dr. Feldman, and Columbia Heart Clinic on April 17, 2006, eventually settling with Medtronic. During discovery, depositions were taken from Melton, his wife, and three of his treating physicians, but not from Dr. Feldman or the nurse at Columbia Heart Clinic. On December 27, 2006, Dr. Feldman and Columbia Heart Clinic filed for summary judgment, which the circuit court granted for all claims against them. The court found Melton's claims of medical malpractice, negligent misrepresentation, and abandonment required expert testimony to establish the standard of care and causation, which Melton did not provide. Furthermore, the court ruled that Melton's claim for intentional infliction of emotional distress lacked sufficient evidence of outrageous conduct by the defendants. Regarding Melton's breach of warranty claims, the court determined these were products liability claims, and as the defendants were not the sellers of the device, summary judgment was warranted. Melton's wife's claim for loss of consortium was also dismissed as it was dependent on Melton's claims. The appeal process is based on the standard of review for summary judgment under South Carolina law, which requires no genuine issue of material fact exists for the moving party to be entitled to judgment. The requirements to establish intentional infliction of emotional distress include proving extreme and outrageous conduct, causation of emotional distress, and the severity of the distress.
In Shupe v. Settle, the court determined that extreme insensitivity alone does not constitute the tort of outrage, as evidenced in the case of Melton against Dr. Feldman and Columbia Heart Clinic. The evidence did not support claims of intentional or reckless behavior intended to inflict severe emotional distress. Dr. Feldman's decision to dismiss Melton as a patient shortly before surgery was deemed insensitive but not sufficiently extreme or outrageous to be considered intolerable by community standards, especially since Melton was referred to another cardiologist.
Regarding the claim of medical abandonment, Melton argued it should be treated as separate from medical malpractice, asserting that the circuit court erred by categorizing it as a medical malpractice claim. The court disagreed, explaining that medical malpractice occurs when a physician fails to meet the standard of care expected in similar circumstances, and a physician cannot abandon a patient without reasonable notice. The court found no South Carolina cases recognizing medical abandonment as an independent tort. Melton's reference to Johnston v. Ward was dismissed, as that case did not establish abandonment as a separate tort but rather illustrated it as a subset of medical malpractice, requiring expert testimony to demonstrate standards of care.
Medical abandonment is recognized as a specific type of medical malpractice that falls under the traditional medical malpractice framework. Claims of medical abandonment involve a breach of duty and are essentially treated as negligent treatment, necessitating the filing of an expert affidavit by the plaintiff. When a doctor establishes a doctor-patient relationship and subsequently abandons the patient without proper notice or referral to another competent physician, this constitutes a failure to exercise the legally required standard of care, thereby resulting in liability for medical malpractice.
The case Linog v. Yampolsky supports this interpretation, emphasizing that issues surrounding medical interactions, such as medical battery, should not create separate causes of action when existing torts like medical malpractice are sufficient to cover these situations. Consequently, the improper termination of the doctor-patient relationship aligns with the broader definitions of not adhering to the expected professional standards.
In the context of Melton's claims against Dr. Feldman for medical malpractice, the circuit court's decision to grant summary judgment was upheld. Melton's argument that he presented enough evidence to create a factual dispute was rejected. For a medical malpractice claim to advance, the plaintiff must provide expert testimony demonstrating accepted medical practices relevant to the case and showing how the physician deviated from these standards, directly causing the alleged injuries. While the expert does not need to be a specialist in the same field, they must be knowledgeable about the applicable standard of care pertinent to the medical procedure in question. Deficiencies in the expert's qualifications impact the weight of the testimony but do not affect its admissibility.
Expert testimony based solely on personal standards of care rather than recognized standards is inadequate to withstand summary judgment. Melton identifies five alleged deviations from the standard of care by Dr. Feldman: (1) failing to inform Melton of risks associated with ICD implantation; (2) implanting a defective ICD; (3) using improper criteria for ICD selection; (4) not timely informing Melton of the ICD defect; and (5) abandoning Melton before surgery.
Regarding the first point, Melton asserts malpractice due to inadequate risk disclosure. However, the doctrine of informed consent requires physicians to disclose specific details to patients, including diagnosis, procedure nature, risks, success probabilities, alternative options, and prognosis without emergency circumstances. Melton did not provide expert testimony to establish what was required for informed consent in this context, nor did he demonstrate that Dr. Feldman’s lack of disclosure caused his injuries. Notably, Melton could not confirm that he would have declined the ICD if fully informed, failing to create a factual dispute regarding malpractice.
On the second point concerning the defective ICD, the expert testimony was insufficient to determine either the standard of care for cardiologists or to establish that the ICD was defective. Dr. Gaddy, a non-cardiologist, declined to offer opinions on Dr. Feldman’s adherence to the standard of care, reinforcing the lack of adequate expert testimony to support Melton's claims.
