ST. LOUIS — A Missouri appeals court has reversed a lower court's decision to grant summary judgment in favor of two doctors and a cardiology group accused of negligence in a wrongful death case, allowing the lawsuit to proceed.
The case stems from the January 2020 death of a patient identified as "Decedent," who arrived at SSM St. Joseph Hospital-Lake St. Louis with severe shortness of breath, according to an opinion filed Feb. 18 in Missouri Court of Appeals, Eastern District.
Despite being diagnosed with acute congestive heart failure, neither of the two physicians named in the suit—Dr. Huilin Li and Dr. Sam Bishara—saw the patient before he suffered cardiac arrest and died approximately eight hours after arriving at the hospital.
Joanne Knight, the decedent’s widow, filed a wrongful death lawsuit alleging that the physicians and St. Louis Cardiologist Consultants, Ltd. (SLCC) failed to meet the appropriate standard of care by not promptly reviewing and addressing her husband’s critical condition.
The trial court initially struck the testimony of Knight’s expert witness and subsequently granted summary judgment in favor of the defendants.
In its ruling, the Missouri Court of Appeals found that the lower court erred in excluding the expert witness’s testimony and determined there was sufficient evidence to create a factual dispute about whether Dr. Li and Dr. Bishara fulfilled their professional duties.
The decedent, who had a history of hypertension, was brought to the emergency department around 2 p.m. on Jan. 21, 2020. He reported experiencing worsening shortness of breath for six weeks, which had recently become so severe that he could no longer lie flat.
Emergency department staff diagnosed him with acute congestive heart failure and requested a cardiology consultation.
According to court documents, a nurse practitioner from SLCC accepted the consultation on behalf of Dr. Bishara and reviewed the decedent’s records. Meanwhile, a separate nurse practitioner admitted the patient under the care of Dr. Li, who was scheduled to begin his shift at 7 p.m.
Despite the patient’s worsening condition, neither Dr. Li nor Dr. Bishara directly evaluated him before he went into cardiac arrest at 9:54 p.m. He was pronounced dead at 10:21 p.m.
During depositions, Dr. Li testified that he was unaware the decedent had been assigned to him until responding to the emergency code.
However, the court noted that the decedent’s medical records listed Dr. Li as the admitting and attending physician. Furthermore, Dr. Li acknowledged that his supervising nurse practitioner had the authority to accept patients on his behalf.
Knight’s expert witness, a board-certified hospitalist with over 13 years of experience, testified that the standard of care required Dr. Li to review his patient list and examine the decedent within an hour of starting his shift.
The expert also stated that Dr. Li’s failure to check patient records on the hospital’s electronic medical system fell below the standard of care.
The trial court struck this testimony, reasoning that it was speculative and based solely on the expert’s personal experience with the hospital’s record-keeping system.
Without expert testimony, the court then granted summary judgment in favor of the defendants, ruling that Knight lacked sufficient evidence to proceed.
The appeals court disagreed with the trial court’s findings, stating that the expert’s testimony addressed broader medical standards and was not limited to the hospital’s specific electronic system.
The court emphasized that the core question was whether an attending physician has a duty to be aware of patients assigned to them and to evaluate those patients within a reasonable timeframe.
“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,” the court wrote. “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 the summary judgment for Dr. Bishara and SLCC, finding that a genuine dispute exists over whether a physician-patient relationship was established when SLCC accepted the cardiology consultation.
The case has been remanded to the lower court for further proceedings.
The appellant was represented by James O’Brien.
Li was represented by Mandy J. Kamykowski, Mariel L. Taylor and Erin N. Pfirrman.
Bishara and SLLC was represented by Jeffrey J. Brinker, Bridgette N. Fi and Thomas S. Powell.
Attorneys for Knight and the defendants did not immediately respond to requests for comment.
Missouri Court of Appeals, Eastern District case number: ED112826