Opinion
2011 CA 1877
11-02-2012
EUGENE G. GUARDIA v. LAKEVIEW REGIONAL MEDICAL CENTER AND NURSING STAFF OF LAKEVIEW REGIONAL MEDICAL CENTER
Rykert O. Toledano, Jr. Brian G. Meissner Ernest N. Souhlas Carter B. Wright Covington, Louisiana Counsel for Plaintiff/Appellee Eugene G. Guardia Aldric C. Poirier, Jr. Elizabeth S. Sconzert James W. Vitrano Mandeville, Louisiana Counsel for Defendants/Appellants Lakeview Regional Medical Center and Nursing Staff of Lakeview Regional Medical Center
NOT DESIGNATED FOR PUBLICATION
On Appeal from the Twenty-Second Judicial District Court
In and for the Parish of St. Tammany
State of Louisiana
Docket No. 2005-11807
Honorable Reginald T. Badeaux, III, Judge Presiding
Rykert O. Toledano, Jr.
Brian G. Meissner
Ernest N. Souhlas
Carter B. Wright
Covington, Louisiana
Counsel for Plaintiff/Appellee
Eugene G. Guardia
Aldric C. Poirier, Jr.
Elizabeth S. Sconzert
James W. Vitrano
Mandeville, Louisiana
Counsel for Defendants/Appellants
Lakeview Regional Medical Center
and Nursing Staff of Lakeview
Regional Medical Center
BEFORE: PETTIGREW, McCLENDON, AND WELCH, JJ .
McCLENDON, J.
In this medical malpractice action, the defendant, Lakeview Medical Center, L.L.C., d/b/a Lakeview Regional Medical Center (Lakeview), appeals the judgment in favor of the plaintiff, Eugene S. Guardia, awarding him damages for injuries sustained following surgery at Lakeview. For the reasons that follow, we affirm.
FACTUAL AND PROCEDURAL HISTORY
On March 17, 2003, Mr. Guardia was admitted to Lakeview for bilateral knee replacement surgery. Following the surgery, Mr. Guardia's surgeon ordered that his legs be placed in continuous passive motion (CPM) machines, designed to aid the recovery process by preventing scar tissue and adhesions. While initially stable after surgery, Mr. Guardia's condition soon deteriorated. He suffered very low blood pressure and significant post operative anemia due to coagulapathy, and he became lethargic and unresponsive. Thereafter, Mr. Guardia developed several complications, including acute renal failure and hypovolemia. Mr. Guardia was moved to the intensive care unit (ICU) on March 19, 2003. He also developed multiple decubitus, or pressure, ulcers on the back of his head and sacral area. Mr. Guardia remained in the hospital until March 28, 2003. His pressure ulcers eventually healed.
Mr. Guardia is a Jehovah's Witness and refused to accept blood transfusions or blood products because of his religious beliefs.
On April 14, 2005, after a medical review panel found no breach of the standard of care by Lakeview, Mr. Guardia filed a petition for damages against Lakeview, asserting that Lakeview breached its standard of care and caused Mr. Guardia injury in failing to prevent the development of the pressure ulcers. Following the denial of Lakeview's motion for summary judgment, the matter proceeded to a bench trial. After taking the case under advisement, the trial court issued its written reasons and judgment on December 10, 2010, in favor of Mr. Guardia and against Lakeview in the amount of $35,000. Lakeview suspensively appealed, assigning the following as error:
In his petition, Mr. Guardia named Lakeview and its nursing staff as defendants. Lakeview subsequently stipulated that it would accept responsibility for any negligent acts or omissions of its employees relative to the treatment of Mr. Guardia at issue herein.
The trial court initially granted Lakeview's motion for summary judgment. A five-member panel of this court, by a vote of 4 to 1, reversed the judgment as premature and remanded the matter. See Guardia v. Lakeview Regional Medical Center, 08-1368 (La.App. 1 Cir. 5/8/09), 13 So.3d 625. On remand, the summary judgment motion was reset, reargued, and denied.
1. The trial court erred by entering a judgment finding that Mr. Guardia suffered injuries as a result of Lakeview's failure to provide a specialty mattress.
2. The trial court erred in relying on the deposition testimony of Dr. David Levine, as he was not qualified to testify to the standard of care owed to a patient following bilateral knee surgery, nor as to the medical causation of Mr. Guardia's injuries.
