Background
On March 20, 2018, Jennifer Greer, a forty-year-old Advanced Practice Registered Nurse with a long history of migraines, presented to Merit Health River Region Hospital in Vicksburg with severe headache, dizziness, nausea, and vomiting. Emergency physician Dr. Darius Fewlass and nurse Yi-Jie Pan treated her for a suspected migraine. While at River Region, Greer developed worsening neurological symptoms — including ataxia, nystagmus, facial drooping, and numbness — prompting Dr. Fewlass to order a brain MRI, which a radiologist read as showing no acute intracranial abnormality. At Greer’s request, she was transferred to Baptist Medical Center in Jackson around 2:30 p.m.
At Baptist, radiologist Dr. Korangy reviewed new MRI and CT images and misdiagnosed Greer with Miller-Fisher Syndrome, a variant of Guillain-Barré Syndrome. Baptist treated Greer under that incorrect diagnosis for twelve days before a neurologist re-reviewed the original images and identified what Dr. Korangy had missed: an arterial dissection causing occlusion of Greer’s right vertebral artery. Greer suffered permanent and significant injuries, including severely impaired vision, inability to walk without a cane, and the end of her nursing career.
Greer filed a medical malpractice suit in Hinds County Circuit Court against River Region, Dr. Fewlass, Dr. Korangy, and Baptist. Dr. Korangy settled before trial. At trial, Greer presented no evidence against Baptist and did not oppose its directed verdict motion. The jury returned a verdict in favor of River Region and Dr. Fewlass. The trial court denied Greer’s post-trial motions for judgment notwithstanding the verdict (JNOV) or a new trial, and Greer appealed solely as to River Region, arguing that nurse Pan’s negligence was unrebutted.
The Court’s Holding
The Mississippi Court of Appeals affirmed the circuit court’s judgment, holding that the jury’s defense verdict in favor of River Region was not against the overwhelming weight of the evidence and that the trial court did not err in denying JNOV or a new trial. The court rejected Greer’s central argument that River Region was required to produce its own nursing expert to rebut plaintiff’s expert Patrick-Williams. Citing Thompson v. Nguyen, 86 So. 3d 232 (Miss. 2012), and McCaffrey v. Puckett, 784 So. 2d 197 (Miss. 2001), the court reaffirmed that the burden of persuasion never shifts to the defense in a medical malpractice case, and a defendant is not required to offer expert testimony or risk a directed verdict simply because the plaintiff establishes a prima facie case.
The court found ample basis for the jury to reject causation even assuming Pan’s conduct fell short of the nursing standard. Dr. Fewlass testified that the small emergency room layout allowed him to monitor patients informally and continuously, supporting an inference that monitoring gaps alleged by plaintiff’s expert did not reflect actual lapses in observation. More fundamentally, four witnesses — Dr. Fewlass and defense experts Dr. Jones, Dr. Evans, and Dr. Stogner — all testified that a tPA (the treatment Greer claimed she should have received) was contraindicated given her symptom timeline and her ultimate diagnosis of arterial dissection, meaning any alleged nursing failure could not have been a proximate cause of her injuries.
The court also noted that the overwhelming weight of the evidence pointed to Dr. Korangy’s undisputed negligence as the proximate cause of Greer’s injuries. The jury was entitled to find that twelve days of treatment for the wrong condition at Baptist — not events at River Region — caused Greer’s permanent harm. One justice concurred in part and dissented in part without written opinion.
Key Takeaways
- In Mississippi medical malpractice cases, a plaintiff bears the full burden of proof and the jury is free to reject plaintiff’s expert testimony even if the defense offers no competing nursing expert; the defendant is never required to rebut a prima facie case with its own expert.
- A jury may find for the defense on causation where multiple credible defense witnesses establish that the treatment plaintiff sought would have been contraindicated or harmful regardless of the alleged nursing breach.
- Where an intervening actor’s negligence is undisputed and independently sufficient to explain a plaintiff’s injuries — here, Dr. Korangy’s misread images and twelve-day misdiagnosis — a rational jury may find that earlier alleged negligence was not a proximate cause.
- Appellate review of denied new-trial motions applies two layers of deference: to the trial court’s assessment of the weight of the evidence, and to the jury’s credibility determinations.
Why It Matters
This decision is a significant reminder for plaintiffs’ counsel in Mississippi malpractice cases that a defendant’s silence on a contested standard-of-care issue does not automatically translate into a directed verdict or JNOV. So long as the overall record supports a reasonable jury finding that the defendant’s conduct was not a proximate cause of injury, an uncontested standard-of-care breach will not compel judgment for the plaintiff. Defense counsel can defeat causation through physician and non-nursing expert testimony even without a head-to-head nursing expert.
The case also illustrates the evidentiary significance of a settling co-defendant’s undisputed negligence at trial. River Region benefited substantially from the jury’s ability to attribute Greer’s catastrophic outcome to Dr. Korangy’s admitted misdiagnosis rather than to any lapses in the emergency department. Plaintiffs’ attorneys handling multi-defendant malpractice cases should carefully consider how settlements and directed verdicts for some defendants will frame the causation narrative for the defendants who remain at trial.