The Superior Court of Pennsylvania (“Pennsylvania Appellate Court”) issued a non-precedential decision on May 26, 2017 that affirmed summary judgment granted to the medical malpractice defendants because the plaintiffs failed to provide an expert report in support of their allegations of medical negligence against the defendants.
In order to set forth a prima facie cause of action for medical malpractice in Pennsylvania, a plaintiff must establish a duty owed by the physician to the patient, a breach of that duty by the physician, that the breach was the proximate cause of the harm suffered, and that the damages suffered were a direct result of the harm. With all but the most self-evident medical malpractice actions, there is also the added requirement that the plaintiff must provide a medical expert who will testify as to the elements of duty, breach, and causation.
The plaintiffs in the case decided by the Pennsylvania Appellate Court relied upon a narrow exception to the requirement that medical malpractice claims be supported by expert testimony: where the malpractice is obvious and the medical and factual issues presented are such that a lay juror could recognize negligence just as well as any expert. Specifically, the plaintiffs relied on the doctrine of res ipsa loquitur, which can be utilized only when all of the following elements are present: (a) the event is of a kind which ordinarily does not occur in the absence of negligence; (b) other responsible causes, including the conduct of the plaintiff and third persons, are sufficiently eliminated by the evidence; and (c) the indicated negligence is within the scope of the defendant’s duty to the plaintiff.
The Underlying Facts
Shortly after undergoing a scheduled caesarian section during which the plaintiffs’ baby was safely delivered, the mother suffered cardiac arrest due to an amniotic fluid embolism. She was revived through the use of cardiopulmonary resuscitation and intubation.
After the mother was stabilized from the embolism, she began to suffer from disseminated intravascular coagulation, which occurs when blood clots form inside blood vessels. A doctor placed a right internal jugular central line inside of the mother’s jugular vein to administer medication, which was later determined to have been incorrectly placed.
The plaintiffs’ medical malpractice complaint alleged that the mother’s intubation was prolonged due to the incorrectly placed internal jugular central line and that she continued to suffer side effects as a result.
The defendants presented two expert witness reports in which it was stated that the defendants did not deviate from the applicable standard of care in their treatment of the plaintiff. The pro se plaintiffs did not produce any expert report, arguing the defendants’ liability based on the misplaced internal jugular central line, the defendants’ failure to recognize that fact, and the defendants’ inability to stabilize the plaintiff’s internal bleeding.
The trial court granted summary judgment to the defendants, stating that the common layperson would not know whether a jugular central line can be misplaced even when a doctor has not been negligent and has exercised reasonable care; an ordinary person would not be familiar with the signs of a misplaced jugular central line and whether the defendants should have detected the issue; and, a layperson would have no idea whether the plaintiff’s prolonged intubation caused her claimed harm. The plaintiffs filed an appeal.
The Pennsylvania Appellate Court stated that the medical events in this case involve complex medical issues and procedures that are beyond the ken of an ordinary person, the events in question could have happened even though the defendants exercised reasonable care, and the plaintiffs failed to establish the first element of the res ipsa loquitur doctrine.
The Pennsylvania Appellate Court held that expert testimony was necessary to establish that the defendants were negligent, and the trial court did not abuse its discretion or commit an error of law in opining that the lack of an expert opinion was fatal to the the plaintiffs’ case.
Source Snyder v. Mount Nittany Medical Center, J-S26004-17
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