3. The trial court erred in allowing Julia Fields, a registered nurse, to testify beyond her qualifications.
4. The trial court erred in failing to give greater weight to expert testimony of qualified physicians practicing in specialties involving Mr. Guardia's care than to the deposition testimony of a general surgeon.
5. The trial court erred in granting judgment in favor of Mr. Guardia without reliable expert testimony.
STANDARD OF REVIEW
An appellate court may not set aside a trial court's finding of fact absent manifest error or unless it is clearly wrong. Sistler v. Liberty Mut. Ins. Co., 558 So.2d 1106, 1111 (La. 1990). In order to reverse a fact finder's determination of fact, an appellate court must review the record in its entirety and meet the following two-part test: (1) find that a reasonable factual basis does not exist for the finding; and (2) further determine that the record establishes that the fact finder is clearly wrong or manifestly erroneous. Stobart v. State tThrough Dept. of Transp. & Dev., 617 So.2d 880, 882 (La. 1993).
The issue to be resolved by a reviewing court is not whether the trier of fact was right or wrong, but whether the fart finder's conclusion was a reasonable one. Where there is conflict in the testimony, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed upon review, even though the appellate court may feel that its own evaluations and inferences are as reasonable. Rosell v. ESCO, 549 So.2d 840, 844 (La. 1989). Where there are two permissible views of the evidence, the fact finder's choice between them cannot be manifestly erroneous or clearly wrong. Id. Further, due to the trial court's opportunity to evaluate live witnesses or to evaluate a mixture of deposition and live testimony, great deference is accorded to the trial court's factual findings. Sistler, 558 So.2d at 1111. Where the testimony of expert witnesses differ, it is the responsibility of the trier of fact to determine which evidence is the most credible. Id.
DISCUSSION
In a medical malpractice action against a physician, the plaintiff must establish by a preponderance of the evidence the applicable standard of care, a violation of that standard of care, and a causal connection between the alleged negligence and the plaintiff's injuries. See LSA-R.S. 9:2794A. Nurses who perform medical services are subject to the same standards of care and liability as are physicians. Cangelosi v. Our Lady of the Lake Regional Medical Center, 564 So.2d 654, 661 (La. 1989). Likewise, in a medical malpractice action against a hospital, the plaintiff must prove that the hospital caused the injury when it breached its duty. Id; Williams v. Our Lady of Lake Hosp., Inc., 09-0267, p. 4 (La.App. 1 Cir. 9/11/09), 22 So.3d 997, 999. Expert testimony is generally required to establish the applicable standard of care and whether that standard of care was breached, except where the negligence is so obvious that a lay person can infer negligence without the guidance of expert testimony. Pfiffner v. Correa, 94-0924, 94-0963, 94-0992, pp. 9-10 (La. 10/17/94), 643 So.2d 1228, 1233-34.
In this matter, Lakeview initially contends that the trial court erred in determining that Lakeview breached the standard of care by failing to provide a specialty mattress, when the medical records and trial testimony established that a specialty mattress was timely provided to Mr. Guardia. Lakeview argues that this factual finding was dearly wrong, and once set aside, it is clear that Lakeview complied with the standard of care owed to Mr. Guardia. Mr. Guardia argues, however, that the evidence established that during the initial twenty-eight hours following surgery, no special bed or mattress was provided to Mr. Guardia to help prevent his pressure ulcers.
