MILLS v. MMG ARCHER INSTITUTE LLC (2025)

This is a slip-and-fall case against a hospital. The trial court sustained the hospital's dilatory exception of prematurity and then dismissed Plaintiff's lawsuit without prejudice. The issue on appeal is whether the trial court erred in sustaining the exception. Resolution of this issue depends on whether Plaintiff's claim falls within the Louisiana Medical Malpractice Act (“MMA”).

FACTS AND PROCEDURAL HISTORY

In March 2024, Plaintiff, Joseph D. Mills, filed a petition for damages against several defendants, including Lake Charles Memorial Hospital's Archer Institute (“Memorial Hospital”).¹ Here are the relevant allegations:

2.

The petitioner, Joseph D. Mills, alleges that on or about March 5, 2022, he was an inpatient of Memorial Hospital located on Nelson Road in Lake Charles, Louisiana, when he slipped and fell on a wet floor, thereby causing the damages and injuries, as set forth below.

․

5.

The aforementioned incident was in no way attributable to any fault on the part of petitioner, Joseph D. Mills, but on the contrary, was due solely and proximately to the fault and responsibility of defendant[ ] ․, its agents, servants and employees, which fault includes, but is not limited to the following:

a. Failing to provide a safe environment in its facility;

b. Allowing a wet substance to remain on the floor;

c. Failing to maintain the floor in a safe condition;

d. Failing to properly inspect the premises;

e. Failing to warn the patients of the unsafe condition when the defendant knew or should have known of the unsafe condition on the floor;

f. Failing to dry the water on the floor after being made aware of it[.]

In response, Memorial Hospital filed an exception of prematurity, alleging that it is a qualified healthcare provider under the MMA, that Joseph's claim falls under the MMA, that his claim has not been submitted to a medical review panel, and that his claim is therefore premature.

The trial of Memorial Hospital's dilatory exception was held on July 22, 2024. After listening to the arguments of counsel and after considering the documents admitted into evidence, the trial court sustained the exception from the bench. A written final judgment was signed at that time. Joseph appealed.

On appeal, Joseph asserts two assignments of error: first, that the trial court erred in sustaining the exception. And second, that the trial court misapplied the law.

LAW AND ANALYSIS

“Under the MMA, a medical malpractice claim against a qualified health care provider is subject to dismissal on a timely exception of prematurity if such claim has not first been reviewed by a pre-suit medical review panel.” Dupuy v. NMC Operating Co., L.L.C., 15-1754, p. 3 (La. 3/15/16), 187 So.3d 436, 438. “The burden of proving prematurity is on the moving party ․ which must show that it is entitled to a medical review panel, because the allegations fall within the MMA.” Id. And in evaluating the exception of prematurity, a court considers two things: the allegations in the petition and the evidence adduced at the trial of the exception. Thomas v. Reg'l Health Sys. of Acadiana, LLC, 19-507, 19-524 (La. 1/29/20), 347 So.3d 595.

On appeal, a trial court's judgment on an exception of prematurity in a medical malpractice case is reviewed de novo. Id. After all, whether a claim falls within the MMA is a question of law. Id.

Here, Memorial Hospital argues that Joseph's claim falls within the MMA's definition of malpractice. The MMA defines “malpractice” as follows:

“Malpractice” means any unintentional tort or any breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient, including but not limited to failure to render services timely and the handling of a patient, loading and unloading of a patient, and all legal responsibility of a health care provider arising from acts or omissions during the procurement of blood or blood components, in the staffing, training, or supervision of health care providers, or from defects in blood, tissue, transplants, drugs, and medicines, or from defects in or failures of prosthetic devices implanted in or used on or in the person of a patient. This includes all acts associated with the medical treatment of an individual, whether directly related to clinical care or performed in an administrative or managerial capacity necessary for the delivery of such care.

La.R.S. 40:1231.1(A)(13).

The MMA also defines “health care,” stating in relevant part:

“Health care” means any act, treatment, administration, service, or care related to policies and procedures and the administration thereof, staffing, custodial services by licensed or certified staff, performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient's medical care, treatment, or confinement[.]

La.R.S. 40:1231.1(A)(9).

