That Which is Not Preserved is Forfeited: Failure to Make Objection at Trial Waives Argument on Appeal

This convoluted medical malpractice case was brought by Shane Berryhill and his wife against his cardiologist, Dr. Daly.  Dr. Daly performed a cardiac procedure following which he instructed Mr. Berryhill not to engage in “any strenuous or risky activity, or any lifting, bending, or stooping over.” Five days later Mr. Berryhill went hunting. After climbing and reaching the top of a deer stand he fainted and fell approximately 18 feet to the ground.  

Plaintiffs sued Dr. Daly, and alleged that he prescribed too much blood pressure medication, which caused Mr. Berryhill to faint. The trial court instructed the jury on the assumption of the risk. After a defense verdict, Plaintiff’s moved for a new trial. Grouns included that it was error to charge the jury on assumption of the risk.  The court denied Plaintiffs’ motion and they appealed.

The Court of Appeals reversed the trial court’s judgment and held that the charge is authorized only when the plaintiff assumes a known risk from a defendant’s conduct or failure to act. The trial court reasoned that climbing a deer stand was not the type of risk associated with Dr. Daly’s duty to Mr. Berryhill, thus it cannot be the risk that justifies the jury instruction. The court went on to write that the particular risk in question was fainting, and the evidence did not establish that Mr. Berryhill understood that if he failed to comply with Dr. Daly’s instructions he risked fainting. Finding the error was not harmless, the Court of Appeals reversed.

The Supreme Court of Georgia granted cert. and reversed the Court of Appeals.  It affirmed the general rule that only slight evidence is necessary to authorize a jury instruction. It further held that Dr. Daly’s instructions not to engage in strenuous activity and not to lift more than 10 pounds, bend, or stoop over for at least seven days was sufficient evidence to support  a jury charge on assumption of the risk.  The Supreme Court went on to write that violating such medical instructions after major heart surgery “poses an obvious cardiovascular risk to which competent adults cannot blind themselves.”

Following the Supreme Court’s reversal, the Court of Appeals vacated its opinion and adopted that of the Supreme Court. Divisions 2 and 3 of the Court of Appeals original decision remained unchanged, and division 5 and 6 were moot.  Division 4, however, alleged that the defense made improper closing arguments relating to Dr. Daly’s reputation, the importance of his career and whether he would lie in front of his mother. In its original opinion, the Court of Appeals declined to address this argument finding that it was related to matters unlikely to recur on retrial.  On remand, the Court of Appeals wrote that at this stage it would normally address such a claim, but since Mr. Berryhill failed to make any objection whatsoever to Dr. Daly’s closing argument at trial the Court of Appeals held the argument was waived.

Take-home: That which is not preserved, is forfeited. At trial preserve every single possible error with a timely objection.


Berryhill v. Daly, ___S.E.2d. ___(2021); 2021 WL 221997.

Georgia Court of Appeals Applies Gross Negligence Standard to Shoulder Dystocia Case

The Georgia Court of Appeals reversed the denial of summary judgment to an obstetrician for care related to a delivery complicated by shoulder dystocia. Plaintiff presented to Wellstar Kennestone Hospital for labor and delivery. Although the opinion is light on details, the inference is that the labor was uncomplicated until delivery of the shoulders. After shoulder dystocia was encountered, the obstetrician resolved it within 40 seconds using generally accepted maneuvers. The baby suffered injuries and the parents sued for medical malpractice.

Defendants moved for summary judgment, arguing that the gross negligence standard under O.C.G.A. §51-1-29.5 should apply. That statute reads, in part:

In an action involving a health care liability claim arising out of the provision of emergency medical care in a hospital emergency department or obstetrical unit or in a surgical suite immediately following the evaluation or treatment of a patient in a hospital emergency department, no physician or health care provider shall be held liable unless it is proven by clear and convincing evidence that the physician or health care provider’s actions showed gross negligence.