The record shows that Mr. Guardia was moved to the surgical floor following surgery on March 17, 2003 at 12:30 p.m. His surgeon ordered the use of CPM devices on both knees and also ordered the use of a trapeze bar above his bed to allow Mr. Guardia to move and reposition himself. Because of the use of the CPMs, Mr. Guardia's legs were strapped to the hospital bed. Mrs. Guardia testified that although Mr. Guardia awoke following surgery and was talking with visitors, he soon became sleepy and difficult to arouse. Mr. Guardia's surgeon had ordered physical therapy for the following morning, which would have allowed Mr. Guardia to ambulate with the use of a walker. Mr. Guardia's participation in the physical therapy would have required that he be taken out of the CPMs by the physical therapist. However, Mr. Guardia was unable to remain awake and unable to participate in physical therapy on the morning of March 18. That afternoon, the physical therapist, David Hendricks, again noted that Mr. Guardia was unresponsive and unable to undergo physical therapy. Mr. Hendricks testified that he ordered an Acucair mattress for Mr. Guardia. He also noted in Mr. Guardia's medical chart at 4:36 p.m. that the Acucair mattress was ordered. Mr. Hendricks testified that he believed Mr. Guardia to be at high risk for developing skin breakdown, since Mr. Guardia was very lethargic and his mobility was compromised. Mr. Hendricks testified, however, that he did not remember if the Acucair mattress was ever delivered, although he thought it was. He also testified that there had been situations at the hospital where a mattress was ordered, but was not delivered the day it was ordered. He did not remember what happened in this instance. However, Mr. Hendricks stated, and noted in the hospital chart, that on the morning of March 19, he ordered the substitution of an Eclipse mattress for the Acucair mattress. Mr. Hendricks testified that he upgraded to an Eclipse mattress because Mr. Guardia showed signs of bruising, meaning that there was already skin breakdown. Therefore, Mr. Hendricks believed, because of Mr. Guardia's developing complications and the use of the CPMs, Mr. Guardia was at a very high risk for developing pressure ulcers.
The Acucair mattress is a mattress overlay for the prevention and treatment of stage one and stage two pressure ulcers.
When asked if the Acucair mattress was delivered, Mr. Hendricks testified: "I believe it was. I can't say for sure. I didn't apply it to the bed myself." Later, when asked whether his charted note regarding the mattress substitution meant to him that the Acucair was on the bed when the Eclipse was delivered, Mr. Hendricks responded, "I think so."
The Eclipse mattress is an entire mattress replacement and provides greater pressure reduction than an Acucair mattress.
In its written reasons, the trial court found that no specialty mattress was used to alleviate Mr. Guardia's condition in the first two days following his surgery. Upon our review of the record, we cannot say that the trial court was clearly wrong as to this factual finding. While we recognize that Mr. Hendricks's note, that an Eclipse mattress had been substituted for the Acucair, suggests that an Acucair mattress was delivered to Mr. Guardia's room, there is no documentation that the mattress was actually delivered. The first documentation in the medical records of any specialty mattress on Mr. Guardia's bed was not until March 19, when Mr. Guardia was in the ICU. Also, given that Mr. Hendricks's testimony, regarding whether the Acucair mattress was actually delivered, was equivocal, the trial court could have determined that it was not delivered. Although we would have found differently sitting as the trier of fact, we cannot say the trial court was manifestly erroneous.
Lakeview's other assignments of error are interrelated in that they question the quality of and the weight given to the testimony of Mr. Guardia's experts. Specifically, Lakeview questions the qualifications of Dr. David Levine and Ms. Julia Fields to testify and contends that the trial court failed to give the proper weight to its own experts. Lakeview asserts that if the trial court had properly excluded the testimony of Mr. Guardia's experts, he would not have been able to meet his burden of proof under LSA-R.S. 9:2794A.
With regard to the deposition testimony of Dr. Levine, Lakeview claims that Dr. Levine was not qualified to testify regarding either the standard of care owed to Mr. Guardia following his bilateral knee replacement surgery or the medical causation of Mr. Guardia's injuries. Lakeview did not object to Dr. Levine's qualification as an expert in the field of general surgery, however, it objected to Dr. Levine's tender as an expert in the field of wound care. At trial, the trial court took the objection to the qualification under advisement, and although it failed to expressly rule on Dr. Levine's qualifications, the trial court relied on Dr. Levine's testimony as expert opinion in its written reasons for judgment. Lakeview contends that because Dr. Levine is not an orthopedic surgeon and because he does not participate in wound care, the trial court erred in relying on Dr. Levine's testimony as contrary to LSA-R.S. 9:2794A(1), which requires expert testimony from a specialist practicing in the field where the alleged acts of malpractice arose. Thus, because Mr. Guardia underwent orthopedic surgery followed by the use of CPMs, only those qualified in that specialty could offer expert opinion as to whether care was proper. Lakeview also cites the case of Cheairs v. State ex rel. Department of Transp. and Dev., 03-0680 (La. 12/03/03), 861 So.2d 536, in support of its argument that Dr. Levine did not have the experience that would assist the trier of fact regarding wound care, orthopedic surgery, and the proper course of recovery following bilateral knee replacement with the use of CPMs,
Louisiana Revised Statutes 9:2794A(1) provides that in a medical malpractice action the plaintiff has the burden of proving:
(1) The degree of knowledge or skill possessed or the degree of care ordinarily exercised by physicians ... licensed to practice in the state of Louisiana and actively practicing in a similar community or locale under similar circumstances; and where the defendant practices in a particular specialty and where the alleged acts of medical negligence raise issues peculiar to the particular medical specialty involved, then the plaintiff has the burden of proving the degree of care ordinarily practiced by physicians ... within the involved medical specialty.