Importantly, the Louisiana Supreme Court has cautioned that the MMA is to be strictly construed. For example, in Dupuy, 187 So.3d at 439 (citations omitted), the supreme court explained:

This Court has also emphasized that the MMA and its limitations on tort liability for a qualified health care provider apply strictly to claims “arising from medical malpractice,” and that all other tort liability on the part of the qualified health care provider is governed by general tort law. Because the MMA's limitations on the liability of health care providers are in derogation of the rights of tort victims, the MMA is to be strictly construed.

A few things before going further. First, only a qualified health care provider can properly raise an exception of prematurity. In our case, Memorial Hospital's status as a qualified health care provider is not disputed. Second, for the MMA to apply, Joseph's allegations against Memorial Hospital must “sound in medical malpractice.” Dupuy, 187 So.3d 436, 440. And third, Memorial Hospital bears the burden of proving that Joseph's allegations fall within the MMA—that the allegations sound in medical malpractice. Id.

So did Memorial Hospital meet its burden of proof? In other words, do the allegations in Joseph's petition sound in medical malpractice or do they sound in general negligence?

To assist us in making this determination, the Louisiana Supreme Court in Coleman v. Deno, 01-1517 (La. 1/25/02), 813 So.2d 303, articulated six factors to consider: (1) whether the particular wrong is treatment related or caused by a dereliction of professional skill, (2) whether the wrong requires expert medical evidence to determine whether the appropriate standard of care was breached, (3) whether the pertinent act or omission involved assessment of the patient's condition, (4) whether an incident occurred in the context of a physician-patient relationship or was within the scope of activities which a hospital is licensed to perform, (5) whether the injury would have occurred if the patient had not sought treatment, and (6) whether the tort alleged was intentional.

We now apply these factors to the allegations and evidence in our case.

 First Coleman Factor

On appeal, Joseph argues that the first Coleman factor—whether the particular wrong is treatment related or caused by a dereliction of professional skill—weighs in his favor. We agree.

As noted earlier, Joseph's petition alleges that Memorial Hospital caused his injuries by failing to provide a safe environment in its facility, by failing to maintain the floor in a safe condition, by failing to properly inspect the premises, by failing to warn the patients of the unsafe condition when it knew or should have known of the unsafe condition on the floor, by failing to dry the water on the floor after being made aware of it, and by allowing the water to remain on the floor.

Joseph contends that his allegations have nothing to do with medical treatment. Nor do the allegations have anything to do with the use of professional skill. As he puts it, “These allegations are geared towards premises liability and general negligence, not medical malpractice.”

In support, Joseph points to Jordan v. Stonebridge, L.L.C., 03-588 (La.App. 5 Cir. 11/25/03), 862 So.2d 181, writ denied, 03-3520 (La. 3/19/04), 869 So.2d 851. There, a three-hundred-ten-pound mentally handicapped resident of a convalescent center, who had no use of his left leg and who required assistance with all activities of daily living, fell and broke his leg when an orderly attempted to transfer him from his wheelchair to a shower. In applying the Coleman factors, the fifth circuit concluded that the actions of the orderly were not treatment related. The fifth circuit also concluded that the resident's plan of care—which required two orderlies to handle the transfer from the wheelchair to the shower chair—did not evidence that the resident was undergoing medical treatment. Rather, it described how his day-to-day activities were to be handled. The fifth circuit ultimately concluded that the plaintiff's claim did not fall under the MMA.

By contrast, Memorial Hospital contends that the particular wrong alleged by Joseph was treatment related. Its argument runs this way:

[Joseph] was involuntarily admitted to [Memorial Hospital] through a Physician Emergency Certificate for inpatient mental and behavioral health treatment for substance abuse. His treatment involved confinement to the facility while he stopped or withdrew from drugs, underwent psychiatric assessments and treatments, and began medication for his mental/behavioral conditions. His treatment, and the professional skills to deliver that treatment, involved providing a safe and secure environment for [Joseph] as he was stabilized and treated․ Whether the environment provided to [Joseph] was safe or appropriately prepared or maintained is a treatment-related issue. It involves determining whether there was a dereliction of professional skills by the hospital and its staff in providing an inpatient health facility and making [Joseph's] treatment plan therein.

