S. THOMAS ANDERSON, District Judge.
Before the Court are Defendants' separately-filed Rule 12 Motions. Specifically, Defendant Frank A. McGrew, M.D., and the Stern Cardiovascular Foundation, Inc. (incorrectly named as the Stern Ownership Group, LLC d/b/a The Stern Cardiovascular Center) filed a Rule 12(b)(6) and 12(e) Motion on March 23, 2012 (D.E. # 31). Defendant Baptist Memorial Health Care Corporation and Baptist Memorial Hospital-Memphis filed a Motion to Dismiss on March 26, 2012 (D.E. # 33). Defendants Edward Garrett, Jr., M.D.; Eva Proctor, M.D.; and Cardiovascular Surgery Clinic, PLLC filed a Motion for More Definite Statement (D.E. # 35) and a Motion to Dismiss (D.E. # 38), both on April 3, 2012. Plaintiffs have filed separate responses in opposition to all of Defendants' dispositive Motions, and Defendants have filed separate reply briefs. For the reasons set forth below, Defendants' Motions are
Plaintiffs have alleged the following in their Amended Complaint. Plaintiffs' decedent Pauline Sloan Shuler (hereinafter "Ms. Shuler") passed away on June 23, 2011, while receiving treatment at the Intensive Care Unit ("ICU") at Baptist Memorial Hospital-Memphis ("Baptist"). (Compl. ¶ 12.) Defendant Frank A. McGrew, M.D. ("Dr. McGrew") was Ms. Shuler's treating cardiologist for a number of years and had actual knowledge of her allergy to the blood thinner Heparin. (Id. ¶ 13.) Dr. McGrew had referred Ms. Shuler to a physician at the West Clinic in August 2006, where testing confirmed Ms. Shuler's allergy to the medication. (Id.) After she learned of her allergy to the drug, Ms. Shuler wore a medicine alert bracelet warning about the allergy and discussed the allergy during office visits, hospitalizations, and in telephone conversations with treating professionals. (Id. ¶ 14.) Ms. Shuler's Heparin allergy had been charted on her records at Baptist since June 18, 2007. (Id. ¶ 15.)
On January 3, 2011, Ms. Shuler was admitted to Baptist for a heart catheterization procedure. (Id. ¶ 16.) Ms. Shuler's admission records for this hospitalization noted her Heparin allergy in several instances. (Id.) Despite actual knowledge of Ms. Shuler's Heparin allergy, Defendants and their employees attempted to administer Heparin or a Heparin derivative to Ms. Shuler on numerous occasions between January 3, 2011 and January 7, 2011. (Id. ¶ 17.) In each instance, Ms. Shuler questioned what she was being given and notified the individual that she was allergic to Heparin. (Id.) Plaintiffs allege on information and belief that Ms. Shuler was given Heparin or a Heparin derivative on one or more occasions during that hospitalization. (Id. ¶18.)
Plaintiffs further allege that Ms. Shuler was given Heparin or a Heparin derivative during subsequent admissions to Baptist, including one occasion in very close proximity to her death at the Baptist ICU on June 23, 2011. (Id. ¶ 19.) Plaintiffs claim that the actions of Defendants and their employees in administering Heparin to Ms. Shuler during admissions between January 3, 2011, and June 23, 2011, were the proximate cause or a contributing proximate cause to her death. (Id.) Furthermore, Defendants left Ms. Shuler unattended for approximately forty-three minutes immediately preceding her death on June 23, 2011. (Id. ¶ 21.)
