The National Deaf Academy, LLC, etc. v. Denise Townes, etc.
The National Deaf Academy, LLC, etc. v. Denise Townes, etc.
Opinion
The issue in this case requires this Court to determine when a negligence claim arises out of the "rendering of, or the failure to render, medical care or services," as the Legislature's definition of medical malpractice provides, thereby subjecting a plaintiff to the onerous presuit requirements and restrictions of the medical malpractice statutory scheme. § 766.106(1)(a), Fla. Stat. (2008).
1
In the decision under review, the Fifth District Court of Appeal held that a claim arising out of the alleged negligence by employees of the National Deaf Academy in attempting to physically restrain one of its residents, which resulted in injury to the resident, sounded in ordinary negligence.
Townes v. Nat'l Deaf Academy, LLC
,
The National Deaf Academy argues, and we agree, that the Fifth District's decision conflicts with the First District Court of Appeal's decision in
Shands Teaching Hospital & Clinics, Inc. v. Estate of Lawson
,
In accordance with the Legislature's definition of medical malpractice and this Court's relevant case law, we hold that for a claim to sound in medical malpractice, the act from which the claim arises must be directly related to medical care or services, which require the use of professional judgment or skill. Because we conclude that neither the claim in Townes nor the claim in Shands arose from an act directly related to medical care or services, which require the use of professional judgment or skill, we approve the Fifth District's decision in Townes and disapprove of the First District's decision in Shands .
*306 FACTUAL AND PROCEDURAL BACKGROUND
This case arises out of an action for damages brought by Denise Townes, on behalf of Cinnette Perry, 3 and Cinnette Perry, individually, against the National Deaf Academy, by and through its employees, for injuries Perry sustained while she was a resident at the National Deaf Academy. As explained by the Fifth District:
[The National Deaf Academy] operates as both a school and a residential treatment facility, licensed pursuant to Chapter 394, Florida Statutes (2008), for deaf, hard of hearing, and autistic individuals suffering from psychiatric and behavioral disorders. [The National Deaf Academy] offers psychiatric, psychological, medical, speech therapy, and educational services to its residents. [The National Deaf Academy's] staff includes psychiatrists, nurses, teachers, therapists, and sign language interpreters.
Before going to [the National Deaf Academy], Perry was diagnosed with bipolar disorder-mixed, intermittent explosive disorder, impulse control disorder not otherwise specified, conduct disorder, and post-traumatic stress disorder. During her admission, a [National Deaf Academy] psychiatrist established a plan of care for Perry that included Therapeutic Aggression Control Techniques ("TACT"), which involves staff members physically restraining the resident. Prior to employing a TACT hold, the most senior employee on scene is required to make a determination as to whether the TACT hold is an appropriate method to control the resident.
Townes
,
The Fifth District set forth the circumstances that led to Perry's injuries as follows:
On August 7, 2008, Danielle Warren, a nurse employed by [the National Deaf Academy], received notice that Ms. Perry "eloped off campus." When Perry voluntarily returned to [the National Deaf Academy's] campus, she began throwing rocks at [the National Deaf Academy] staff and its buildings, causing several windows to shatter. Perry also pulled on cables, wires, and lightning rods, trying to dislodge them.
After the staff removed the other residents from the area, four [National Deaf Academy] staff members attempted to verbally de-escalate the situation. Since Perry was not responding to the verbal de-escalation attempts, Nurse Warren made the decision to perform a TACT protective hold. After Nurse Warren called Dr. Karen Goldberg, [the National Deaf Academy's] Associate Medical Director, the staff attempted to employ a TACT hold. The attempt was unsuccessful as Perry was agitated. According to Nurse Warren, Perry positioned her toe down into where "the dirt meets the concrete" and then wrapped her leg around Nurse John Barclay, causing both to fall. As she fell, Perry sustained an injury to her leg, which the staff believed to be a dislocated knee.
Townes filed a two-count complaint, alleging claims of ordinary negligence against the National Deaf Academy, by and through its employees.
