Fritz Swint v. Tonya Mae, 340 Ga. App. 480

On December 3, 2009, Mr. Swint underwent a robotic-assisted laparoscopic prostatectomy (RALP) in steep Trendelenburg with arms tucked; the surgery lasted ~9 hours 21 minutes.
Dr. Alphonse (surgeon) and Dr. Pak (proctor) positioned the patient; Dr. Mae (anesthesiologist) tilted the table; Nurse Roy was the circulating nurse.
Plaintiffs alleged Defendants (Dr. Mae and Nurse Roy) breached the standard of care by failing to correctly position and/or insist on repositioning Mr. Swint, causing right-arm compartment syndrome and permanent injury.
Plaintiffs’ proximate-cause proof relied on expert testimony from Drs. Rosenfeld and Palese, who offered differing opinions about timing and causation (initial positioning, length of surgery, or both).
Experts conceded limited or no documentary support that initial positioning violated the standard of care, were uncertain about when the injury occurred, and could not quantify how repositioning would have prevented the injury.
Trial court granted summary judgment for Defendants for lack of causation; Court of Appeals affirmed, finding expert testimony legally insufficient to establish proximate causation to a reasonable medical probability.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Plaintiffs presented expert proof that Defendants’ actions in initial positioning proximately caused the injury	Swint: experts show initial positioning or mispositioning contributed to injury	Defs: experts uncertain; no testimony to a reasonable degree of medical certainty linking Defs’ acts to injury	Held: expert opinions were speculative or equivocal; insufficient to establish causation
Whether failure to insist on repositioning proximately caused the injury	Swint: expert Rosenfeld opined insistence to reposition may have avoided or lessened injury	Defs: even if negligent, plaintiffs must show more than possibility that insistence would have changed outcome; no causal link proved	Held: plaintiffs failed to show that insisting on repositioning would probably have prevented or lessened injury; speculation insufficient
Whether the trial court misapplied the standard for medical causation by requiring speculation about the surgeon’s response	Swint: court improperly required experts to speculate about how Dr. Alphonse would act if Defs insisted	Defs: surgeon’s response is irrelevant; plaintiffs still must prove causation to reasonable medical probability	Held: no misapplication — court properly required non-speculative expert causation evidence

Zwiren v. Thompson, 276 Ga. 498 (expert must give basis for confidence in causation opinion)
Knight v. Roberts, 316 Ga. App. 599 (medical causation requires reasonable degree of medical certainty; jury issue from experts)
Allen v. Family Med. Ctr., P.C., 287 Ga. App. 522 (causation may be established by linking multiple experts but must meet probative standard)
Anthony v. Chambless, 231 Ga. App. 657 (summary judgment standard and need to show causation beyond mere possibility)
Cannon v. Jeffries, 250 Ga. App. 371 (expert testimony that negligence "may have contributed" is insufficient to avoid summary judgment)