Based on these fact pleadings, Plaintiffs allege that Defendants are liable for medical battery upon Ms. Shuler. (Id. ¶ 22.) Defendant Stern Cardiovascular Clinic is vicariously liable for the acts and omissions of its employees including Dr. McGrew. (Id. ¶ 23.) Likewise, Defendant Cardiovascular Surgery Clinic, PLLC is vicariously liable for the acts and omissions of its employees including Defendant H. Edward Garrett, M.D., ("Dr. Garrett") and Eva Proctor, M.D. ("Dr. Proctor"). (Id. ¶ 24.) The Amended Complaint further alleges that Defendants' failure to observe Ms. Shuler and the act of leaving Ms. Shuler unattended for forty-three minutes constitute negligence per se or at the very least gross negligence. (Id. ¶ 25.) According to Plaintiffs, these acts and omissions were the proximate cause of injuries to Ms. Shuler, including the proximate cause or a contributing proximate cause of her death. (Id. ¶ 26.)
In their separate Rule 12 Motions, Defendants have raised one common, dispositive argument to seek dismissal of Plaintiffs' claims. All Defendants argue that Plaintiffs failed to comply with the pre-suit notice requirements of the Tennessee Medical Malpractice Act, Tenn. Code Ann. § 29-26-121. According to Defendants, Tennessee law requires that a plaintiff bringing a medical malpractice claim give each healthcare provider to be named as a defendant sixty (60) days notice before filing suit. The statute sets out the elements required for the notice, including a HIPAA compliant medical authorization. The statute further requires that the pleadings state that notice was given and attach documentation of the notice. Defendants cite a number of cases applying Tennessee law where the complaint was dismissed for failure to provide pre-suit notice as the statute requires. In particular, federal courts applying Tennessee law have concluded that the statutory pre-suit notice provision is substantive law, and thus it applies in diversity cases filed in federal court. Here Plaintiffs failed to give pre-suit notice of their claim sounding in medical malpractice. Therefore, Defendants argue that the Court should dismiss their Complaint.
In the alternative, Defendants contend that Plaintiffs failed to file a certificate of good faith as required by Tenn. Code Ann. § 29-26-122. That statute provides that the Court must dismiss a complaint that fails to include a certificate of good faith. Like the statute's pre-suit notice requirements, courts have construed the certificate of good faith requirement to be substantive law and applied it in federal diversity cases. Plaintiffs' Complaint in this case does not include a certificate of good faith. For these reasons Defendants assert that dismissal of Plaintiffs' Complaint is required.
In their response briefs in opposition, Plaintiffs argue that the Medical Malpractice Act does not apply to their claims. Plaintiffs emphasize that their claims sound in medical battery, res ipsa loquitur, negligence per se, wrongful death, and abuse and neglect of an elderly person. All of these theories are separate and distinct from a claim for medical malpractice. For example, Plaintiffs contend that unlike a claim for medical malpractice, expert proof is not required to make out any of these claims. Plaintiffs contrast their claim for medical battery with the similar theory of lack of informed consent, arguing that expert proof is not required to establish medical battery. Plaintiffs also indicate in a footnote that they have prepared and circulated to Defendants a second amended complaint, which contains even more fact pleadings in support of their negligence and medical battery claims. To date, Plaintiffs have not filed a motion for leave to amend their pleadings.
Defendants have filed separate replies. Defendants essentially contend that the gravamen of Plaintiffs' Complaint is medical malpractice. Plaintiffs' claims derive from the administration of medication and medical monitoring in the ICU by doctors and nurses. Plaintiffs' claims involve the acts or omissions of health care providers; are based on medical art, science, training or expertise; and bear a substantial relationship to the rendition of medical treatment by a medical professional. Therefore, Defendants argue that Plaintiffs were required to comply with the statutory prerequisites before bringing this suit.
A defendant may move to dismiss a claim "for failure to state a claim upon which relief can be granted" under Federal Rule of Civil Procedure 12(b)(6). When considering a Rule 12(b)(6) motion, the Court must treat all of the well-pled allegations of the complaint as true and construe all of the allegations in the light most favorable to the non-moving party.
Under Rule 8 of the Federal Rules of Civil Procedure, a complaint need only contain "a short and plain statement of the claim showing that the pleader is entitled to relief."