Defendants argued that all emergency medical care provided in an obstetrical unit is governed by the gross negligence standard. Defendants further argued that the limiting phrase “immediately following the evaluation or treatment of a patient in a hospital emergency department” only modifies “in a surgical suit” and not “obstetrical unit.” The Court agreed and reversed.

Take-home: This is a significant change in the application of this statute. Virtually all “birth injury” cases involve allegations of obstetrical emergency and applying the higher standard of care and burden of proof of Section 51-1-29.5 will provide additional protection to obstetrical providers. It remains to be seen whether Plaintiffs petition for certiorari and, if so, whether it is granted.

The case is Ob-Gyn Associates, P.A. v. Brown, __ S.E.2d ___ 2020 WL 6253453 (Ga.Ct.App. October 23, 2020).

Georgia Court of Appeals Affirms Summary Judgment for Psychiatrist

The Georgia Supreme Court has affirmed summary judgment for a psychiatrist on a wrongful death claim filed by the widow of a man killed in a car accident by the psychiatrist’s patient. The patient was under the care of the psychiatrist for alcoholism and had been prescribed Lorazepam. The patient returned to Atlanta from a trip and scheduled an emergency visit with the psychiatrist. The patient instead went to a bar before going to the appointment. After the appointment, he returned to the bar and drank more. Later that evening, after drinking more, the patient struck Plaintiff’s husband and killed him.

Plaintiff sued the psychiatrist in “ordinary negligence” and professional malpractice. The trial court granted the psychiatrist summary judgment and Plaintiff appealed. The Court of Appeals affirmed, holding that there was no claim for “ordinary” negligence, either under the “Bradley Center” rule or because of violation of various statutes regarding involuntary commitment. In a word, the Court reaffirmed the rule that a third party cannot sue a professional for the acts of the professional’s patient because the duty to control the patient does not arise unless the professional exercises “legal authority” to “place restraints on the liberty” of the patient. Here, the patient was a voluntary outpatient, so the control element was missing. The Court also affirmed summary judgment on the professional malpractice claim because of lack of privity between Plaintiff and the provider.

Take-home: this case seems to strengthen the general rule regarding professional liability to third-parties after a slight weakening of the rule in cases like Peterson v. Reeves.

The case is Stanley v. Garrett, ___ S.E.2d ___, 2020 WL 5554398 (Ga.Ct.App. Sept. 17, 2020).

Georgia Court of Appeals Holds Hospital Can be Liable for Attempted Suicide

The Georgia Court of Appeals affirmed the denial of summary judgment to a hospital after a patient was severely injured attempting suicide after discharge. Plaintiff suffered from paranoia and bipolar disorder. He suffered an acute decompensation and was transported from his apartment to the emergency department at Grady Memorial Hospital. There, a physician signed an involuntary commitment order (“1013”) and transfer to the psychiatric floor for “suicidal, bipolar/anxiety.” Plaintiff was then treated with Ativan.

Around the time of transfer to the psychiatric floor, a social worker “intercepted” and reassessed Plaintiff. The social worker determined Plaintiff was stable and should be discharged. After shift change, a second physician rescinded the 1013 order, reassessed Plaintiff, determined there were no current suicidal ideations or threats, and found that Plaintiff was safe for discharge. Approximately 11 hours later, Plaintiff attempted suicide by jumping from three stories, suffering severe injuries and brain damage.

The hospital moved for summary judgment under O.C.G.A. §§37-3-4 and 37-3-43(c), claiming it was entitled to “immunity” based on good faith compliance with the admission and discharge statutes concerning involuntary commitment. First, the Court of Appeals held there were genuine issues of material fact whether Grady had shown it was entitled to “immunity” because there were discrepancies between the first doctor’s assessment of suicide risk, the social worker’s intervention, and the second doctor’s concurrence with the social worker’s assessment after the patient received Ativan.

Next, the Court of Appeals held there were factual questions with whether Grady complied with the notice provisions of the statute. Under the notice rules, the hospital is required to give notice to the patient or their representative of proposed discharge. There was nothing in the chart to indicate compliance.

