The Minnesota Court of Appeals ruled in its nonprecedential decision filed on April 29, 2024 involving a Minnesota medical malpractice case alleging that a vascular surgeon committed medical malpractice in his surgical treatment of the plaintiff’s popliteal artery entrapment syndrome (PAES), in which the plaintiff designated an interventional radiologist to testify on her behalf with regard to the standard of care, “we discern no abuse of discretion in the district court’s determinations that the circumstances underlying Luczak’s claims involve the surgical and postsurgical treatment for her PAES and that Dr. Resnick lacks the practical experience necessary to opine as to the standard of care applicable to physicians under those circumstances.”
Background Facts
In May 2019, Jolene Luczak sought medical care for right calf pain. Dr. Christopher Bunch diagnosed her with claudication (muscle pain from reduced blood flow) due to popliteal artery entrapment syndrome (PAES). PAES is a condition in which the calf muscle presses on the main artery behind the knee, the popliteal artery, making it
harder for blood to flow to the lower leg and foot. In Luczak’s case, the pressure resulted from the artery’s aberrant course around the muscle.
Dr. Bunch referred Luczak to vascular surgeon Dr. Christopher DeMaioribus at The Duluth Clinic Ltd. Dr. DeMaioribus confirmed the diagnosis and discussed two surgical options for addressing her PAES: (1) a bypass, which would involve using a grafted vessel to bypass the area of compression; or (2) a decompression, which would involve division of the calf muscle and moving the popliteal artery into a normal anatomic position so that it would no longer be compressed. Bypass surgery was scheduled for August 26, 2019 at St. Mary’s Medical Center.
During the surgery, Dr. DeMaioribus elected to perform a decompression. After decompressing the artery, he performed an intraoperative angiogram, which showed some residual compression and vasospasm, meaning narrowing or tightening of the artery. He did a balloon angioplasty, inserting a balloon into the artery and inflating it to open the area of vasospasm. He then determined the release was complete and finished the procedure.
Luczak experienced complications after the surgery, ultimately requiring a stent placed to address a pseudoaneurysm at the site of a left iliac artery repair. Her wound fully healed by July 2020, although her PAES remained unresolved.
Luczak identified Dr. Scott Resnick as her medical expert, submitting his curriculum vitae (CV) and his expert report
regarding her care. Dr. Resnick’s CV indicated that he has more than 20 years’ experience working as an interventional radiologist and teaching in radiology and vascular surgery departments. His expert report stated that he has “knowledge of and skill in evaluating vascular anatomy, the mechanical forces involved in [PAES], diagnosis and treatment of pseudoaneurysm, and is a true expert in the field of interventional radiology.” Dr. Resnick proposed to testify to “the accepted standard of care for diagnosis and management of [PAES] with claudication, angiography, and pseudoaneurysm in the same or similar circumstances.”
The trial court considered Dr. Resnick’s CV, his initial report, and his supplemental report, and determined that Dr. Resnick is not qualified to testify as an expert in this Minnesota medical malpractice case because he lacks “practical experience in dealing with PAES in surgery and with postsurgical care.” Because the trial court concluded that excluding Dr. Resnick’s testimony meant Luczak lacked the necessary medical testimony to present her case to the jury, the trial court granted summary judgment in favor of the defendants. Luczak appealed.
The Minnesota Court of Appeals stated that the plaintiff must present evidence that the witness has both the necessary schooling and training in the subject matter involved, plus practical or occupational experience with the subject: “the district court accurately recited the six allegations of medical negligence detailed in Dr. Resnick’s report, and it recognized that Luczak does not challenge Dr. DeMaioribus’s “surgical decisions.” But it disagreed that her allegations concern nothing more than the diagnosis of PAES based on radiological tools: “[D]iagnosis is not what is at issue here. Rather it is the decisions Dr. DeMaioribus made in surgery and with postsurgical care, which happened long after the diagnosis was made.” The court reasoned that, “[u]nder these circumstances, [Luczak’s] expert would need to be able to show practical experience in dealing with PAES in surgery and with postsurgical care.” That context-specific description of the circumstances that inform the applicable standard of care is consistent with caselaw.””
Furthermore, “the district court excluded Dr. Resnick because Luczak failed to demonstrate that he has the requisite practical experience. Certainly, it is apparent from Dr. Resnick’s CV that he is an accomplished interventional radiologist, well versed in the full panoply of radiological tools and knowledgeable about vascular anatomy. And his reports show that he is familiar with the “mechanical forces involved” in PAES and has experience diagnosing the condition. But nothing in his CV or his reports indicates that he has consulted on the use of radiological tools during a PAES surgery, used those tools to assess or treat PAES patients after surgery, or otherwise acquired experience in the surgical and postsurgical “management of [PAES] with claudication, angiography, and pseudoaneurysm”—the very circumstances for which he proposes to articulate the standard of care.””
Source Luczak vs. St. Mary’s Medical Center, A23-1548.
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