Doyle, Presiding Judge. Following the death of Elzabad H. Ferguson III (“Chaz”), his parents, Elzabad H. Ferguson, Jr. and Wilhelmena Ferguson, brought this action against Blaire Bowers, D.O.; Steven Currier, M.D.; and Augusta Physicians Group, LLC, based on emergency mental health care they rendered to Chaz. Shortly after the defendants discharged Chaz to his parents, he fled from them and was found three days later having accidentally drowned. The trial court granted summary judgment to the defendants, holding that any alleged negligence was not the proximate cause of Chaz’s death. We agree and affirm. Summary judgment is proper when there is no genuine issue of material fact and the movant is entitled to judgment as a matter of law. In reviewing a grant or denial of summary judgment, we owe no deference to the trial court’s ruling[,] and we review de novo both the evidence and the trial court’s legal conclusions. Moreover, we construe the evidence and all inferences and conclusions arising therefrom most favorably toward the party opposing the motion. In doing so, we bear in mind that the party opposing summary judgment is not required to produce evidence demanding judgment for it, but is only required to present evidence that raises a genuine issue of material fact.[1] Viewed in the light most favorable to the Fergusons, the record shows that they lived in Chattanooga, Tennessee, with their 27-year-old son, Chaz. Chaz had been diagnosed with schizophrenia, bipolar disorder, and oppositional defiance disorder; he was under the care of doctors and had been prescribed medication. Although Chaz could be paranoid and delusional, he was not suicidal or violent.[2] In July 2020, Chaz and his father traveled to North Carolina to visit family. According to his father, Chaz had stopped taking his medicine approximately one or two weeks before the visit, and he began to show signs of a worsening mental condition. One night, he told his father he was going for a walk and disappeared for several hours before ending up at a stranger’s door several miles away, claiming that he had been kidnapped. Police who responded to the kidnapping call returned Chaz to his father, who encouraged Chaz to take his medication, believing he did so on three occasions over the next two days, although his father did not see whether Chaz actually swallowed the pills at that time. They remained in North Carolina the following day before beginning the drive home to Chattanooga on Monday July 13, 2020. On the drive home, just after they passed Augusta, Georgia, Chaz told his father that his stomach was bothering him and asked him to stop the car. After the father pulled over, Chaz got out of the car, walked away, and jumped a fence. When Chaz failed to return within half an hour, his father called 911. Chaz was subsequently found naked and barefoot at a construction site two miles away. Chaz was taken by ambulance to a hospital in Augusta for a psychiatric evaluation. Upon arrival, Chaz ran from the medical staff, but he was located in the parking lot, restrained, and returned to the emergency room. Dr. Blaire Bowers saw Chaz in the emergency room, but Chaz would not answer any of her questions. Dr. Bowers placed Chaz on an involuntary “1013 hold”[3] due to his acute psychosis and ordered a behavioral health consultation and chemically restrained him.[4] Counselor Charlene Moore-Peterson assessed Chaz and believed he met the criteria for in-patient treatment, and Dr. Bowers agreed. Accordingly, the plan was to find an in-patient facility for him. The next morning, Chaz’s mother called the hospital and asked if Chaz could be admitted to a facility near his home, which was her preference, but she was told the hospital could not “cross state lines.” Attempts were made to find Chaz a placement, but the hospital was unable to find an inpatient facility that did not have a waiting list and could take him in the foreseeable future. The matter was complicated by the fact that Chaz was a Tennessee resident who did not have insurance. On July 14, Chaz took off his clothes and fondled himself and refused to take all of his prescribed medication. He did, however, become more alert and oriented to place and time. Chaz took his medicine the morning of July 15, and was re-evaluated by Dr. Bowers, to whom he reported that he was having auditory hallucinations but confirmed that he had no thoughts of harming himself or anyone else. As a result, Dr. Bowers, in consultation with counselor Moore-Peterson and Dr. Currier (another emergency physician), believed the best course of action was to discharge him to his parents’ care rather than hold him indefinitely in the emergency department, so they could take him back to Chattanooga where he could be seen by his doctor. . So, on July 15, 2020, Dr. Bowers ordered that Chaz be discharged the next day unless he became uncooperative and needed to be reevaluated. In the early morning hours of July 16, 2020, Chaz took his second dose of medication, but refused the next dose at 11:00 a.m. While waiting for Chaz’s parents to arrive, the nurse noted at 12:35 p.m. that Chaz refused instructions to remain in view, so within about five minutes she “moved him to another room that had a camera to assist with observing him,” and to make him more comfortable.[5] After consulting with the overnight doctor that Chaz had not been disruptive overnight, Dr. Currier rescinded the involuntary hold based on Dr. Bower’s determination from the day before that Chaz was stable enough to be released and posed no danger to himself or others. While Dr. Currier did not personally examine Chaz, he had communicated over the last three days with the team of doctors and nurses working with Chaz and had reviewed his medical chart for anything of concern. Chaz’s parents arrived at the hospital at around 2:00 p.m. on July 16, and his mother went in to bring him a change of clothes and retrieve him. Chaz’s mother asked where she should go to request his medical records, and she was directed to a different building. They went back to the car, and Chaz’s father drove them to the records building. Chaz and his mother went in the building to complete the paperwork before returning to the car. After buckling his seat belt, Chaz said “wait a sec.” He then unbuckled himself, exited the car, and began walking back to the records department, and his father followed him. His father asked a security officer near the door for help, saying his son was “going to run.” Meanwhile, his mother had caught up and also asked for help from a staff member, who indicated that they could not force someone to be admitted; as they stood with Chaz, the mother called the emergency department. She initially reached the discharge nurse who told her to bring him back, but she hung up when Chaz wandered out of the building. Chaz then returned back inside so she attempted two more calls to counselor Moore-Peterson, but she only reached voice mail.