Take-home: proving immunity from liability can be difficult, especially on summary judgment.

The case is Fulton-DeKalb Hospital Authority v. Hickson, 830 S.E.2d 582 (June 28, 2019).

Georgia Court of Appeals Holds that Forged Mammogram Reports Do Not Support Fraud Claim

The Georgia Court of Appeals has held that multiple plaintiffs could not recover against a hospital based on forged mammogram reports by its employee. The plaintiffs received mammograms at the hospital in 2008 and 2009. The employee was supposed to transmit the images to a radiologist for interpretation. Instead, for reasons unknown, the employee forged the reports as normal. The hospital discovered the forgeries, terminated the employment, refunded the money, and the employee was prosecuted.

Plaintiffs sued for malpractice, fraud, RICO violations, and other torts. Plaintiffs alleged that the proper interpretation of the mammograms showed evidence of cancer or other conditions that needed follow-up. Notably, the plaintiffs had follow-up mammograms after the fraud was discovered. To this, the plaintiffs claimed exposure to excess radiation. The Court held that Plaintiffs could not prevail on this claim without proof that they actually suffered “injuries” from having to undergo the second mammograms. In addition, the Court held that the plaintiffs failed to prove they suffered compensable damages as a result of the alleged fraud.

This is an interesting case because it would seem that the fraud itself – caused a sufficient legal injury to justify nominal damages and, potentially, punitive damages, against the employee but not the employer. However, it does not appear that issue was the subject of the appeal.

The case is Houston Hospitals, Inc. v. Felder, 2019 WL 2482099 (June 14, 2019).

Georgia Court of Appeals Reverses Defense Verdict on Hearsay Ruling

The Georgia Court of Appeals has reversed a defense verdict in a medical malpractice case because the trial court improperly admitted hearsay testimony under the “learned treatise” exception. In Moore v. Wellstar Health, plaintiff sued a surgeon and an anesthesiologist after her husband died when he aspirated during rapid sequence induction.

The evidence showed that the patient had a high grade bowel obstruction. Plaintiff’s expert anesthesiologist contended that the standard of care required placement of a nasogastric tube before induction of anesthesia. The defense countered that placement of an NG tube after rapid sequence induction was reasonable.

The defense cross-examined plaintiff’s expert with a document published by the American Society of Anesthesiologists entitled “Committee on Expert Witness Testimony Review and Findings” regarding the testimony of a different expert in a different case. In the document, the ASA sanctioned an expert for testifying that the standard of care required placement of a nasogastric tube before rapid sequence induction. The Moore defense used the document to cross-examine plaintiff’s expert over objection. The jury returned a defense verdict.

The Court of Appeals reversed, holding that the document was hearsay and did not qualify as a “learned treatise” because it was not a published treatise, periodical, or pamphlet. Rather, relying on cases from other jurisdictions, the Court held that the “learned treatise” exception to the hearsay rule is limited and does not include documents that are litigation-inspired, even if they are published by a reputable entity. In addition, the Court held that the error was harmful because the use of the document implied that the plaintiff’s expert’s testimony was sanctionable and therefore not worth of belief.

Take-home: a similar theory has been leveled against a number of publications, including the widely-used ACOG guidelines regarding neonatal encephalopathy (the “Green Book”), among others. Practitioners should look carefully at documents they intend to use for cross-examination to make sure that they are admissible. Notably, the Court did not delve into whether the issue was admissibility into evidence versus use on cross-examination solely for impeachment.

The case is Moore v. Wellstar Health, 2019 Ga.App. LEXIS 170 (March 12, 2019).

Georgia Court of Appeals Reverses Immunity for Ambulance

The Georgia Court of Appeals reversed the grant of summary judgment for an ambulance service based on the emergency responder statute. Plaintiff was the wife of a deceased driver and the mother of a son injured in a car accident. Plaintiff alleged that when the ambulance service responded, they failed to treat her husband, resulting in his death. Plaintiff also alleged that the ambulance service improperly treated her son, resulting in additional injuries.