Memorial Hospital then likens Joseph's claim to two cases: Hernandez v. Diversified Healthcare-Abbeville, LLC, 09-546 (La.App. 3 Cir. 11/4/09), 24 So.3d 284, writ denied, 09-2629 (La. 2/12/10), 27 So.3d 849; and Matherne v. Jefferson Parish Hosp. Dist. No. 1, 11-1147 (La.App. 5 Cir. 5/8/12), 90 So.3d 534, writ denied, 12-1545 (La. 10/12/12), 98 So.3d 873.

In Hernandez, 24 So.3d 284, a resident of a nursing home had suffered no less than thirteen falls in that facility and ultimately died. The resident “was taking multiple medications and had been diagnosed with Alzheimer's, dementia, hypertension, coronary artery disease, depression, hyperlipidemia, benign prostatic hyperplasia, cerebrovascular insult, and cerebrovascular accident.” Id. at 287. The resident's causes of death included “malnutrition, dehydration, failure to thrive, and Alzheimer's dementia.” Id. A wrongful death action was filed against the nursing home. Ultimately, a different panel of this court concluded that the allegations in the petition—including allegations of inadequate training, inadequate supervision, and inadequate monitoring—fell under the MMA:

There can be no way to assess the fault of the nursing home without reference to [the decedent's] extensive medical and pharmacological needs and the care and treatment that was rendered to him by the staff. The level of supervision and monitoring required by a patient necessarily requires an assessment of his medical condition and capabilities. It is clear from the record that [the decedent] was not in the nursing home merely for custodial care, but for treatment of a host of medical conditions. The decedent's serious medical conditions required the knowledge and expertise of medical professionals.

Id. at 287.

Similarly, in Matherne, 90 So.3d 534, the plaintiff sued after falling while being transported to a hospital bed by a hospital employee. In analyzing the Coleman factors, the fifth circuit explained:

The first Coleman factor considers whether the particular wrong is “treatment related” or caused by a dereliction of professional skill. The record reflects that West Jefferson has an organizational-wide “Fall Assessment and Prevention” program, which focuses on assessing and identifying patients at risk for falls and on educating staff on fall prevention. The program mandates that West Jefferson employ a scoring system—the Morse Risk Fall Assessment—to determine all patients’ risk for falls. Some factors that comprise the risk assessment include fall history, ambulatory aid, and gait, which is the manner of movement. Once all factors are considered, patients are then assigned a score which is indicative of their risk for falls. Patients scoring 45 or higher are considered high risk.

In this case, West Jefferson performed a risk assessment on Mrs. Matherne on September 2, 2010, at 7:30 A.M.—approximately five hours before the fall occurred. The assessment indicated that Mrs. Matherne had a history of falls and a weakened gait. Her overall fall-risk score at that time was 70, which is high risk. Because of the high-risk score, West Jefferson's fall prevention program should have been implemented as part of Mrs. Matherne's treatment. Because fall assessment is part of the treatment for all patients at West Jefferson, the first Coleman factor is satisfied.

Id. at 537.

To sum up, Hernandez, 24 So.3d 284, involved allegations of inadequate training, inadequate supervision, and inadequate monitoring based on the decedent's medical conditions. Matherne, 90 So.3d 534, questioned whether the hospital's fall prevention program should have been implemented as part of the plaintiff's treatment. Clearly, the alleged negligent acts in Hernandez and Matherne relate to treatment and professional skill. And just as clearly, the alleged negligent acts in our case have nothing to do with the treatment for which Joseph was admitted to Memorial Hospital. Nor were Joseph's alleged injuries caused by a dereliction of professional judgment, knowledge, or skill: no medical expertise is needed to inspect the premises and dry a wet floor.

Also, “not every act that occurs in a Hospital is ‘treatment related’ under the MMA.” Dupuy, 187 So.3d at 441. For example, in Williamson v. Hospital Service District No. 1 of Jefferson, 04-451 (La.12/1/04), 888 So.2d 782, a health care provider failed to properly maintain a wheelchair, which lost a wheel causing injury to a patient. The supreme court held that these alleged acts were not treatment related. Nor did they implicate professional skill. Likewise, in Blevins v. Hamilton Medical Center, Inc., 07-127 (La. 6/29/07), 959 So.2d 440, a health care provider failed to properly maintain a hospital bed, which rolled while the patient was attempting to use the commode and resulted in a knee injury. Here too, the supreme court held that the alleged acts were not treatment related. Nor was professional skill needed to secure the bed.

