Frausto v. Yakima HMA, LLC
93312-0
| Wash. | Apr 27, 2017Background
- Rudy Frausto, a quadriplegic patient, developed pressure ulcers while hospitalized and sued Yakima HMA alleging nursing negligence caused the ulcers.
- Frausto submitted an affidavit from Karen Wilkinson, an ARNP with 30+ years’ experience, opining that nurses breached the standard of care and that the breach proximately caused the ulcers.
- Yakima HMA moved for summary judgment arguing Frausto lacked admissible expert proof of causation because nurses (including ARNPs) are categorically disqualified from testifying on medical causation.
- The trial court granted summary judgment, allowing the ARNP to testify on standard of care but ruling she could not testify on proximate cause as a matter of law.
- The Washington Supreme Court reviewed de novo (summary judgment posture) and considered whether ER 702 permits ARNPs to testify about causation given Washington’s statutes authorizing ARNPs to diagnose and treat within their scope.
- The Court reversed and remanded, holding that ARNPs are not per se disqualified; the trial court must determine under ER 702 whether a particular ARNP is qualified to testify on causation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ARNPs are categorically disqualified from testifying on proximate cause in medical malpractice cases | ARNPs may testify on causation if qualified under ER 702; Washington law allows ARNPs to diagnose and treat | Nurses (including ARNPs) are categorically incompetent to opine on medical causation and thus testimony must be excluded | Reversed: ARNPs are not categorically disqualified; admissibility is governed by ER 702 and the trial court's gatekeeping function |
| Proper standard of review for exclusion of expert causation testimony on summary judgment | De novo review applies because the ruling was made on summary judgment | Trial court abuse-of-discretion standard should govern evidentiary rulings | De novo review applied to the summary-judgment-based exclusion |
| Whether Washington nursing statutes bar ARNPs from diagnosing (impacting ability to opine on causation) | ARNP statutory scope includes authority to examine, diagnose, interpret tests, and prescribe within certification | Defendant relies on out-of-state cases where statutes forbid nurse diagnosis to support categorical bar | Washington statutes permit ARNPs limited independent diagnosis and treatment; statutory scheme supports case-by-case ER 702 analysis |
| Weight vs admissibility of nonphysician expert testimony | Nonphysician status affects weight, not automatic admissibility; court must evaluate qualifications and scope | Nonphysician testimony should be excluded as legally insufficient on causation | Admissibility is for the court under ER 702; challenges to credibility/weight remain for the jury |
Key Cases Cited
- Young v. Key Pharm., 112 Wn.2d 216 (Wash. 1989) (expert testimony generally necessary to establish medical standard of care)
- McKee v. Am. Home Prods. Corp., 113 Wn.2d 701 (Wash. 1989) (trial court evidentiary rulings reviewed for abuse of discretion)
- Colwell v. Holy Family Hosp., 104 Wn. App. 606 (Wash. Ct. App. 2001) (Court of Appeals held RN incompetent to testify to medical causation in that case)
- Hill v. Sacred Heart Med. Ctr., 143 Wn. App. 438 (Wash. Ct. App. 2008) (rejected categorical bar; expert scope, not title, governs admissibility under ER 702)
- Davies v. Holy Family Hosp., 144 Wn. App. 483 (Wash. Ct. App. 2008) (affirmed dismissal where RN was held not competent to testify as to cause of death)
- Gaines v. Comanche County Med. Hosp., 143 P.3d 203 (Okla. 2006) (pressure ulcer causation is primarily a nursing issue; nurses may testify under evidence rule)
- Freed v. Geisinger Med. Ctr., 601 Pa. 233 (Pa. 2009) (Pennsylvania Supreme Court allowed nurse causation testimony under rules of evidence despite nursing statute language)