The Court holds that Plaintiffs' claims are subject to dismissal for failure to comply with the statutory requirements of the Tennessee Medical Malpractice Act ("the Act"). The parties do not dispute that the substantive law of Tennessee applies in this diversity case. As such, the Court is bound to apply the substantive law of Tennessee as if the action had been brought in Tennessee state court.
The threshold issue presented is whether the Medical Malpractice Act controls Plaintiffs' claims against Defendants. The Tennessee Supreme Court has recently explained that the labels attached to a cause of action by the parties are not conclusive for purposes of the Act.
Applying these principles of Tennessee law, the Court holds that the Medical Malpractice Act governs Plaintiffs' claims. The factual allegations of Plaintiffs' Amended Complaint concern services performed by Defendants, which bear a substantial relationship to the rendition of medical treatment. The Amended Complaint alleges that Defendants administered Heparin or a derivative to Ms. Shuler on at least one occasion during a hospitalization in 2011. The Amended Complaint further alleges that while treating Ms. Shuler at the Baptist ICU, Defendants left her unattended for approximately forty-three minutes immediately prior to her death. The Court holds that the use of a drug prescribed by a physician in a hospital setting bears a substantial relationship to the rendition of medical treatment by a medical professional. Likewise, the failure to attend to a patient being treated in an ICU also bears a substantial relationship to the rendition of medical treatment. The Defendants whom Plaintiffs seek to hold liable for Ms. Shuler's injuries are all medical professionals or organizations providing medical services. Defendants include the hospital where Plaintiff was being treated, three treating physicians, and two medical groups. Based on the facts alleged in the pleadings, the Court finds that the nature and substance of Plaintiffs' claims sound in medical malpractice. Therefore, the Court concludes that Plaintiffs' claims are actually claims for medical malpractice controlled by the Act.
Having concluded that Plaintiffs' claims for the administration of Heparin to Ms. Shuler and for leaving Ms. Shuler unattended in the ICU sound in medical malpractice, the Court holds that Plaintiffs were required to comply with the statutory requirements of the Medical Malpractice Act. The statute requires that any person "asserting a potential claim for medical malpractice shall give written notice of the potential claim to each health care provider that will be a named defendant at least sixty (60) days before the filing of a complaint based upon medical malpractice."
In the alternative, the Court holds that Plaintiffs have not complied with the statute's good faith requirements. The Medical Malpractice Act requires that a plaintiff (or the attorney for the plaintiff) file a certificate of good faith with the complaint, stating that the plaintiff has consulted an expert about the malpractice claim and obtained a written statement from the expert opining that there exists a good faith basis for the claim.
Plaintiffs argue that their claims related to the administration of Heparin to Ms. Shuler do not sound in negligence at all but instead are based on a medical battery theory. Plaintiffs contend that Ms. Shuler never gave consent to the use of Heparin during her treatment and that Defendants "purposefully and willfully" gave her the drug despite the fact that she had a documented allergy to the medication.
While it is true that the same constellation of facts may give rise to claims for medical battery or medical malpractice, the Court concludes that Tennessee law does not provide a claim for medical battery under the facts presented in this case. As Plaintiffs correctly point out, one of the key issues in a medical battery case is whether the patient gave informed consent for the treatment or procedure. The Tennessee Supreme Court has adopted a two-part inquiry to determine whether a claim constitutes a medical battery: (1) whether the patient had prior knowledge that the doctor was going to perform the procedure; and, if so (2) whether the patient gave consent to authorize performance of the procedure.
Although the Tennessee Supreme Court has not spoken to these issues, the Tennessee Court of Appeals has held that a patient's claim based on "the injurious consequence of a therapeutic drug treatment" is one for medical malpractice, and not battery.
On appeal, the patient argued that the trial court should have charged the jury on the issue of whether the patient had given his informed consent to be treated with the phospholine iodide drops.
The Court of Appeals also cited with approval a decision from a Pennsylvania appellate court, holding that the "the doctrine of informed consent should continue to be limited in its applicability to only those cases involving surgical or operative medical procedures and not expanded to therapeutic treatment which is usually an on-going treatment upon examination by a treating physician."
