The Court of Appeal of the State of California Second Appellate District Division Eight (“California Appellate Court”), in its June 1, 2020 published opinion, stated: “The trial court granted summary judgment to a hospital in a lawsuit brought by the family of an emergency room patient who was released from the hospital and died eight hours later. We conclude no evidence showed that the nursing staff caused or contributed to the patient’s death; no evidence showed the hospital was negligent in the selection and retention of the two emergency room doctors who treated the patient; and the evidence conclusively established the emergency room doctors were not the ostensible agents of the hospital.”
The decedent had gone to the ER of the defendant hospital, complaining of “[s]tomach pain[,] tight chest.” Later in the ER, he complained of neck pain, cough, sore throat, and “chest congestion x tonight per patient ‘like a dull ache in my throat, like I’m getting strangled below my neck.’”
About seven hours later, an ER doctor decided to discharge the man after seeing him a second time and noting that he had “improved” and by that time a second ECG and a second troponin test had been performed. The discharge instructions included a diagnosis of “chest pain of unclear etiology,” and a referral to a cardiologist, as well as a follow-up with his primary care physician in one day. The man died less than eight hours later due to an acute dissection of his aorta.
A California medical malpractice wrongful death lawsuit was subsequently filed. One of the plaintiff’s experts opined that if the nurses had obtained the man’s medical history, a reasonably prudent emergency physician would have summoned a cardiologist for an emergency consult, the cardiologist would have ordered a CT scan with IV contrast, the CT scan would have shown the cause of the man’s chest pain was an aortic dissection, and the cardiologist and ER physician would have arranged for a cardiothoracic surgery consult; if no surgeon was at its facility, the man would have been transferred to another facility, and the man “would have received timely diagnosis and treatment.”
The trial court granted defendant’s motion for summary judgment, ruling that the plaintiff’s expert’s opinion that the nurses deprived the decedent of timely care was predicated “upon a long series of alleged dependent probabilities, which is legally a mere possibility,” and thus “too speculative to be admitted as a matter of law.” The trial court further ruled that the plaintiff’s other expert’s opinion was likewise deficient. The plaintiff appealed.
California Appellate Court Opinion
The California Appellate Court stated, “we find neither expert declaration created a material disputed fact that the nurses’ performance caused or contributed to [the man’s] death to a reasonable medical probability,” explaining, in part, “What the ER doctors did not know is that [the man] would suffer an aortic dissection several hours later, but [the plaintiff’s expert] does not explain how nurses’ notes or an inquiry about [the man’s] level of pain immediately before his discharge would have alerted the ER doctors that they needed to rule out aortic dissection.” The California Appellate Court concluded that the plaintiff’s expert’s opinions “lack reasoned explanation for his conclusions, and his opinions rest not on facts but on a series of hypothetical conditions, i.e., if the ER doctors had ordered an emergency cardiology consult, then more tests would have been ordered, and the tests would have revealed the risk of aortic dissection, and surgery would have been performed, and [the man] would have survived. An expert’s opinion rendered without a reasoned explanation of why the underlying facts lead to the ultimate conclusion has no evidentiary value because an expert opinion is worth no more than the reasons and facts on which it is based.”
The California Appellate Court further stated that the plaintiff’s other expert “hedged in giving his testimony by saying he had no opinion on whether the nurses met the standard of care, or on what an ER doctor would have done if the nurses had met the standard of care. He simply assumed as true the facts and opinions expressed by [the plaintiff’s other expert]. An expert may not predicate an opinion on the opinion of another expert … An expert’s opinion that something is true if certain assumed facts are true, without any foundation for concluding those assumed facts exist, has no evidentiary value.”
The California Appellate Court held that the trial court did not err in sustaining the defendant’s objections to the plaintiff’s experts’ declarations on causation and “[b]ecause plaintiffs did not create a triable issue on whether the nurses’ conduct caused or contributed to [the man’s] death, summary judgment for the hospital was proper.”
Source Wicks v. Antelope Valley Healthcare District, B297171.
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