The admission of expert testimony is governed by LSA-C.E. art. 702:
If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.Thus, the admissibility of expert testimony under Article 702 turns upon whether the evidence would assist the trier of fact to understand the evidence or to determine a fact in issue. Cheairs, 03-0680 at p. 8, 861 So.2d at 541-42; Williams, 09-0267 at p. 7, 22 So.3d at 1001. Experience alone is normally sufficient to qualify a witness as an expert. Cheairs, 03-0680 at p. 8, 861 So.2d at 542. Further, a trial court is accorded broad discretion in determining whether expert opinion evidence should be held admissible and its decision will not be overturned absent an abuse of discretion. MSOF Corp. v. Exxon Corp., 04-0988, p. 11 (La.App. 1 Cir. 12/22/05), 934 So.2d 708, 717, writ denied, 06-1669 (La. 10/6/06), 938 So.2d 78.
In this matter, Dr. Levine testified that he was a board certified general surgeon with seventeen years of surgical practice and that an integral part of general surgery is wound care. Dr. Levine testified that he was no longer performing surgeries, because of carpel tunnel syndrome in both hands, and was currently a teaching professor in the surgery department at North Shore University Hospital in New York. He also stated that he had academic appointments at two other New York medical schools. Dr. Levine testified that he keeps his medical license current in New York. He stated that in his career, he was called upon to treat more than two hundred patients with decubitus ulcers.
Mr. Guardia asserts that Lakeview breached the standard of care it owed to him regarding the development of decubitus ulcers. There are no allegations that the knee replacement surgery was improperly performed. Thus, we cannot say that the trial court abused its discretion in admitting the expert testimony of Dr. Levine in the fields of general surgery and wound care.
Lakeview also contends that Ms. Fields was not qualified to provide an expert opinion as a nurse as to whether Lakeview breached the standard of care owed to Mr. Guardia. Lakeview asserts that Ms. Fields testified that she never cared for a patient using CPM devices and that she only worked briefly in a medical-surgical unit of a hospital more than ten years prior to trial. Therefore, according to Lakeview, Ms. Fields' testimony that Lakeview's staff breached the standard of care owed to Mr. Guardia was based on speculation and the erroneous interpretation of Lakeview's policies and procedures regarding pressure ulcer prevention.
Ms. Fields testified that she has been a registered nurse since 1994. She testified that she began working at LSU in Shreveport as a staff nurse and became a charge nurse in the medical and cardiac intensive care units. Ms. Fields stated that while working as a floor nurse for almost five years she worked with critically ill patients all the time. Thereafter, Ms. Fields continued to work as a nurse in the home health care area and as a legal nurse consultant. Ms. Fields testified that her education included assessment of skin care and prevention of pressure ulcers. Ms. Fields admitted that she had never cared for a patient in a CPM machine, but stated that she has been responsible for patients using other equipment that kept them from moving around. Ms. Fields also acknowledged that she had not worked in a hospital in more than ten years.
Thereafter, Lakeview objected to Ms. Field's qualification as an expert in the field of nursing. The trial court overruled the objection, citing the Cheairs case, and stated, "I find pursuant to the aforementioned education and training and experience that she possesses a specialized knowledge which may assist the trier of fact in determining an issue or issues in the case." The court then qualified Ms. Fields as an expert in the field of nursing and nursing care pursuant to LSA-C.E. art. 702. Based on our review of the record, we find no abuse of discretion by the trial court in admitting the expert testimony of Ms. Fields.
Lakeview next contends that the trial court erred in failing to give the proper deference to its own experts, all of whom practice in the medical specialties at issue herein. Lakeview argues that had the appropriate weight been given to its experts, Mr. Guardia would not have been able to meet his burden of proof under LSA-R.S. 9:2794.