Two registered nurses involved in the incident testified in deposition that a TACT hold is "a form or a style of physical intervention for the mentally ill." They explained that a TACT hold is administered "[t]o protect the resident from himself or herself, as well as protect the other residents from [the resident] if [the resident is] violent." The nurses testified that the purpose of a TACT hold is "[f]or safety of the resident and for safety of the other residents. For safety in general." While the inclusion of a TACT hold in a resident's plan of care is a decision made by a medical doctor, the nurses explained that the decision to administer a TACT hold need not be made by a medical doctor. Rather, a nurse, supervisor, or "the most senior person that is train[ed] and qualified in TACT," has the authority to decide that a TACT hold is necessary. Moreover, everyone employed by the National Deaf Academy, including mental health technicians and sign language interpreters, completes TACT training.
After the limited discovery period and the National Deaf Academy's renewed motion to dismiss, Townes amended her complaint.
Townes
,
The National Deaf Academy moved for final summary judgment, arguing that Counts I and II alleged medical malpractice claims and were time-barred because the two-year statute of limitations for medical malpractice claims had expired prior to the filing of the original complaint.
See
Townes
,
Townes appealed and, upon review, the Fifth District reversed, concluding that Townes's claims alleged ordinary negligence.
We find that on the record before this court, the use of the TACT protective hold on Perry was not for treatment or diagnosis of any condition, was not employed to meet Perry's daily needs during care, and did not require medical skill or judgment as non-medical staff were taught the procedure and were authorized to decide whether to employ it. We find that Counts I and II assert claims sounding in ordinary negligence, rather than medical malpractice. Accordingly, we reverse the summary judgment entered on Counts I and II.
ANALYSIS
The issue in this case requires this Court to determine when a negligence claim arises out of the "rendering of, or the failure to render, medical care or services," as the Legislature's definition of medical malpractice provides, thereby subjecting a plaintiff to the restrictions and requirements of the medical malpractice statutory scheme, as well as a shorter statute of limitations than for ordinary negligence claims. § 766.106(1)(a), Fla. Stat. (2008). The specific facts of this case involve the alleged negligent administration of a method of physical restraint, which is performed for the safety of both the resident and others, and can be performed by nonmedical personnel.
See
Townes
,
Whether a claim arises from ordinary negligence or medical malpractice has significant implications. For example, as shown by the facts of this case, medical malpractice claims have a shorter statute of limitations than ordinary negligence claims-two years versus four years, respectively.
See
§ 95.11(3)(a), (4)(b), Fla. Stat. (2008). Prospective medical malpractice plaintiffs must also comply with complex presuit requirements, as set forth in chapter 766, Florida Statutes, before filing a medical malpractice suit, which includes conducting "an investigation to ascertain that there are reasonable grounds to believe" that medical malpractice occurred.
*309
ability to bring medical malpractice claims."
Dockswell
,
Because of the statutory restrictions and requirements that apply only to medical malpractice claims, any "doubt" as to whether a claim is for ordinary negligence or medical malpractice should be "generally resolved in favor of the claimant."
J.B. v. Sacred Heart Hosp. of Pensacola
,
To resolve the issue in this case, we begin with the statutory definition of medical malpractice, enacted by the Legislature and interpreted by this Court and the district courts of appeal. We then examine how that statutory definition has been applied by courts tasked with determining whether a claim sounds in ordinary negligence or medical malpractice. Finally, we turn to address the conflict and facts presented in this case.
I. Medical Malpractice
The Legislature has defined a claim for medical negligence or medical malpractice as "a claim, arising out of the rendering of, or the failure to render, medical care or services." § 766.106(1)(a), Fla. Stat. (2008). The Legislature has further provided that proving a medical malpractice claim requires establishing that the allegedly negligent act "represented a breach of the prevailing professional standard of care," as testified to by a qualified medical expert.
In
Silva v. Southwest Florida Blood Bank, Inc.
,
At issue in
Silva
was whether blood banks were subject to the two-year statute of limitations applicable to medical malpractice actions.
We can find no indication that the legislature intended for blood banks to be considered "providers of health care" for purposes of the medical malpractice statute of limitations. Nor do we find it permissible generally to construe that term broadly. In the absence of clear legislative intent to the contrary, we are not at liberty to construe that term so as *310 to deprive plaintiffs of their causes of action .
Consistent with our case law, the district courts have constructed additional principles for determining whether a claim sounds in ordinary negligence or medical malpractice. For example, the Fifth District has explained that the wrongful act from which the claim arises "must be directly related to the improper application of medical services and the use of professional judgment or skill."
Joseph v. Univ. Behavioral LLC
,
In
Joseph
, relied on by the Fifth District in
Townes
, a psychiatric patient sued the psychiatric hospital for negligence after he was punched in the face by another patient.
