dewayne-krawl-individually-and-as-the-of-the-estate-of-grace-eloise-krawl ( 2003 )


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  •       TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN
    NO. 03-03-00052-CV
    DeWayne Krawl, Individually and as the Executor of the Estate of Grace Eloise Krawl,
    Deceased; Kimali Jane Kane; Karen Sue Kenyan; and
    Randall William Krawl, Appellants
    v.
    R. Vincent Murray, Jr., M.D.; and Sunbridge Health Care Corporation d/b/a Sunbridge
    Care & Rehabilitation for Highland Hills f/k/a Sunrise Health Care
    Corporation, Appellees
    FROM THE PROBATE COURT NO. 1 OF TRAVIS COUNTY
    NO. 73657A, HONORABLE GUY S. HERMAN, JUDGE PRESIDING
    MEMORANDUM OPINION
    DeWayne Krawl, Individually and as the Executor of the Estate of his mother, Grace
    Eloise Krawl, Deceased (“Mrs. Krawl”), and his siblings, Kimali Jane Kane, Karen Sue Kenyan, and
    Randall William Krawl (collectively, “appellants”), sued appellees R. Vincent Murray, Jr., M.D. and
    Sunbridge Health Care Corporation d/b/a Sunbridge Care & Rehabilitation for Highland Hills, f/k/a
    Sunrise Health Care Corporation (“Highland Hills”) for negligence. Mrs. Krawl was a resident of
    the nursing home operated by Highland Hills and was Dr. Murray’s patient. Appellants alleged that
    Highland Hills and Dr. Murray (1) were negligent in their care, causing Mrs. Krawl to suffer ulcers,
    infections, and pneumonia, which led to her death, and (2) failed to inform the family of her
    worsening condition. A jury found in favor of Highland Hills and Dr. Murray, and the trial court
    entered a take-nothing judgment. On appeal, appellants contend the evidence is factually insufficient
    to support the jury’s verdict. We will affirm.
    Standard of Review
    When an appealing party attacks a jury’s failure to find on issues upon which it had
    the burden of proof, to prevail, it must demonstrate that its cause of action was established as a
    matter of law. Vinson v. Brown, 
    80 S.W.3d 221
    , 228 (Tex. App.—Austin 2002, no pet.); see Sterner
    v. Marathon Oil Co., 
    767 S.W.2d 686
    , 690 (Tex. 1989). This is a difficult burden and the party
    essentially must show that it established all vital facts in support of its issues so conclusively as to
    be entitled to judgment as a matter of law. Vinson, 
    80 S.W.3d at 228
    ; see Sterner, 767 S.W.2d at
    690. In this cause, however, appellants do not assert that the evidence is legally insufficient to
    support the jury’s failure to find in their favor, nor do they contend that they conclusively proved the
    contrary proposition. They contend only that the evidence supporting the jury’s failure to find in
    their favor was against the great weight and preponderance of the evidence, and they seek only to
    have the cause remanded for a new trial. Assuming without deciding that appellants would be
    entitled to relief without having conclusively established all issues on which they had the burden of
    proof, we will conduct a factual sufficiency review alone, without regard to the legal sufficiency.
    As discussed below, because we hold that appellants have not shown the evidence is insufficient to
    support the jury’s failure to find in their favor, we need not discuss appellants’ failure to establish
    the contrary proposition as a matter of law. See Sterner, 767 S.W.2d at 690.
    2
    We review the factual sufficiency of the evidence supporting a jury’s failure to find
    a fact under the same standard used to review affirmative findings. McMillon v. Texas Dep’t of Ins.,
    