In considering expert testimony, the trier of fact may accept or reject in whole or in part the opinion expressed by an expert. The effect and weight to be given expert testimony is within the broad discretion of the trier of fact. The trier of fact may accept or reject any expert's view, even to the point of substituting its own common sense and judgment for that of an expert witness where, in the trier of fact's opinion, such substitution appears warranted by the evidence as a whole. Cotton v. State Farm Mut. Auto. Ins. Co., 10-1609, p. 7 (La.App. 1 Cir. 5/6/11), 65 So.3d 213, 219; Morgan v. State Farm Fire and Cas. Co., Inc., 07-0334, pp. 8-9 (La.App. 1 Cir. 11/2/07), 978 So.2d 941, 946. The law is well settled that where the testimony of expert witnesses differs, the trier of fact has great, even vast, discretion in determining the credibility of the evidence, and a finding of fact in this regard will not be overturned unless clearly wrong. Cotton, 10-1609 at pp. 7-8, 65 So.3d at 220; Harper v. Falrig Offshore, Inc., 03-28, p. 3 (La.App. 3 Cir. 4/30/03), 845 So.2d 589, 591, writ denied, 03-1905 (La. 10/31/03), 857 So.2d 483.
Where the fact finder's determination is based on its decision to credit the testimony of one of two or more witnesses, that finding can virtually never be manifestly erroneous. This rule applies equally to the evaluation of expert testimony, including the evaluation and resolution of conflicts in expert testimony. LeBlanc v. Landry, 08-1643, p. 11 (La.App. 1 Cir. 6/24/09), 21 So.3d 353, 362, writ denied, 09-1705 (La. 10/2/09), 18 So.3d 117. Where expert witnesses present differing testimony, it is the responsibility of the trier of fact to determine which evidence is the most credible. Graf v. Jim Walter Homes, Inc., 97-1143, p. 10 (La.App. 1 Cir. 5/15/98), 713 So.2d 682, 691.
With regard to its own experts, Lakeview points out that Dr. Scott Sondes, a board-certified wound care specialist and physical medicine rehabilitation specialist, routinely evaluates patients following bilateral knee replacements and has direct experience with preventing and treating patients with decubitus ulcers, with and without the use of CPMs. Lakeview further notes that Dr. Simon Finger, a board certified orthopedic surgeon, and a member of the medical review panel, has personally ordered the use of CPMs for his patients, and was therefore familiar with the limitations that the use of CPMs place on a patient's movements. Additionally, Lakeview argues that the testimony of its nurse expert, Renee Alterman, and physical therapist expert, David Hendricks, both Lakeview employees, should have been accorded greater weight than Mr. Guardia's witnesses. Lakeview asserts that Ms. Alterman had been a medical-surgical nurse for twenty-eight years, providing post-surgery care to more than one hundred patients with knee replacement surgery, and Mr. Hendricks was familiar with the use of CPMs.
Lakeview also maintains that its patient care manual established the standard of care that required the nursing staff to reposition Mr. Guardia every two hours, only if it was consistent with the patient's overall goals. Lakeview contends that the testimony of Dr. Sondes and Dr. Finger established that the overall goals were to save Mr. Guardia's life and maintain the integrity of the bilateral knee replacement surgery. Both testified that Lakeview's staff followed doctors' orders and explained that interrupting the use of the CPMs to reposition or turn a patient would not only jeopardize the integrity of the surgery, but would also be a violation of the physician's orders. Dr. Sondes further testified that even with the use of the specialty mattress, Mr. Guardia's medical condition would have inevitably caused the development of the decubitus ulcers.
Lakeview's Patient Care Manual provides, in pertinent part:
Any individual in bed, who is assessed to be at risk for developing pressure ulcers should be repositioned every 2 hours if consistent with overall patient goals. A written schedule for systematically turning and repositioning the individual should be used.
Conversely, Ms. Fields testified that Mr. Guardia was a high risk patient for pressure ulcers initially upon his admit to the surgical floor following surgery. She explained that he was lethargic from surgery and he was in the CPMs. He was also on a morphine pump. Ms. Fields testified that Mr. Guardia was not assessed as high risk for pressure sores by the nursing staff according to the Braden scale and that the score was not corrected until after Mr. Guardia was in the ICU. She stated that the charting on Mr. Guardia was irregular and that if there had been scheduled skin assessments, the assessments should have been noted in the nurses' charting. Ms. Fields testified that there was no documentation by the nurses of any assessment of Mr. Guardia's skin integrity until he was in the ICU. In her opinion, Lakeview violated the standard of care by failing to properly assess a patient who was at risk for developing pressure ulcers. It was her opinion that Lakeview should have developed a skin care plan for Mr. Guardia at the early stages of his post-operative treatment.
