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By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Elena N. Sandell, JD
UCLA School of Law, 2018
News: A court of appeals affirmed a trial court’s decision that plaintiffs’ medical malpractice claim against a hospital and two physicians lacked factual support, and that the claim required expert testimony to establish the applicable standard of care.
A patient’s parents alleged that physicians negligently administered medication used to treat mental and mood disorders, causing the patient to suffer cardiac arrest and distress. They also alleged that the physicians failed to appropriately treat the patient’s distress. During trial, the defendants moved to summary judgment, which was granted.
The court of appeals found that, although the plaintiffs identified an expert witness in their summary judgment affidavit, this alone was not sufficient to create an issue of material fact. Thus, the trial court did not err in granting summary judgment, nor did it abuse its discretion in failing to grant extensions for plaintiffs to produce an expert testimony.
Background: In 2012, a patient was admitted to a hospital to receive treatment for a mental health condition, where she received an antipsychotic medication. However, after the patient received two injections of the medication in a short time, the patient developed a pulmonary embolism and suffered from cardiac arrest and cardiac distress. In the litigation that followed, the plaintiffs alleged that the physicians did not adequately respond to the medical emergency and that the hospital was not equipped with trained personnel and appropriate equipment, which led the hospital to call a separate city emergency unit to administer emergency care to the patient. These emergency services were insufficient, and the patient died because of the cardiac arrest.
A year later, the patient’s estate and parents filed a malpractice complaint with the state under the state’s medical malpractice act against two physicians and the hospital. The medical review panel unanimously found in favor of the defendant hospital and physicians, concluding that the evidence did not support a finding that any defendant failed to meet the applicable standard of care. The review panel found that the medication had been administered only once in accordance with the physician’s instruction and pursuant to the “regular” course of treatment followed under these circumstances. Further, the panel found that the administration of the medication was in accordance with the standard practice, emergency services had been timely contacted to address the emergency, the patient had received the medication previously and had not experienced an adverse reaction, and no causal link had been found between the medication and the development of a pulmonary embolism.
Following the panel’s decision, the plaintiffs sued in state court. Early in the litigation, the defendant hospital and physicians moved for summary judgment based on a lack of expert testimony. Between the filing of the motion for summary judgment, the plaintiffs presented an affidavit stating they had retained a physician who would testify as an expert, but the affidavit did not contain any of the substance of the physician’s purported testimony. The court granted the motion for summary judgment because the plaintiffs’ secured expert could not provide a written report; thus, there was no actual expert testimony on the necessary subjects for a medical malpractice action, including the applicable standard of care. The plaintiffs appealed the court’s dismissal; the court of appeals affirmed the decision.
What this means to you: This case reveals lessons in substance and legal procedure, as the defendant hospital and physicians successfully defeated the medical malpractice claim in multiple forums and prior to the need for a jury. In the first forum, the medical review panel agreed that the hospital and physicians adhered to the applicable standard of care concerning the administration of the medication and the seeking of emergency services.
Procedures before medical review panels and trial courts are extremely important. Cases can be won far in advance of trial, saving substantial amounts of time, energy, and money, depending on the circumstances. Fortunately for the defendants in this matter, the legal procedures enabled a swift and decisive victory without a jury even hearing the allegations. When a patient alleges injury and brings litigation, the patient bears the initial burden of demonstrating multiple aspects of the claim, including that the physician or hospital failed to satisfy the applicable standard of care.
In this case, the issue revolved around whether the plaintiffs presented an issue of fact pertaining to the standard of care and whether it was satisfied. The plaintiffs initiated the proceeding with the medical review panel, which was comprised of three qualified physicians. The decision stated that no evidence existed in support of a claim that the defendant physicians and the hospital had failed in administering care in compliance with the applicable standard. The report was admissible in the summary judgment proceedings, and the court explained that the findings of a medical review panel are admissible as evidence in a subsequent action brought by an injured patient. In particular, the report served to demonstrate that the plaintiffs’ claim failed to present an issue of fact. The plaintiffs then should have introduced evidence in support of their negligence claim to prevent summary judgment.
In fact, based on the panel’s findings, the medication was administered to the patient in accordance with proper medical standards. Furthermore, the patient had been administered the same medication before and had not experienced adverse reactions. The dosage and frequency of administration also were in compliance with the accepted standard of care. Lastly, although the patient suffered from a pulmonary embolism, there was no indication in medical literature that a link existed between the administered medication and the development of pulmonary embolism. The report of the medical panel, which was introduced into evidence by the defendants, effectively exonerated the hospital and physicians from a negligence claim because the plaintiffs could not produce evidence of factual or expert support for essential elements of their claim.
Because of the inherently complex nature of a medical malpractice case — which typically is beyond the scope of a layperson’s knowledge — the plaintiffs were required to introduce expert testimony to support the allegations, particularly those related to the applicable standard of care. There are rare medical malpractice cases in which the negligent actions are self-evident and can be easily understood by a layperson, such as if a physician amputates the incorrect limb. But absent those exceptional and rare circumstances, expert testimony is required. If a patient fails to retain and present sufficient expert testimony, it is almost inevitable that the care providers will be successful in defending against the action.
Defendants in such circumstances can defeat a malpractice claim in advance of trial by bringing a motion for summary judgment, as the defendants did here. A motion for summary judgment is a legal mechanism that enables a court to resolve claims as a matter of law — without the need for a jury’s findings — based on undisputed facts. In this case, the defendants’ position was that even assuming everything the plaintiff alleged is true, the plaintiff did not and could not satisfy its burden because the plaintiff did not show evidence that the defendants deviated from the applicable standard of care.
The defendants also presented the panel’s report, which similarly found that there was no evidence that the defendants failed to satisfy the standard of care, and the report further found that the medication was properly administered. Although the plaintiffs presented an affidavit identifying an expert witness, the court explained that merely naming a witness and promising that he or she will testify in the future does not create a question of fact.
This case demonstrates the importance of securing proper expert testimony and how successful claimants must ensure that each element of a negligence claim is addressed and supported by evidence. Furthermore, the case demonstrates how trial procedures and adequate preparation may be used to defeat a claim at an early stage of the litigation. Here, the plaintiffs requested and were granted several extensions; nevertheless, the plaintiffs failed to present appropriate evidence to overcome the motion for summary judgment. As a result, the defendant hospital and physicians saved a substantial amount of time and money through the early dismissal of the action prior to trial. Typically, maximizing the effectiveness of these types of legal procedures is the realm of attorneys. However, physicians and care providers should keep these in mind and work closely with counsel when defending malpractice actions to evaluate the potential for seeking summary judgment and dismissal of an action as early as possible to reduce the burden on innocent physicians and care providers.
Decided on July 24, 2019, in the Court of Appeals of Louisiana, Fourth Circuit, Case Number 2019-CA-39.
Financial Disclosure: Author Greg Freeman, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Accreditations Manager Amy Johnson, MSN, RN, CPN, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Arnold Mackles, MD, MBA, LHRM, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.