    963 S.W.2d 935
    , 938 (Tex. App.—Austin 1998, no pet.); see Cropper v. Caterpillar Tractor Co.,
    
    754 S.W.2d 646
    , 651 (Tex. 1988). Thus, we view the record as a whole, weigh all the evidence, and
    may set aside the verdict only if it is so contrary to the overwhelming weight of the evidence as to
    be clearly wrong and unjust. Cain v. Bain, 
    709 S.W.2d 175
    , 176 (Tex. 1986); McMillon, 963
    S.W.2d at 938. The jury as fact-finder is the sole judge of witness credibility and the weight to be
    given the testimony. Simons v. City of Austin, 
    921 S.W.2d 524
    , 531 (Tex. App.—Austin 1996, writ
    denied). We will not substitute our opinion for that of the jury if the verdict is sufficiently grounded
    in the evidence. 
    Id.
    Factual Summary
    In September 1995, Mrs. Krawl was admitted to Highland Hills suffering from
    dementia, and was later diagnosed as suffering from Alzheimer’s. Dr. Murray came to Highland
    Hills occasionally and was kept informed of Mrs. Krawl’s condition by telephone calls and faxes
    from Highland Hills. It is undisputed that Dr. Murray last examined Mrs. Krawl in April 1999 and
    in the two prior years had failed to visit her every six months, as required by Medicare. In the last
    six months of her life, Mrs. Krawl’s health worsened, she became bedridden and had trouble
    swallowing, and she eventually contracted bronchopneumonia, the “terminal event” that caused her
    death on August 25, 1999, three days short of her seventy-sixth birthday.
    In February 1999, DeWayne Krawl, Mrs. Krawl’s son, signed a “Do Not Resuscitate”
    order (“DNR order”), stating that resuscitation measures should not be initiated should Mrs. Krawl
    3
    go into cardiac or respiratory arrest. In March 1999, Dr. Murray spoke to Karen Kenyon, Mrs.
    Krawl’s daughter, and “confirmed their wishes for conservative terminal care.” Dr. Murray believed
    that the Krawls would discuss whether to feed Mrs. Krawl artificially or to allow nature to take its
    course; the family never contacted him regarding their decision on feeding tubes. Dr. Murray took
    Kenyon’s use of the term “conservative care” to mean giving Mrs. Krawl “comfort care and allowing
    the disease to progress in its natural course.” Kenyon testified that she discussed feeding tubes with
    Dr. Murray and told him that the family had not reached a decision. Kenyon said she did not have
    a full understanding of the meaning of the term “conservative terminal care.” In March, Highland
    Hills asked the Krawl family about funeral homes. On August 22, Highland Hills told DeWayne that
    the family should discuss feeding tubes, but DeWayne testified that he did not realize Mrs. Krawl’s
    need for artificial feeding was imminent.
    The medical examiner who conducted an autopsy of Mrs. Krawl testified that most
    Alzheimer’s patients die of pneumonia because they lose the ability to cough; Alzheimer’s patients
    often die even when being treated with antibiotics. Mrs. Krawl was well nourished, and the autopsy
    indicated she “had been eating more or less properly before she died.” During the autopsy, he found
    two pressure sores, both treated and covered with surgical dressing and neither showing signs of
    infection. Such sores are not uncommon in bedridden patients, and one of appellants’ experts
    testified that they were not due to negligence.
    Highland Hills’s records indicate that the nursing staff monitored and attempted to
    treat Mrs. Krawl’s rapid weight loss, swallowing problems, and pressure sores. Highland Hills kept
    Dr. Murray and Mrs. Krawl’s family informed about her weight loss and difficulty swallowing, her
    4
    pressure sores and their treatment, and her general decline. Highland Hills’s records show that on
    August 22 members of the family visited, reminded a nurse of Mrs. Krawl’s DNR status, and said
    they would discuss feeding tubes. On August 25, Highland Hills’s nursing staff observed signs of
    pneumonia and faxed a report to Dr. Murray. Mrs. Krawl died about ninety minutes later.
    Appellants’ experts believed that Dr. Murray and Highland Hills failed to monitor
    Mrs. Krawl adequately and ensure she received adequate hydration and nutrition. Several experts
    agreed that a feeding tube might have extended Mrs. Krawl’s life from two weeks to several months,
    but would not have improved her quality of life. They further testified about the risk of infection
    when inserting a tube directly into a patient’s stomach or of food aspiration leading to pneumonia
    when inserting a tube down a patient’s throat. There was testimony that patients with dementia
    sometimes have to be restrained to keep from pulling out their feeding tubes. One of appellants’
    experts testified that he would have recommended against a feeding tube, had the family asked him.
    Appellants’ experts also believed Dr. Murray should have ordered tests and lab work
    and examined Mrs. Krawl himself, and that the nursing home should have called Dr. Murray on
    August 25, rather than using faxes to communicate urgent matters. Dr. Murray testified that he
    rejected requests for various tests because Mrs. Krawl showed no signs of an infection and he knew
    her swallowing problems were due to Alzheimer’s. He testified that he did not see the fax sent on
    August 25; if he had, he would have gone to see Mrs. Krawl. He also believed antibiotics would not
    have saved her life. One of appellants’ experts said it was unlikely that Dr. Murray could have saved
    Mrs. Krawl had he had gone to the nursing home immediately. He agreed that patients like Mrs.
    Krawl can develop pneumonia very quickly and die within a matter of hours, and testified that hers
    5
    developed at most one and one-half days before her death. Experts testified that, although she might
    have recovered had her pneumonia been treated early enough, end-stage Alzheimer’s patients usually
    suffer from increasingly severe and repeated bouts of pneumonia.
    Appellees’ expert testified that it would have been appropriate for Dr. Murray, having
    been told to treat Mrs. Krawl conservatively, to decide against tube feeding and antibiotic therapy
    in favor of only comfort measures. He concluded that Dr. Murray did not proximately cause Mrs.
    Krawl’s death, and that Highland Hills’s care did not fall below the standard of care.
    Conclusion
    It is clear that the evidence in this case is factually sufficient to support the jury’s
    failure to find that negligence on the part of Highland Hills or Dr. Murray proximately caused Mrs.
    Krawl’s death. Mrs. Krawl was in the end stages of Alzheimer’s disease. Several witnesses testified
    that pneumonia is a very common cause of death in such patients and that it can strike quickly,
    killing patients in a matter of hours. There was evidence that the Krawl family was aware of Mrs.
    Krawl’s condition and the option of a feeding tube. One of appellants’ experts said he would not
    have recommended a feeding tube in this case. Dr. Murray believed the family wished for Mrs.
    Krawl to receive conservative terminal care, meaning comfort care without attempts to prolong her
    life. Although Mrs. Krawl lost weight rapidly at the end of her life, there was testimony that such
    an occurrence is not unusual in these cases and that she remained well-nourished. The presence of
    two pressure sores was not of concern to most of the medical experts, who said bedridden patients
    often develop sores under the best of care. Having viewed the record as a whole and weighed all the
    evidence, we hold that the jury’s verdict was not so contrary to the overwhelming weight of the
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    evidence as to be clearly unjust. See McMillon, 963 S.W.2d at 938. We affirm the trial court’s
    judgment.
    __________________________________________
    Mack Kidd, Justice
    Before Chief Justice Law, Justices Kidd and Patterson
    Affirmed
    Filed: October 30, 2003
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Document Info

Docket Number: 03-03-00052-CV

Filed Date: 10/30/2003

Precedential Status: Precedential

Modified Date: 2/1/2016