It was Dr. Levine's opinion that it was the failure to reposition and turn Mr. Guardia that directly caused the decubitus ulcers, regardless of his other medical problems. Dr. Levine testified that the only direct factor in causing such ulcers is direct pressure. He stated that any patient in one position will develop ulcers in two days and, in fact, he testified, in less than two hours there are already microscopic signs of tissue damage and, if not relieved, the earliest signs will visibly be seen in one to two days. He testified that decubitus ulcers are purely a pressure phenomenon. Dr. Levine also noted, as did Ms. Fields, that there was no documentation in the record until the third day after Mr. Guardia's surgery of any nursing care regarding turning, positioning, cushioning or assessments of skin changes.
The Pressure Ulcer Prevention Program section of Lakeview's Patient Care Manual, which was prepared by the nursing administration, provides comprehensive procedures for skin assessment and treatment. The purpose of the program is to "assess and appropriately identify those patients who are at risk for possible pressure ulcers while hospitalized, therefore preventing patient pressure ulcers through a comprehensive program of staff awareness, family and patient education, and patient protection." According to the program, all patients are to be "evaluated by an RN upon admission and every 48 hours to determine their risk for pressure ulcers." Further, "[p]atients should be reassessed after any transfer or change in status." The manual also provides that "[a]ll individuals at risk should have a systematic skin inspection at least once a day, paying particular attention to the bony prominences. Results of skin inspection should be documented."
In its reasons for judgment, the trial court stated that the Pressure Ulcer Prevention Program section of Lakeview's Patient Care Manual clearly required that Mr. Guardia's risk for pressure ulcers be evaluated using the Braden scale upon admission and every forty-eight hours thereafter. The court determined that Mr. Guardia was assessed initially with a score of twenty, which indicated that he was at no risk for skin breakdown. The trial court also noted Ms. Fields's testimony that this assessment was error, considering Mr. Guardia's age, his loss of blood, and the fact that he was not ambulatory after surgery. Mr. Guardia's score was not changed to indicate he was at high risk until March 19, 2003, when he entered the ICU. The trial court further found that the medical records did not indicate that Mr. Guardia's skin was assessed until 7:00 p.m. on March 19, which was more than two days after surgery. It also found no evidence of a written schedule to reposition Mr. Guardia as required by the patient care manual. The trial court, noting the differing opinions of Dr. Sondes and Dr. Levine, found Dr. Levine's testimony to be persuasive and concluded that Mr. Guardia's injuries were caused by Lakeview's violation of the standard of care it owed to him.
While we may have given greater weight to Lakeview's expert witnesses if we had been sitting as the trier of fact, we cannot substitute our judgment for that of the trial court. The effect and weight to be given expert testimony was within the broad discretion of the trial court, and, as the trier of fact, the trial court was able to accept or reject any expert's view. See Cotton, 10-1609 at p. 7, 65 So.3d at 219. Upon our own review of the record, we find no abuse of the trial court's discretion in choosing not to give greater weight to Lakeview's experts.
We also cannot say that the trial court manifestly erred in finding that Mr. Guardia's injuries were caused by Lakeview's violation of the standard of care it owed to him. Even though we agree with Lakeview that the nurses could not disregard the doctors' orders to leave Mr. Guardia in the CPMs, they should have assessed Mr. Guardia's risk of skin breakdown following his change in status and discussed same with Mr. Guardia's treating physicians. Further, no evidence was presented that in the first two days following surgery the nurses had any schedule or plan for skin assessment, especially in light of the fact that Mr. Guardia's declining medical condition put him at high risk to develop decubitus ulcers. Considering the above, the trial court could have reasonably found that Mr. Guardia met his burden of proof under LSA-R.S. 9:2794, and we cannot say its finding is clearly wrong.
CONCLUSION
For the above and foregoing reasons, the December 10, 2010 judgment of the trial court in favor of Eugene G. Guardia is affirmed. Costs of this appeal are assessed to Lakeview Medical Center, L.L.C., d/b/a Lakeview Regional Medical Center.
AFFIRMED.