Wrongful death dispute revived by appeals court

The trial court abused its discretion by striking an expert opinion and material questions of fact existed regarding whether a physician-patient relationship was established in a wrongful death case, the Missouri Court of Appeals, Eastern District ruled on February 18, reversing summary judgment in favor of the defendants.

Joanne Knight’s husband arrived by ambulance to the emergency department at SSM St. Joseph Hospital-Lake St. Louis at 2 pm on Jan. 21, 2020. He had a history of hypertension and had collapsed earlier in the day due to severe shortness of breath.

Initial tests to evaluate his cardiac condition were determined to be abnormal and the emergency department doctor diagnosed him with “acute congestive heart failure.”

The emergency department doctor further ordered a cardiology consultation. The nurse practitioner on duty for SLCC, a medical group contracted to provide cardiology consultations, accepted Knight’s husband as a patient around 3:35 pm.

Electronic medical records show that Dr. Sam Bishara was listed as a consulting physician for Knight’s husband and that a SLCC nurse briefly reviewed his records around 4:30 pm.

Knight’s husband was admitted to the hospital and a nurse assigned Dr. Huilin Li as his attending physician. Dr. Li was scheduled to come on shift at 7 pm.

At 9:54 pm, Knight’s husband suffered a cardiac arrest and was pronounced dead at 10:20 pm. Neither Dr. Li nor Dr. Bishara saw him prior to his cardiac arrest.

Knight filed a wrongful death claim against the doctors and SLCC. Her expert testified that the standard of care required physicians to review patient records and see patients within approximately an hour of beginning their shifts and that any reasonable doctor would have known about the decedent’s status as a patient prior to the code blue at 9:54 pm.

Dr. Li moved to strike and exclude the expert’s standard of care opinions, arguing that they equated to mere speculation and conjecture, and that his opinion that Dr. Li could have used the Epic System — the hospital’s electronic record system — to inform himself of decedent’s designation as a patient was based merely on his personal use of the Epic system.

The trial court granted the motion to strike the expert testimony and subsequently granted summary judgment for all the defendants.

Knight appealed.

In an opinion authored by Judge Renee D. Hardin-Tammons, the court reversed.

During his deposition, the expert explained that Dr. Li should have made himself aware of decedent’s designation as a patient, which could have been done by viewing Epic, the hospital’s record system, and that, had Dr. Li been using the system as he claimed to have done that evening, Dr. Li would have been alerted to the fact that he was named as the admitting and attending physician for decedent.

The expert also explained that Dr. Li could have been informed of his role in decedent’s care through his designation as a co-signer on the “note” started by the nurse practitioner related to decedent’s initial admission care.

“While Expert did testify that Dr. Li could have used the Epic system to learn that Decedent was his patient, Expert’s testimony did not suggest or imply that the Epic system, on its own, sets the standard of care relating to when a physician should be aware of the assignment of a patient and in what timeframe the physician must see a patient,” the court wrote. “Rather … Expert’s testimony opines that the standard of care requires attending physicians to review their current patients at the beginning of their shifts, and that the Epic system may aid a physician in obtaining the necessary knowledge in order to do so.”

Therefore, the trial court “abused its discretion in striking Expert based entirely on the reasoning that Expert relied only on his knowledge and use of the Epic system to support his opinion as to standard of care,” the court added. “Notably, the standard of care question is not whether Dr. Li actually knew about Decedent’s designation as his patient or whether he could have easily accessed such information using Epic, as both are questions of fact. Rather, the standard of care question is whether Dr. Li had a duty to know about Decedent’s designation as a patient and see him within an hour of starting his shift.”

The court also reversed summary judgment in favor of Dr. Bishara and SLCC.

While Dr. Bishara admitted that he had a contractual obligation to perform a consultation on the decedent as a consulting physician with SSM St. Joseph, he told the court that because the emergency department doctor did not request an urgent consultation and he was not contacted directly by that doctor about the decedent, no physician-patient relationship was established.

The court disagreed.

“Whether a physician-patient relationship existed here is entirely dependent on whether [the nurse’s] express acceptance of Decedent as a patient on behalf of Dr. Bishara or as an agent of SLCC, and her subsequent review of Decedent’s medical records, satisfied the requirement … that physician-patient relationships may exist where the physician consents to treat the patient or where a physician is contractually obligated to provide assistance in the patient’s diagnosis or treatment and does so, in that the relationship here was purportedly consented to by [the nurse] and the treatment process subsequently begun, although cut short by Decedent’s death,” the court wrote.

Ultimately, this determination involved material questions of fact regarding whether a physician-patient relationship was established either by consent or by contract and treatment, which is reserved for the fact finder and improper for summary judgment, the court said.

James V. O’Brien of Buchanan, Williams & O’Brien in Brentwood, who represented Knight, did not respond to a request for comment.

Neither did Mandy J. Kamykowski of Kamykowski & Taylor in St. Louis, who represented Dr. Liu, and St. Louis attorney Jeffrey J. Brinker of Brinker & Doyen, who represented Dr. Bishara and SLCC.

The case is Knight v. Li, No. ED112826.