The ambulance service moved for summary judgment under Section 31-11-8, which grants immunity to ambulance services who provide services in good faith and without remuneration. The trial court granted the motion, ruling that the statute applied even though Plaintiff alleged omissions and that the ambulance service did not receive remuneration.

The Court of Appeals reversed, holding there was a fact dispute as to whether the ambulance service received remuneration within the meaning of the statute. The evidence was the ambulance service received compensation for mileage and for “ALS1.” Under the CMS manual for reimbursement, ALS1 is for charges related to emergency services and not an administrative cost like mileage. Accordingly, the ambulance service received remuneration and was not entitled to immunity as a matter of law.

The case is Ortega v. Coffey, 2019 Ga.App. LEXIS 86 (Feb. 26, 2019).

Georgia Court of Appeals Holds Treating Doctor Must Be Identified as Expert Witness

The Georgia Court of Appeals affirmed the exclusion of a treating physician who was not identified as an expert witness on standard of care during discovery and only on the eve of trial. Plaintiff claimed she was injured by the defendant physician following three foot surgeries. The defendant recommended additional treatment, including removal of bone spurs. The defendant physician then recommended the plaintiff seek a second opinion from Dr. Light.

Plaintiff sued the defendant and attached the affidavit of a specially-retained expert witness, who offered three opinions regarding deviation from the standard of care. The parties also had a scheduling order, which was modified three times, but included specific deadlines for the identification of experts, including “rebuttal” experts. During discovery, defendant asked plaintiff to identify “any witness whom you expect to call as an expert witness at trial, including any . . . treating physicians from whom you may elicit standard of care or causation testimony at trial.” Initially, Plaintiff responded that she had not decided who she was going to call. During the extended discovery period, Plaintiff identified the affiant/specially-retained expert, who only testified to the three deviations set forth in the affidavit.

After the close of the discovery period per the scheduling order, the trial was set for over a year later. Less than a month before trial, plaintiff served supplemental discovery responses, identifying the treating physician, Dr. Light, as a witness and stating that he would offer three new opinions regarding deviations from the standard of care. Defendant deposed Dr. Light and established what he reviewed to form his opinions, which included records and imaging studies that he had not reviewed while he was caring for plaintiff.

Defendant moved to exclude Dr. Light’s standard of care testimony because he had not been identified as an opinion witness during the discovery period. The trial court granted the motion and the Court of Appeals affirmed. On appeal, plaintiff conceded she failed to identify Dr. Light as an expert witness, but argued that she was not required to do so under what she called the “treating physician exception.” The Court rejected the idea of such an exception, holding that once Dr. Light reviewed materials that he did not have while he was treating the patient and offered standard of care opinions, he was an expert witness for purposes of disclosure during discovery. The Court distinguished cases in which a treating provider is called to offer opinions derived solely from firsthand observation and those opinions are not standard of care opinions, writing “a party may present expert testimony from a fact witness (i.e., a witness who does not have to be identified pursuant to Rule 26), who is testifying as to facts he or she observed or learned” while treating the patient, but that “such a witness may not, however, provide expert opinion testimony on the standard of care and whether that standard was breached, unless the witness has been identified as an expert” under Rule 26.


This is the clearest declaration by the Georgia appellate courts regarding the distinction between an “expert witness” and what is labeled a “percipient witness” in Federal court. In the course of discovery, if a treating physician is going to review data that they did not have at the time they were taking care of the patient and they are offering standard of care testimony, that witness must be disclosed. In our practice, we ask two separate interrogatories, one regarding witnesses who have been specially-retained for purposes of litigation and a separate interrogatory regarding any witness who will offer opinion testimony at trial regarding standard of care, causation, or damages.

The case also supports the notion that Georgia courts are strongly enforcing scheduling orders and doing so against all parties. All parties should be mindful that, within the confines of a scheduling order, the deadlines are meaningful and discovery and disclosure should be focused on full compliance.

