2018 Ohio 664
Ohio Ct. App.2018Background
- Gaye Harris-Miles, with history of interstitial lung disease and bronchiectasis, underwent arthroscopic rotator cuff surgery by Dr. Alfred Serna at Cleveland Clinic–Lakewood on October 6, 2014; post-op she developed alveolar hemorrhage and was transferred to the main Cleveland Clinic campus.
- Pulmonologist Dr. Highland cleared Harris-Miles for surgery on September 8, 2014, recommending a hospital setting (not an outpatient surgery center) because supplemental oxygen might be needed.
- Plaintiffs sued Dr. Serna, unnamed anesthesiologists, and Cleveland Clinic (respondeat superior), alleging negligent care; plaintiffs supplied an affidavit of merit from family-medicine physician Casey Darrah, M.D.
- Defendants moved for summary judgment arguing (inter alia) the proffered expert was unqualified or insufficient on standard of care and causation; trial court granted summary judgment for Serna and Cleveland Clinic; judgment affirmed on appeal.
- Central contested issue on appeal: whether Dr. Darrah’s testimony established, to a reasonable degree of medical probability, that defendants’ breach (failure to prescribe pre-op steroid/pulmonary management) proximately caused the alveolar hemorrhage.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiff's expert was qualified to opine on standard of care for surgeon/anesthesiologist/pulmonologist | Darrah (family medicine) was experienced with pre-/post-op care and alveolar hemorrhage and thus qualified to offer standard-of-care opinions | Darrah lacked specialty training in orthopedics, pulmonology, and anesthesiology and thus was unqualified to opine on those specialties | Court found Darrah’s qualifications insufficient to support reliable causation opinions for the specialties at issue (expert testimony ultimately inadequate) |
| Whether expert established breach of care by Dr. Serna or others | Darrah argued pulmonology clearance should have noted ILD and slow emergence and that steroids should have been used pre-op | Defendants argued Darrah did not identify actionable acts/omissions by Serna and that pulmonology’s clearance negated causation | Court focused on causation failure rather than detailed breach findings; breach testimony was not proved to the requisite standard of causation |
| Whether expert established proximate causation (more likely than not) | Darrah testified steroids would have changed management and mitigate risk of hemorrhage; plaintiffs contended a "could have prevented" standard sufficed | Defendants argued Darrah could not state, to a reasonable degree of medical probability (>50%), that steroid use would have prevented the hemorrhage | Court held Darrah could not state causation to a reasonable degree of medical probability; his testimony (saying "reduced the risk" but not >50% likelihood) was legally insufficient and thus inadmissible |
| Whether Cleveland Clinic is liable absent a viable claim against the pulmonologist | Plaintiffs argued Clinic can be liable under respondeat superior regardless of whether Dr. Highland was separately liable | Defendants argued no proximate cause established against treating physicians, so Clinic cannot be liable | Because causation evidence failed, claims against Clinic also failed; summary judgment affirmed |
Key Cases Cited
- Grafton v. Ohio Edison Co., 77 Ohio St.3d 102 (de novo standard for appellate review of summary judgment)
- Harless v. Willis Day Warehousing Co., 54 Ohio St.2d 64 (summary judgment standards)
- Mitseff v. Wheeler, 38 Ohio St.3d 112 (movant must specifically delineate basis for summary judgment)
- Dresher v. Burt, 75 Ohio St.3d 280 (adverse party must present specific facts showing genuine dispute)
- Stinson v. England, 69 Ohio St.3d 451 (causation expert must state opinion in terms of probability—>50% standard)
- Wells v. Miami Valley Hosp., 90 Ohio App.3d 840 (language like "could" or "chance" is insufficient to establish probability)
- Culp v. Olukoga, 3 N.E.3d 724 (summary judgment proper where plaintiff fails to present expert proving breach and proximate cause)