Plaintiff’s Expert Testimony on Causation Deemed Too Speculative

Where the expert causation testimony in aT ennessee HCLA (medical malpractice) case was deemed too speculative, summary judgment was affirmed.

In Franklin-Mansuo v. AMISUB (SFH), Inc. D/B/A Saint Francis Hopsital, No. W2016-01623-COA-R3-CV (Tenn. Ct. App. Sept. 6, 2017), plaintiff filed an HCLA action based on the death of his mother. Mother had arrived at defendant hospital’s ER with difficulty breathing and swallowing, and was treated by a physician’s assistant (PA). The PA ordered a CT scan, and then consulted by phone with an ear, nose and throat physician (ENT). The ENT stated that the mother needed to be admitted to the ICU. The PA, however, thought that the ENT was coming to the hospital to oversee the admission. Almost three hours passed, at which point another doctor at the hospital admitted the mother to the ICU. At some point during her transfer or shortly after her ICU admission, the mother lost her airway and suffered brain damage. She eventually died ten days later, though her death certificate listed the cause of death as a stroke.

Plaintiff brought suit against several defendants, but by the time relevant to this appeal the only remaining defendant was the doctor who was the PA’s supervising physician on the day of the incident. The doctor filed for summary judgment, asserting that plaintiff’s experts were not qualified to testify as to the applicable standard of care and that the causation testimony they offered was too speculative. The trial court agreed, granting the motion for summary judgment, and the Court of Appeals affirmed.

A plaintiff in an HCLA case must present expert testimony regarding the standard of care, a breach of the standard of care, and causation. Regarding causation, a plaintiff must show “that it is more likely than not that the defendant’s negligence caused plaintiff to suffer injuries that would not have otherwise occurred.” (internal citation omitted). Here, the Court of Appeals only analyzed plaintiff’s expert’s causation testimony, finding it dispositive of the case.

Plaintiff’s theory was essentially that defendant doctor could have given the PA “his knowledge and expertise,” that he should have communicated with the ENT about the mother’s condition, and that he should have “advocated for [the mother] by calling back [the ENT] or making alternative arrangements” for the mother. When looking at plaintiff’s expert’s testimony, the Court noted:

[Expert’s] testimony as to causation does not establish, to a reasonable degree of medical certainty, that it is more likely than not that [the mother] would not have suffered injury and death but-for the alleged negligent supervision by [defendant]. [Expert] faults [defendant] for not ensuring that [the ENT] arrived to assess [the mother]. However, [expert] was not able to say whether [the ENT] would have performed any particular procedure that would have prevented [the mother’s] hypoxic event. Even if [the ENT] had arrived and attempted to intubate [the mother], [expert] conceded that there are difficulties and risks associated with establishing an airway in a patient with epiglottitis. Also, according to [expert], the determination of if, when, and what kind of procedure to perform would have been dependent on medical conclusions of the ENT and anesthesiologist involved—not [defendant].

The Court found that this testimony had “too many contingencies and [was] the equivalent of a domino theory of causation.” Based on this analysis, the Court held that the expert’s testimony “did not establish, with a reasonable degree of medical certainty, that [defendant’s] role as a supervising physician was, more likely than not, the cause of [the mother’s hypoxic event.” Accordingly, summary judgment was affirmed.


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