Based on this authority, the Court concludes that Plaintiffs do not have a claim under Tennessee law for medical battery under the facts of this case. Plaintiffs allege that Defendants gave Ms. Shuler Heparin or a derivative of that drug on at least one occasion prior to her death. Defendants did this even though Ms. Shuler had an allergy to the drug and had not consented to being given the medication. However, the Amended Complaint alleges that Ms. Shuler was given the medication as a component part of her treatment at Baptist. The administration of Heparin cannot be said to be a "procedure" or "treatment" as the Tennessee Court of Appeals considered the terms in Cary. Rather, the use of Heparin was a "component part of the treatment process" during Ms. Shuler's hospitalizations. It follows that Defendants were not required under Tennessee law to obtain Ms. Shuler's informed consent for the use of Heparin so long as Defendants had her informed consent to be treated at the hospital. Under these facts, Plaintiffs' "adequate legal remedy . . . for the injurious consequence of therapeutic drug treatment" is a "malpractice action sounding in negligence." Therefore, the Court finds Plaintiff's medical battery theory to be unpersuasive.
In addition to their claim for medical battery, Plaintiffs contend that their fact pleadings also support claims of negligence per se, res ipsa loquitur, and abuse and neglect of an elderly person. Even so, the Court holds that these alternative theories do not alter the fact that Plaintiffs' claims sound in medical malpractice and therefore are governed by the statutory requirements of the Act.
First, the Court concludes that Plaintiffs' allegations of negligence or gross negligence are essentially claims for medical malpractice. The Amended Complaint alleges that Defendants' failure to attend to Ms. Shuler during the forty-three minutes immediately preceding her death constitutes negligence per se.
The Court has held that the acts of negligence alleged against Defendants in this case are governed by the Medical Malpractice Act, regardless of what evidentiary theory Plaintiffs might plead. As previously discussed, whether the parties label a cause of action as one for medical malpractice or common law negligence, "the issue is whether the alleged negligent conduct `bears a substantial relationship to the rendition of medical treatment by a medical professional.'"
For similar reasons, Plaintiffs cannot rely on their passing mention of abuse and neglect of an elderly person to escape the requirements of the Medical Malpractice Act.
Having concluded that the Medical Malpractice Act and its requirements govern Plaintiffs' claims in this case, the Court concludes that Plaintiffs have failed to satisfy the statute's pre-suit notice provision or certificate of good faith requirement. Therefore, Plaintiffs' claims are subject to dismissal.
Finally, the Amended Complaint asserts in a single allegation that Defendants Baptist; Cardiovascular Surgery Clinic, PLLC; and Stern Cardiovascular Center ("the Defendant-employers") are liable for punitive damages for the negligent hiring and retention of their employees whose acts and omissions were allegedly the cause of Ms. Shuler's death.
The Court holds that the Amended Complaint has failed to state a plausible claim for negligent hiring or retention. Plaintiffs' pleadings fail to "contain either direct or inferential allegations with respect to all material elements of the claim."
In the alternative, the Court holds that the Medical Malpractice Act governs Plaintiffs' negligent hiring and retention claim and as previously explained that Plaintiffs have failed to comply with the statute's requirements. Another member of this Court has recognized that in medical malpractice cases, claims for negligent hiring or retention might be separate and distinct from claims related to medical treatment, meaning that the requirements of the Medical Malpractice Act may not apply to a claim for negligent hiring or retention.
As mentioned previously, Plaintiffs have stated in their briefs an intention to amend their pleadings in response to Defendants' Rule 12 motions. Plaintiffs first indicated their plan to seek leave to amend the pleadings in a brief filed on April 20, 2012,
The Court holds that Plaintiffs' claims "bear a substantial relationship to the rendition of medical treatment by a medical professional, or concern medical art or science, training, or expertise."