The case is Glover v. Atkinson-Sneed, 2019 Ga. App. LEXIS 73 (Ga.Ct.App. Feb. 20, 2019).

Georgia Court of Appeals Holds that Statute of Repose Prevents Adding New Doctor to Case

The Georgia Court of Appeals has held that a doctor could not be added to an existing lawsuit filed against her practice group and a physician in her practice group more than five years after the date of the negligent act or omission. In Preferred Women’s Healthcare v. Sain, the plaintiff originally sued an obstetrician and the group for malpractice arising out of an alleged failure to diagnose a malignancy on ultrasound. The ultrasounds allegedly showing the malignancy were performed in April 2012. The patient died of cancer in December 2013.

Plaintiff filed the original lawsuit in 2014 and only named one obstetrician and the practice group. In February 2017, Plaintiff deposed the ultrasound technologist, who testified that a second doctor’s “squiggly line” mark appeared on the ultrasound reports. In May 2017, Plaintiff deposed the second doctor, who confirmed that she provided care in April 2012 and reviewed the reports.

In June 2017, Plaintiff moved to add the second doctor. The second doctor opposed and claimed that the case against her was barred by expiration of the five year statute of repose. The trial court granted the motion to add and this appeal followed. The Court of Appeals reversed the trial court, holding that the five year statute of repose “destroys” the cause of action against the second doctor and that the otherwise liberal rules for adding parties and relation back of amendments do not apply once the statute of repose has expired.

Take-home: the statute of repose has always been a hard stopping point for medical malpractice claims and this case reaffirms this principle. The decision is timely as other cases support the notion that parties and claims may be added at various points before expiration of the statute of repose.

The case is Preferred Women’s Healthcare v. Sain, 2019 Ga. App. LEXIS 30 (Ga.Ct.App. Jan. 28, 2019

Georgia Court of Appeals Holds that Metastatic Cancer is New Injury

The Georgia Court of Appeals has held that metastatic cancer constitutes a “new injury” for purposes of calculating the statute of limitations. Plaintiff went to an obstetrician/gynecologist in August 2013 with complaints of abnormal bleeding from a large uterine fibroid mass. Plaintiff and the doctor discuss treatment options, including robotic hysterectomy. The doctor then referred the patient to a gynecological oncologist.

The oncologist examined the patient and reviewed films. In November 2013, the oncologist reported to the obstetrician that there was a “very low suspicion” for malignancy. The obstetrician proceeded with the robotic procedure on December 13, 2013 based on the oncologist’s report. During the procedure, the fibroids were cut (“morcellated”) and not removed intact. Pathology reports showed the fibroids were cancerous. Post-operative CT and PET scans were negative until October 24, 2014, when the patient presented with pelvic tumors. The patient passed away on May 19, 2015.

On December 9, 2015, the patient’s husband was appointed administrator of her estate. He then filed suit against the obstetrician, the practice group (Wellstar Physicians), and named several “John Doe” defendants. In April 2017, plaintiff filed an amended complaint to name the oncologist and substitute him in for one of the John Doe defendants.

The oncologist moved to dismiss on the grounds of expiration of the two year statute of limitations. The trial court converted the motion to a partial motion for summary judgment and held that the “new injury” exception to the statute of limitations did not apply.

The Court of Appeals reversed, holding the evidence showed the “new injury” exception did apply.  The general rule in misdiagnosis cases is that the misdiagnosis is the injury because the plaintiff suffers pain and incurs medical expenses from that point forward. In some cases, however, when the injury from the misdiagnosis is relatively benign or treatable but then develops into a more debilitating or “less treatable” condition, the injury is the “subsequent development of the other condition.” In this case, the Court held that the metastasis led to “a substantially reduced likelihood of her survival” and was a result of the morcellation, rather than removal of the fibroids intact.

The Court also held that the statute of limitations was tolled until the administrator was appointed and that the amendment related back to the filing of the original complaint.

The case is Hayes v. Hines, 2018 Ga. App. LEXIS 615 (Oct. 26, 2018).