In its opinion filed on October 13, 2021, the Court of Appeal Fourth Circuit State of Louisiana (“Louisiana Appellate Court”) held: “Respondent’s fall and subsequent injury were neither treatment-related nor caused by dereliction of professional skill. Expert medical evidence is likely unnecessary to determine whether the appropriate standard of care was breached. Respondent’s use of the stool to climb on the table did not involve assessment of her condition. The injury could have happened to anyone using the stepstool regardless of whether the individual was seeking medical treatment. There is no allegation that either Relator or Respondent acted with an intent to cause harm. We, therefore, conclude that the trial court did not err in denying Relator’s Exception of Prematurity.”
The Underlying Facts
On December 26, 2019, Plaintiff-Respondent, Patricia Phoenix (“Respondent”), visited, for the first time, Defendant-Relator, David A Beary’s, M.D. (“Relator”) office for a gastrointestinal examination and consultation. During the visit, but prior to examination, Relator instructed Respondent to climb onto the examination table using the stepstool that was attached to the table. As Respondent attempted to climb onto the table, she fell backwards off of the stepstool. As a result of the fall, Respondent claims that she sustained a closed fracture to the right tibial plateau of her leg.
Louisiana Medical Malpractice Act (“LMMA”)
Louisiana courts weigh six (6) factors when determining whether certain conduct by a qualified health care provider constitutes “malpractice” as defined under the LMMA:
1. Whether the particular wrong is treatment related or caused by a dereliction of professional skill,
2. Whether the wrong requires expert medical evidence to determine whether the appropriate standard of care was breached, and
3. Whether the pertinent act or omission involved assessment of the patient’s condition.
4. Whether an incident occurred in the context of a physician-patient relationship, or was within the scope of activities which a hospital is licensed to perform,
5. Whether the injury would have occurred if the patient had not sought treatment, and
6. Whether the tort alleged was intentional.
Louisiana Appellate Court Opinion
The Louisiana Appellate Court stated that even though Respondent was in the examination room, treatment had not begun; the stepstool was not a necessary tool needed for the treatment, but merely a device to aid in rising onto the examination table; and, Respondent was seeking treatment for gastrointestinal issues, for the first time, with Relator and the stepstool was not a necessary instrument for her treatment. Furthermore, there is no allegation that attachment and use of the stepstool had to be accomplished or monitored by professionally trained medical staff. “In consideration of the above, this factor weighs in favor of not applying LMMA.”
The Louisiana Appellate Court further stated, “The type of equipment used to aid in climbing onto an examination table and whether that equipment has adequate support devices may need to be established by medical expert opinion regarding common practice and the equipment used because the stepstool was allegedly attached to the examination table. In this case, however, there has been no allegation that the stool used was unusual or different from common practice and claims regarding how it should be assembled – on the surface – seems to be easily resolved by observation, or even the attachment of the stool’s assembly instructions as evidence in the case. Without factual support that this particular stool is medically necessary equipment requiring assembly by trained medical personnel, to which there are none, this factor weighs in favor of not applying LMMA.”
Furthermore, “Relator does not allege the stepstool is a necessary assessment tool and fails to provide any facts evincing why using a stepstool in necessary for the assessment of gastrointestinal problems. This factor weighs in favor of not applying LMMA.”
Nonetheless, “This Court, however, cannot ignore the fact that Respondent was following Relator’s instructions in anticipation of receiving the care she sought out. Based on the aforementioned jurisprudence, we find that a physician-patient relationship existed in this case. Thus, this factor weighs in favor of applying LMMA.”
On the other hand, “The stepstool was not a necessary part of Respondent’s treatment, and her fall was not related to her treatment or even the reason she sought treatment. Respondent fell because she stepped onto the stepstool and lost her balance. Any person, whether they were seeking medical treatment or not could have fallen from the stepstool. A colleague or friend visiting Relator and choosing to sit on the examination table for whatever reason could just as easily have fallen from the stepstool just as Respondent did. This factor weighs in favor of not applying LMMA.”
The Louisiana Appellate Court concluded: “Overwhelmingly, when applying the Coleman factors, we find that they were not met such that the LMMA applies to the instant matter.”
Source Phoenix v. Beary, M.D., No. 2021-C-0497.
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