[6] Chaz again walked outside and turned to his father and asked, “why are you following me?” He then took off running toward a parking deck. The father called the sheriff’s department, and deputies and hospital security searched the deck, but they were unable to find Chaz. The sheriff’s department put out a missing persons alert; although a deputy encountered Chaz a few hours later on a trespassing call, the deputy did not detain him. Three days later, Chaz’s body was discovered in a lake three miles away from the hospital. Following an autopsy, the death was ruled an accidental drowning. The Fergusons filed a medical malpractice suit against the defendants.[7] The crux of the complaint is that the defendants were negligent in discharging Chaz without assessing or reassessing him on the date of discharge. In support of their complaint, the Fergusons obtained two medical experts — Dr. Martin Lutz and Dr. Tobias Wasser — who testified that the doctors breached the standard of care. Both doctors testified that Chaz should have been reassessed prior to his discharge. They opined that Chaz remained in an ongoing state of psychosis that rendered him incapable of caring for himself. The defendants moved for summary judgment based on the lack of proximate cause.[8] Following a hearing, the trial court granted the motion. The trial court found that the chain of causation was broken by both the remoteness in time and space between Chaz’s discharge and his subsequent death and the deputy’s failure to detain Chaz after he fled the hospital. The Fergusons now appeal. Based on the undisputed facts of this case, the Fergusons’ burden, in part, is to elicit evidence showing that the defendants’ decision to discharge Chaz to his parents’ care was the proximate cause of his accidental drowning death, which occurred miles away from the hospital at some point during the next three days.[9] In medical malpractice cases, expert testimony on causation is required.[10] Proximate cause is that which, in the natural and continuous sequence, unbroken by other causes, produces an event, and without which the event would not have occurred. In this regard, a negligent actor who breaches a duty to another is not responsible for a consequence which is merely possible, according to occasional experience, but only for a consequence which is probable, according to ordinary and usual experience. It is important to recognize that “probable,” in the rule as to causation, does not mean “more likely than not but rather not unlikely”; or, more definitely, “such a chance of harm as would induce a prudent man not to run the risk; such a chance of harmful result that a prudent man would foresee an appreciable risk that some harm would happen.” The requirement of proximate cause constitutes a limit on legal liability; it is a policy decision that, for a variety of reasons, e.g., intervening act, the defendant’s conduct and the plaintiff’s injury are too remote for the law to countenance recovery. The determination of whether proximate cause exists requires both factfinding in the “what happened” sense, and an evaluation of whether the facts measure up to the legal standard set by precedent. And, while proximate cause is ordinarily a jury question, it will be determined by the court as a matter of law in plain and undisputed cases.[11] “Jury questions on proximate cause do not exist simply because it may be ‘possible’ to connect a defendant’s negligence to an otherwise unforeseen outcome, and to do so stretches the concept of proximate cause beyond its legal limits.”[12] Under the facts in this record, Chaz’s accidental drowning at some point in the three days after his discharge is too remote to be the proximate result of his discharge. There is no evidence that Chaz’s death was a result of suicide or violence, nor did Chaz have a history of self harm or violence. Instead, this case turns on expert testimony that despite the treatment and medication Chaz received in the hospital emergency department, he should not have been released to his parents, even with their consent.[13] Nevertheless, as a matter of law, the record merely establishes “but for” causation or “cause in fact,” which is only part of the plaintiffs’ burden.[14] It is true in a broad sense that holding Chaz further would have foreclosed all other outcomes outside the hospital, whether they were benign or harmful, but it does not demonstrate that releasing him proximately caused this outcome.[15] There is no expert testimony or other evidence that explains what actually caused Chaz’s drowning death. It is undisputed that Chaz was able to swim, and it was warm summer weather when he drowned — there is nothing unreasonably dangerous about swimming in July in Georgia. The experts understandably conceded that they lacked sufficient information to be able to form any specific conclusion about what caused Chaz to drown.[16] In this way, this case is different from others in which a suicidal mental health patient died by suicide. Further, there is no evidence that Chaz was physically impaired or unsafe to walk on his own. And the fact that Chaz was stopped and not detained by law enforcement on July 16 further demonstrates that the causal chain between his discharge and his death was too remote to demonstrate proximate cause. Unfortunately, we are left only with assumptions that are based on speculation about the circumstances causing Chaz’s death. This is insufficient to overcome a summary judgment motion.[17] As noted above, “[t]he requirement of proximate cause constitutes a limit on legal liability; it is a policy decision that, for a variety of reasons, e.g., intervening act, the defendant’s conduct and the plaintiff’s injury are too remote for the law to countenance recovery.”[18] Despite the tragic outcome of the events, in light of the interval of time and events between Chaz’s discharge and his death, the undisputed record here fails to support an inference that the alleged negligence proximately caused Chaz’s death. Therefore, the trial court correctly granted the defendants’ motion for summary judgment. Judgment affirmed. Gobeil, J., concurs. Senior Judge C. Andrew Fuller, dissents.
