The Commonwealth of Massachusetts Appeals Court (“Massachusetts Appellate Court”) held in its unpublished opinion filed on February 6, 2018 that the plaintiff’s offer of proof in a Massachusetts medical malpractice case was sufficient to raise a legitimate question appropriate for judicial inquiry.
From April 8, 2011 to November 28, 2012, the decedent was under the care of the defendant primary care physician. On multiple occasions, the decedent complained of various symptoms, including several that are commonly associated with heart disease, such as chest tightness and shortness of breath. The defendant primary care physician arrived at certain diagnoses unrelated to heart disease and prescribed various medications. While the defendant primary care physician referred the decedent to a neurologist, he never diagnosed the decedent with, or treated him for, heart disease, and he failed to refer him to a cardiologist.
On November 28, 2012, the decedent was brought to an emergency room in full cardiac arrest where he was diagnosed with 100% occlusion of his left anterior descending artery. He died five days later, at age 46.
The decedent’s mother filed a Massachusetts medical malpractice wrongful death lawsuit in her capacity as the personal representative of the decedent’s estate, alleging that the defendant primary care physician’s failure to appreciate and address the decedent’s heart disease violated the applicable standard of care and caused the decedent’s premature death.
The Massachusetts medical malpractice action was referred to a Massachusetts medical malpractice tribunal, pursuant to G. L. c. 231, § 60B. After a hearing, the tribunal concluded that the plaintiff’s offer of proof, even if properly substantiated, was insufficient to raise a legitimate question of liability appropriate for judicial inquiry.
Required Offer Of Proof
Before a medical malpractice tribunal, a plaintiff’s offer of proof must (1) show that the defendant is a provider of health care as defined in G. L. c. 231, § 60B; (2) demonstrate that the health care provider in question did not conform to good medical practice; and (3) establish resulting damage. The relevant standard of care is the one that applies to the average qualified physician in his or her area of specialty. Whether the physician met the applicable standard of care generally can be answered only with the aid of expert opinion. The expert opinion must be rooted in the record evidence and not be based on speculation, conjecture, or assumptions not supported by the evidence.
In determining whether a plaintiff’s offer of proof is sufficient, the question to be decided by the tribunal is a factual one. The tribunal’s task is akin to a trial judge’s evaluation of a motion for a directed verdict: the tribunal must consider the proof in the light most favorable to a plaintiff and the tribunal may not examine the weight or credibility of the evidence. An offer of proof is sufficient if anywhere in the evidence, from whatever source derived, any combination of circumstances could be found from which a reasonable inference could be drawn in favor of the plaintiff.
In the present case, the plaintiff’s expert opined that the decedent repeatedly had presented his primary care physician with complaints about symptoms that were indicative of coronary artery disease. Furthermore, based on specific facts reflected in the medical record, the plaintiff’s expert opined that the defendant primary care physician’s failure to address such symptoms constituted a deviation from the standard of care and that this caused the decedent’s death.
The defendant primary care physician argued that the plaintiff’s expert’s opinion letter is based on facts that are contradicted by the medical records. The Massachusetts Appellate Court stated that the medical records and the plaintiff’s expert’s detailed report, fairly read, presented more than conclusory assertions and provided evidence from which a reasonable juror could infer sub-par professional conduct on the defendant primary care physician’s part, which was sufficient.
With regard to the defendant’s argument that the plaintiff’s offer of proof does not sufficiently establish causation between the decedent’s death and the defendant’s deviation from the standard of care, the Massachusetts Appellate Court held that it is enough to adduce evidence that there is a greater likelihood or probability that the harm to the plaintiff flowed from conduct for which the defendant was responsible.
Source Greene v. Elgeziry, 17-P-780.
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