Certificate of Good Faith Required When Expert Must Prove Causation

In Redick v. Saint Thomas Midtown Hospital, No. M2016-00428-COA-R3-CV (Tenn. Ct. App. Oct. 26, 2016), the Court addressed the need for a certificate of good faith in an HCLA (f/k/a Tennessee medical malpractice) claim when the breach of duty question falls within the common knowledge exception, but the causation portion of the claim would require expert testimony.

Here, plaintiff was admitted to the hospital with complaints of dizziness and falling. Certain fall precautions were put into place during her stay. Five days after she was admitted, a hospital employee was assisting her in using a portable toilet and allegedly did not follow the prescribed fall precautions—the toilet was not put within reach of the bed, and the employee did not adequately assist plaintiff in getting back to her bed. Plaintiff fell when trying to return to her bed and struck the bedside table, which prompted this suit.

Before filing suit, plaintiff did not give pre-suit notice under the HCLA, and she failed to file a certificate of good faith with her complaint. In response to defendant hospital’s motion to dismiss with prejudice due to the lack of a certificate of good faith, plaintiff asserted that “her claims [fell] within the common knowledge exception such that expert proof is not required, thus forgiving her failure to file a certificate of good faith.” After a hearing, the trial court held: “While this Court finds this case is appropriate for application of the common knowledge exception, expert testimony would still be required on the element of causation to show that ‘as a proximate result of the defendant’s negligent act or omission, the plaintiff suffered injuries which would not otherwise have occurred.’” On appeal, the ruling was affirmed.

Tenn. Code Ann. § 29-26-122 requires an HCLA plaintiff to file a certificate of good faith showing that she has expert proof to support her claim. However, if the claim falls under the common knowledge exception, meaning that the “matter is within the common knowledge of a layperson,” then no certificate of good faith is required. (internal citation omitted).

In this case, the alleged breach of duty involved not providing proper assistance for a patient with a known risk of falling to get to a toilet and back to her bed. Regarding these allegations, the Court affirmed the trial court’s holding that “the common knowledge exception applies in this case with regard to the element of breach of duty.” Accordingly, the Court held that no expert proof was needed to show the standard of care or breach of such standard.

This finding, though, did not end the analysis. The hospital argued that plaintiff would need expert proof to establish her alleged damages, and the Court agreed. The Court reasoned:

Plaintiff would have to prove that the particular fall at issue in this case, and not any other fall or event Plaintiff may have suffered prior to the fall at issue, was the proximate cause of the injuries she allegedly received. …The fall at issue in this case occurred less than one week after Plaintiff was admitted to the hospital. Given this, it is not unreasonable to suppose that Plaintiff may have suffered injuries from falls other than the fall at issue in this case. Expert proof would be required to show that Plaintiff’s alleged injuries were proximately caused by the particular fall at issue in this case. The cause of Plaintiff’s injuries simply is not within the common knowledge of a layperson, and therefore, would require expert proof.

The Court thus affirmed the finding that a certificate of good faith was needed and upheld the dismissal of the case with prejudice.

This is yet another cautionary tale regarding carefully following the requirements of the HCLA when filing a claim related to medical care. Here, the plaintiff most likely believed that her case did not fall under the HCLA at all, as she did not comply with either the pre-suit notice or certificate of good faith requirements. As we’ve seen many times before, however, cases dealing in any way with the provision of medical care will most likely be found to fall under the HCLA under the current statute. Further, as this case illustrates, even when you believe your case might fall under the common knowledge exception and not require expert proof, the best practice is to file a certificate of good faith with your HCLA complaint. Even if the breach of duty might not require expert proof, another issue in your case (such as causation and damages here) may be subject to the expert requirement and your case may be dismissed with prejudice if a certificate of good faith was not filed.


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