Dr. Venegas, a family physician, stated he does not perform pacemaker implants and would defer to a cardiologist regarding such procedures. He indicated that based on the notes provided by Dr. Feldman, he saw no deviation from the standard of care in her treatment of Mr. Melton. Both Dr. Gaddy and Dr. Venegas did not establish the standard of care for implanting implantable cardioverter-defibrillators (ICDs), rendering their testimony inadequate to create a genuine issue of material fact. Melton did not present evidence of a defective ICD battery; rather, he noted that the battery functioned well, activating during normal heart rates. He also affirmed that the battery did not malfunction between implantation and explantation. There was no evidence to suggest Dr. Feldman or Columbia Heart Clinic were aware of any propensity for over-activation of the ICD at the time of implantation, failing to demonstrate malpractice.
Regarding the selection criteria for the ICD, even if expert testimony established a standard of care and a breach, Melton failed to show a causal link between Dr. Feldman's selection criteria and his injuries. Dr. Gaddy’s testimony that he would not select a device based on a manufacturer's sales representative did not indicate a breach of the generally accepted standard of care. Dr. Venegas stated that proper evaluation should consider the benefits, risks, and alternatives associated with a device. However, Melton did not provide evidence that different selection criteria would have led to a different ICD choice or that another device would not have caused similar issues. Negligence requires a demonstration that it was the proximate cause of the injury, which Melton did not establish. Consequently, there was no genuine issue of fact regarding whether Dr. Feldman’s selection criteria constituted medical malpractice.
Dr. Feldman’s failure to inform Melton about the potential defect in the ICD was deemed a breach of the generally accepted standard of care; however, there was no evidence proving that this failure was the proximate cause of Melton’s injuries. Testimony from medical experts indicated that waiting over a year to inform a patient about a device issue was inappropriate, but none linked this failure directly to Melton's injuries. Melton's fear of an unexpected discharge from the ICD was noted as a common concern among all ICD patients, suggesting that even timely notification would not have significantly altered his circumstances.
Regarding abandonment, the argument was made that Melton did not provide evidence of the standard for patient dismissal, breach, or proximate causation. Dr. Gaddy indicated that best practices involve notifying patients and assisting them in finding new providers, but his testimony reflected personal standards rather than widely accepted practices. Similarly, Dr. Venegas acknowledged that terminating a doctor-patient relationship shortly before surgery is uncommon and that giving advance notice and helping patients find new doctors is typical but not a strict standard. This lack of universally accepted standards in the testimonies contributed to the conclusion that Melton did not meet the burden of proof to survive summary judgment on both the failure to inform and abandonment claims.
Dr. Beard's testimony regarding the termination of doctor-patient relationships was personal and did not establish a general standard of care. He emphasized the importance of trust and suggested that termination might depend on the relationship's quality. This testimony did not support the claim that Dr. Feldman's actions were a breach of standard care, leading to Melton's failure to prove malpractice.
Melton argued that expert testimony was unnecessary due to the common knowledge exception in medical malpractice cases. This exception applies when laypersons can assess negligence without specialized knowledge. However, Melton's situation did not meet this criterion; mere speculation was insufficient to establish negligence. Melton cited *Green v. Lilliewood*, where the court found sufficient evidence for a jury to infer malpractice. He claimed that the failure to remove a defective medical device was comparable to his case. However, the court found this analogy unconvincing, noting that Melton's injuries were unrelated to the ICD's power loss, which he conceded. The complexities of the ICD's operation were beyond the understanding of a lay jury, thus rejecting the applicability of the common knowledge exception in this instance.
Melton referenced the case Thomas v. Dootson, where a patient successfully sued for malpractice after suffering burns from a malfunctioning surgical drill during oral surgery. The doctor’s concession regarding the defective equipment negated the need for expert testimony about the drill's operation. However, in Melton's case, no similar concession was made regarding the function of the battery in his implantable cardioverter defibrillator (ICD), indicating that expert testimony was necessary. Melton's argument for the applicability of the common knowledge exception was contradicted by his reliance on expert testimony to support his claims regarding alleged abandonment, improper selection criteria, and delays in communication about the defect. Consequently, the court determined that the common knowledge exception did not apply, affirming the circuit court's decision. The trial court also granted summary judgment on additional claims against Dr. Feldman and Melton's wife’s claim for loss of consortium, which Melton did not contest on appeal. There was inconsistency regarding when Melton learned of the ICD defect, with his testimony conflicting with a signed "Device Alert" form dated prior to his hospital visit. Melton's ten causes of action included products liability, negligence, breach of warranty, medical malpractice, and outrage, though his outrage claim was limited to Dr. Feldman's alleged abandonment. Melton expressed ongoing mental distress related to the ICD's function and the associated risks.