An additional principle discussed by the Fifth District in
Joseph
and other district courts of appeal is that merely because "a wrongful act occurs in a medical setting does not necessarily mean that it involves medical malpractice."
On appeal, the Third District Court of Appeal rejected the hospital's contention that "because the nurse used her medical judgment" in giving the patient hot tea, "the actual act of serving the hot tea amounts to a medical service," determining that this was "simply a claim that arises out of the act of serving a cup of hot tea."
The process of serving tea did not involve medical skill or judgment. The injury is not a direct result of receiving *311 medical care from the provider. Even though, arguably, the nurse may have used her medical judgment to agree with [the patient's] request for hot tea to help his condition, the process of serving the hot tea did not require medical skill or judgment. Not only was [the patient] not injured as a direct result of receiving medical care or treatment by the hospital employee, but in order to bring forth a claim of negligence, [the patient] would not have had to show that a hospital employee breached a prevailing professional standard of care which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by similar healthcare providers, and that such a breach was the cause of his injuries. There does not appear to be a medical standard of care for serving hot tea. Therefore, [the patient] was not required to comply with the medical malpractice pre-suit requirements.
For these same reasons, the Fourth District Court of Appeal properly held that a claim arising out of an injury sustained by a dialysis patient when a hospital employee inadvertently kicked the patient's foot in an attempt to return the footrest of the patient's chair to the upright position sounded in ordinary negligence.
Tenet St. Mary's Inc. v. Serratore
,
On the other hand, where a claim arose from injuries sustained while a patient was connected to physical therapy equipment, the Second District Court of Appeal properly concluded that the claim sounded in medical malpractice, since the injuries were "directly inflicted by the medical care-that is, physical therapy treatment" provided by the health care provider.
Corbo v. Garcia
,
In
Goldman v. Halifax Medical Center, Inc.
,
Our holding today flows naturally from these cases that faithfully construe the Legislature's definitions in chapter 766 and this Court's precedent. Accordingly, we hold that for a claim to sound in medical malpractice, the act from which the claim arises must be directly related to medical care or services, which require the use of professional judgment or skill. This inquiry involves determining whether proving the claim requires the plaintiff to establish that the allegedly negligent act "represented a breach of the prevailing professional standard of care," as testified
*312
to by a qualified medical expert. Our holding will allow ordinary negligence cases to proceed without requiring the plaintiff to obtain a presuit corroborating expert and follow the additional matrix of presuit procedures, while still advancing the Legislature's policy goals of encouraging the early settlement of meritorious and screening out frivolous medical malpractice claims.
See
Kukral v. Mekras
,
We now turn to address the conflict in this case.
II. The Conflict
The National Deaf Academy argues that the Fifth District's decision in Townes , concluding that Townes's claim arising out of the TACT hold that led to Perry's injuries sounds in ordinary negligence, conflicts with Shands , where the First District held that a claim arising out of a psychiatric hospital employee leaving her badge and keys where a patient could access them, which led to that patient's death, sounded in medical malpractice. 6 The National Deaf Academy asserts that, had the Fifth District followed the First District's reasoning in Shands , it would have properly determined that Townes's complaint set forth a claim for medical malpractice. For the reasons that follow, we conclude that the First District applied an overly broad and attenuated standard for determining whether a claim sounds in medical malpractice.
In
Shands
, a patient was admitted to the locked unit at a psychiatric hospital.
The First District framed the estate's claim as the failure to keep the patient "adequately confined within the locked unit as her condition required."
*313
We disagree with the First District's analysis in
Shands
. While it is true that the hospital failed to confine the patient to her locked unit, the estate's claim arose out of the hospital employee leaving her badge and keys unattended where the patient could access them, not out of any act directly related to medical care or services that required the use of professional judgment or skill. Thus, contrary to the First District's conclusion, medical expert testimony on the professional standard of care would not be necessary for the estate to prove its negligence claim.
Construing what constitutes medical malpractice as broadly as the First District did in Shands would render essentially any claim arising out of a negligent act by a health care provider subject to the onerous presuit requirements in chapter 766 and the shortened statute of limitations for medical malpractice claims. As Judge Wolf observed dissenting in Shands , such a broad construction is inconsistent with the Legislature's clear purpose for instituting the presuit procedures:
The clear import of these extensive procedures [set forth in chapter 766] is to prevent frivolous second guessing of health care providers in their diagnosis of patients and their method of treatment of patients. The onerous procedures were not intended to provide unnecessary obstacles to injured parties attempting to institute claims against health care providers for simple carelessness. Indeed, requirements of extensive investigation and written medical expert opinions would make no sense in the context of simple careless acts, such as carelessly leaving one's keys where a patient can get them.
