Causation in Medical Negligence: Admission vs. Observation Clarified

Introduction

This commentary examines the Supreme Court of Mississippi’s decision in United Emergency Services of Mississippi, Inc. and Keith E. McCoy, M.D. v. Oliver Miller, on behalf of the wrongful death beneficiaries of Shannon Reed (No. 2023-IA-00767-SCT; 2025-04-24). The case arises from allegations that emergency-room personnel and an attending physician breached the standard of care in diagnosing, monitoring, and discharging Shannon Reed, leading to his death. The core issue on interlocutory appeal was whether genuine issues of material fact existed as to causation—specifically, whether expert proof showed that different medical decisions would more likely than not have prevented Reed’s death.

Summary of the Judgment

The Supreme Court of Mississippi held:

Affirmed in part and reversed and rendered in part the denial of summary judgment.
Denied summary judgment on all negligence theories except the claim that Dr. McCoy should have admitted Reed to the hospital (no causation because on-call cardiologists attested they would not have admitted him).
Remanded the case for trial on the remaining negligence claims concerning monitoring, communication of pain, EKG interpretation, Troponin testing, discharge timing, and instructions.

Analysis

1. Precedents Cited

Smith v. Hardy Wilson Memorial Hospital (300 So. 3d 991, Miss. 2020): Held that causation fails if no evidence shows an alternate decision-maker (e.g., an administrator or on-call physician) existed or would override the doctor’s discharge decision. Summary judgment affirmed where nurses’ failure to prevent discharge could not change the outcome.
Harris v. Mississippi Baptist Health Systems (320 So. 3d 484, Miss. 2021): Reinforced Smith by requiring expert proof that notification would have altered treatment decisions.
Memorial Hosp. at Gulfport v. White (170 So. 3d 506, Miss. 2015): Described the “loss-of-chance” doctrine, requiring proof that negligence deprived the patient of a >50% chance of survival or substantial recovery.
Hubbard v. Wansley (954 So. 2d 951, Miss. 2007): Rejected a loss-of-chance claim when expert testimony was “wholly conclusory” and lacked specific facts or analysis supporting causation.

2. Legal Reasoning

The Court applied the familiar four-element negligence test: duty, breach, proximate cause, and injury. On summary judgment, the moving party must show no genuine factual dispute. The non-movant must then set forth specific facts demonstrating a triable issue.

– Causation as a Jury Question: Ordinarily, causation is reserved for the jury unless expert proof is legally insufficient.
– Admission vs. Observation: Reed’s counsel argued Dr. McCoy should have admitted him. Because Dr. McCoy lacked admitting privileges, he would have sought approval from on-call cardiologists. Their affidavits stated they would not have admitted Reed under the same facts. Under Smith, that foreclosed causation on any “failure to admit” theory.

– Other Breaches: Reed’s experts identified multiple lapses: failure to compare current and prior EKGs; misinterpretation of serial EKG changes; improper timing of Troponin tests; failure to communicate a late pain spike; premature discharge with overly broad follow-up instructions. Expert affidavits opined these breaches were contributing or proximate causes of death. Unlike the “admission” claim, these theories did not hinge on any unavailable decision-maker and thus survived summary judgment.

– Loss-of-Chance: Defendants argued that, even if breaches occurred, plaintiff failed to prove Reed had >50% chance of survival but for the negligence. The Court found the experts’ detailed opinions (linking specific failures to fatal outcome) sufficient to raise a jury question under White and distinguishable from the conclusory testimony in Hubbard.

3. Impact and Implications

Clarifies that summary judgment on causation in medical malpractice hinges on expert proof that alternate decisions would indeed have been made.
Reinforces Smith’s requirement: whenever a medical decision is made by someone other than the treating physician, experts must address that decision-maker’s hypothetical conduct.
Distinguishes “admission” from “observation and monitoring”: failure to admit may be cut off by testimony from admitting authorities, but breaches in monitoring, testing, and communication remain triable if expert testimony ties them to harm.
Signals that loss-of-chance claims can proceed on summary judgment when experts offer specific analysis rather than broad conclusions.

Complex Concepts Simplified

Summary Judgment (M.R.C.P. 56): A judge grants it only if no real factual dispute exists. If experts on both sides disagree on causation, it goes to a jury.
Prima Facie Case of Negligence: Plaintiff must show (1) duty, (2) breach, (3) causation, and (4) injury. In medical cases, causation typically requires expert testimony.
Loss-of-Chance Doctrine: Even if death was not certain, a patient can recover if negligence deprived a >50% chance of survival.
Interlocutory Appeal: Defendants appealed the denial of summary judgment before trial, asking the Supreme Court to decide a single legal issue (causation) early.

Conclusion

The Supreme Court of Mississippi’s decision in United Emergency Services v. Miller sharpens the contours of causation in medical negligence. It reaffirms that summary judgment is inappropriate when expert testimony on critical breaches—other than a simple “failure to admit”—raises genuine disputes about whether different care would have saved the patient. Conversely, it underscores the non-negotiable requirement that any claim resting on a decision by another medical authority must be backed by expert proof that the authority would have decided differently. This holding will guide practitioners and courts in structuring expert opinions, framing motions for summary judgment, and advising clients on the viability of medical-malpractice claims.