On March 12, 2013, the Supreme Court of Arizona (“Arizona Supreme Court”) filed its opinion in a case that defined what a “specialist” is under Arizona law in the medical malpractice context. The definition of “specialist” is important because Arizona law (A.R.S. § 12-2604) sets the requirements for experts who testify about the appropriate standard of care in medical malpractice actions.
§ 12-2604 provides, in part:
A. In an action alleging medical malpractice, a person shall not give expert testimony on the appropriate standard of practice or care unless the person is licensed as a health professional in this state or another state and the person meets the following criteria:
1. If the party against whom or on whose behalf the testimony is offered is or claims to be a specialist, specializes at the time of the occurrence that is the basis for the action in the same specialty or claimed specialty as the party against whom or on whose behalf the testimony is offered. If the party against whom or on whose behalf the testimony is offered is or claims to be a specialist who is board certified, the expert witness shall be a specialist who is board certified in that specialty or claimed specialty.
In the case before the Arizona Supreme Court, a medical malpractice claim (wrongful death claim) was brought by the surviving father of a 17-year-old who was treated for blood clots by the defendant physician who was certified by the American Board of Pediatrics in pediatrics and in pediatric hematology-oncology (pediatrics is recognized as a specialty and pediatric hematology-oncology is recognized as a subspecialty of pediatrics). The plaintiff designated an expert certified by the American Board of Internal Medicine in internal medicine and in hematology and medical oncology (internal medicine is recognized as a specialty and hematology and medical oncology are recognized as subspecialties of internal medicine) to testify about the standard of care on behalf of the plaintiff
The trial judge determined that the relevant specialty in the medical malpractice case was pediatric hematology and since the plaintiff’s designated expert was not certified in pediatric hematology, he was not a qualified expert under the Arizona statute.
On appeal, the Arizona Supreme Court interpreted § 12-2604(A) as requiring that a testifying expert specialize “in the same specialty or claimed specialty” as the treating physician only when the care or treatment at issue was within that specialty. The Arizona Supreme Court then turned its attention to the meaning of “specialty” and “specialist” for purposes of § 12-2604.
The Arizona statute requires a testifying expert to have spent a majority of his or her professional time practicing or teaching in the specialty or claimed specialty of the medical malpractice defendant during the year preceding the occurrence, thus requiring a testifying expert to have experience and training comparable to the medical malpractice defendant. Therefore, the Arizona Supreme Court concluded that a “specialist” is someone who devotes most of his or her professional time to a particular “specialty.”
The lower Arizona appellate court had determined that “specialty” refers to an area of practice occupied by one of the twenty-four American Board of Medical Specialties (“ABMS”) member boards, such as pediatrics. The Arizona Supreme Court determined that defining “specialty” by reference to practice areas in which a physician may obtain board certification is a workable approach because these areas are objectively identifiable and reflect recognition by certifying bodies that certain practice areas involve distinct training and experience. The Arizona Supreme Court construed “specialty” for purposes of § 12-2604 as referring to a limited area of medicine in which a physician is or may become board certified.
However, the Arizona Supreme Court held that § 12-2604 does not confine the word “specialty” to only the twenty-four ABMS member boards — a “subspecialty” is a more focused area of practice encompassed by a broader specialty, but the subspecialty is itself a specialty. The Arizona Supreme Court stated that whether the relevant “specialty” is an area of general certification, like pediatrics, or subspecialty certification, like pediatric hematology-oncology, will depend on the circumstances of a particular case. Just as a physician who is a specialist may practice outside of his or her specialty, a physician who is a subspecialist, such as in pediatric hematology-oncology, may afford treatment or care that does not involve that particular subspecialty but is embraced by the broader specialty of pediatrics. In that event, § 12-2604(A) would require testifying experts to specialize in pediatrics.
The Arizona Supreme Court stated that the trial court must initially determine if the care or treatment at issue involves the identified specialty, which may include recognized subspecialties. If it does, testifying experts must share the same specialty as the treating physician. The trial court then must determine if the treating physician is board certified within that specialty. If so, any testifying expert must also be board certified in that specialty. Depending on the circumstances, the relevant specialty may be a subspecialty in which the treating physician is board certified. Because an individual cannot devote a “majority” of his or her time to more than one specialty, the statute suggests that only the one relevant specialty need be matched.
The Arizona Supreme Court noted that the parties contested whether the relevant specialty was pediatric hematology-oncology or hematology and that the trial court determined that pediatric hematology, in which the defendant doctor was board certified, was the relevant specialty. Because the plaintiff’s expert was not certified in this specialty, the trial court ruled that he was not qualified as an expert under § 12-2604 and the trial court then granted summary judgment in favor of the medical malpractice defendant because the medical malpractice plaintiff lacked the required evidence to establish the standard of care and causation without expert testimony.
The Arizona Supreme Court determined that the trial court correctly interpreted § 12-2604 to require a testifying expert to be board certified in the same specialty as the defendant if the defendant was practicing within that specialty while providing the treatment at issue, and that the trial court did not abuse its discretion when it determined that the medical malpractice defendant was practicing within her specialty of pediatric hematology-oncology. Because § 12-2604 required a testifying expert to be certified in that specialty, even if physicians in other specialties might also have competently provided the treatment, the Arizona Supreme Court held that the trial court did not err in ruling that the plaintiff’s expert was not qualified as an expert.
If you, a family member, or a friend were injured as a result of medical malpractice in Arizona or in another U.S. state, you should promptly seek to consult with an Arizona medical malpractice attorney or a medical malpractice attorney in your state who may be willing to investigate the possible medical malpractice claim for you and file a medical malpractice case on your behalf, if appropriate.
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