Further, the Legislature chose to define medical malpractice as a claim arising out of the rendering of, or failure to render, "medical care or services." § 766.106(1)(a), Fla. Stat. (2008). The Legislature also made clear that proving a medical malpractice claim requires the testimony of a qualified medical expert that the alleged negligent act breached the prevailing professional standard of care.
See
III. This Case
The National Deaf Academy argues that Townes's claim sounds in medical malpractice because the decision to include the use of TACT holds in Perry's plan of care was made by a medical doctor and medical expert testimony on the prevailing professional standard of care will be necessary to prove Townes's claim. We disagree.
*314
Although it is undisputed that the decision to include the use of TACT holds in Perry's plan of care was made by a medical doctor, "the purpose of a TACT protective hold is to ensure the safety of the residents."
Townes
,
Moreover, as one of the National Deaf Academy's nurses testified in deposition, a TACT hold is administered "to control an out-of-control resident" and "[t]o protect the resident from himself or herself, as well as protect the other residents from them if they are violent." Indeed, the TACT hold was only administered after Perry "eloped off campus," "began throwing rocks at [National Deaf Academy] staff and its buildings" upon her return, and "pulled on cables, wires, and lightning rods" in an attempt to dislodge them.
The gravamen of Townes's claim is that the National Deaf Academy, by and through its employees, negligently administered the TACT hold that led to Perry's injuries. Proving that claim will not require testimony from a medical expert on the professional standard of care. Therefore, because Townes's claim does not arise out of an act that is directly related to medical care or services, which require the use of professional judgment or skill, the Fifth District properly concluded that her claim does not allege medical malpractice, but ordinary negligence.
CONCLUSION
Limiting medical malpractice claims to those that are directly related to medical care or services, which require the use of professional judgment or skill, ensures that plaintiffs bringing claims of ordinary negligence are not subjected to the complex presuit procedures for medical malpractice claims, while still advancing the Legislature's policy goals of encouraging early settlement and screening out frivolous medical malpractice claims. In this case, because the administration of a TACT hold was not directly related to medical care or services, which require the use of professional judgment or skill, Townes's claim does not arise from medical malpractice, and her lawsuit is not barred by the two-year statute of limitations or her failure to comply with the presuit requirements set forth in chapter 766. For the same reasons, a claim arising out of a hospital employee leaving her keys and badge where a patient can access them does not sound in medical malpractice.
Shands
,
It is so ordered.
LABARGA, C.J., and QUINCE, CANADY, and POLSTON, JJ., concur.
LEWIS, J., concurs in result.
LAWSON, J., recused.
While the 2008 version of the Florida Statutes applies to this case, the current version of the Florida Statutes is materially the same.
In
Shands
, the patient's estate petitioned this Court for review based on conflict. However, before we made a determination on jurisdiction, the parties resolved the case and we approved the dismissal.
See
Estate of Lawson v. Shands Teaching Hosp. & Clinics, Inc.
, No. SC15-1827,
Townes is Perry's adult aunt.
It is undisputed that the National Deaf Academy is
not
a health care provider, as defined in section 766.202(4), Florida Statutes (2008). However, the National Deaf Academy employs health care providers, such as psychiatrists and nurses.
See
Townes
,
Townes's amended complaint also added four new counts.
Townes
,
Counts V and VI of the amended complaint alleged violations of chapter 394, Florida Statutes (2008) ("The Florida Mental Health Act" or "The Baker Act").
Townes
,
The National Deaf Academy also asserts conflict with
South Miami Hospital, Inc. v. Perez
,
This requirement does not apply to cases where a foreign body is discovered, because such a discovery "shall be prima facie evidence of negligence on the part of the health care provider." § 766.102(3)(b), Fla. Stat. (2017) ;
see
Dockswell
,
Reference
- Full Case Name
- The NATIONAL DEAF ACADEMY, LLC, Etc., Petitioner, v. Denise TOWNES, Etc., Et Al., Respondents.
- Cited By
- 22 cases
- Status
- Published