In our case, it was Memorial Hospital's burden to prove that Joseph's claims sounded in medical malpractice. And although nine pages of medical records were introduced into evidence at the trial of the exception, nothing in the records indicates that Joseph's injuries were related to treatment or caused by a dereliction of professional skill. For instance, a report by one of the doctors on the day after the accident provides: Joseph “states there was too much water on the floor in the bathroom after showering last night and while walking from bathroom to his bed, he slipped and fell to the floor onto his back.”

In sum, the negligent acts alleged in Joseph's petition do not relate to treatment. Nor were his alleged injuries caused by a dereliction of professional skill. Thus, the first Coleman factor weighs heavily in Joseph's favor.

 Second Coleman Factor

The second Coleman factor asks whether the wrong requires expert medical evidence to determine whether the appropriate standard of care was breached.

Here, Joseph's petition alleges that he slipped, fell, and was injured as a result of a dangerous condition on Memorial Hospital's premises. Based on the allegations in the petition, medical expert testimony will not be necessary to prove Memorial Hospital's duty of care. Nor will expert medical testimony be necessary to prove Memorial Hospital's breach of that duty. And Memorial Hospital introduced no evidence to the contrary.

This factor also favors Joseph.

 Third Coleman Factor

The third Coleman factor asks whether the pertinent act or omission involved an assessment of the patient's condition.

It is evident that this factor favors Joseph: he did not allege that Memorial Hospital performed a risk assessment on him; he did not allege that Memorial Hospital was negligent in failing to perform a risk assessment on him; and Memorial Hospital did not adduce any evidence at the trial of the exception that a risk assessment was performed (or needed to be performed) on him before the accident.

 Fourth Coleman Factor

The fourth factor asks whether the incident occurred in the context of a physician-patient relationship or was within the scope of activities which a hospital is licensed to perform.

As discussed earlier, the incident here was not related to a physician-patient relationship. Additionally, Memorial Hospital did not adduce any evidence showing that the incident was within the scope of activities that the hospital is licensed to perform.

This factor also favors Joseph.

 Fifth Coleman Factor

The fifth factor explores whether the injury would have occurred if the patient had not sought treatment.

Memorial Hospital's argument here is simple: “[Joseph] would clearly not have been present in the facility had he not sought treatment and been admitted as an inpatient.” Hence, Joseph would not have been injured had he not sought treatment.

The Louisiana Supreme Court addressed a similar argument in LaCoste v. Pendleton Methodist Hosp., L.L.C., 07-8, p. 15 (La. 9/5/07), 966 So.2d 519, 529, explaining: “In a general sense, any wrong that a patient suffers in a hospital or doctor's office would not occur if the patient had not first entered the facility.” However, because the wrongful conduct alleged in that case was neither treatment related nor caused by a dereliction of professional skill, the supreme court concluded that the fifth Coleman factor did “not weigh greatly in favor of finding that the wrongful conduct alleged in the petition as amended was medical malpractice[.]” Id.

For these same reasons, factor five here does not weigh greatly in favor of Memorial Hospital.

 Sixth Coleman Factor

The sixth and final Coleman factor asks whether the tort alleged was intentional. Because Joseph has not alleged an intentional tort against Memorial Hospital, this factor is not an issue in this appeal.

In summary, based on our analysis of this case using the Coleman factors, Joseph's claim sounds in general negligence or premises liability, not medical malpractice. Joseph's allegations do not fall within the MMA, and Memorial Hospital did not prove otherwise at the trial of its exception. Hence, the trial court committed legal error in sustaining Memorial Medical's exception of prematurity.

DISPOSITION

We reverse the trial court's judgment of July 22, 2024, which sustained Memorial Hospital's dilatory exception of prematurity: that exception is hereby overruled. We remand this matter to the trial court for further proceedings. All costs of this appeal are assessed to Memorial Hospital.

REVERSED AND REMANDED.

FOOTNOTES

1.   The Archer Institute is an inpatient facility offering mental health and substance abuse treatment. It is owned and operated by Lake Charles Memorial Health Systems.

FITZGERALD, Judge.