Jaki Holzer v. Ascension Providence Rochester, 369402

Plaintiff Jaki Holzer underwent a breast biopsy in 2017 performed by Dr. Jeffrey Shulak, during which her saline breast implant was allegedly punctured, causing rupture and subsequent pain.
Diagnostic mammogram immediately after the biopsy confirmed evidence of implant puncture/deflation not present before.
Plaintiff's radiology expert, Dr. Washburn, testified that the Mammotome needle caused scars and one likely punctured or compromised the implant, leading to rupture.
Plaintiff subsequently required two removal and replacement surgeries due to the rupture, and claims ongoing pain and disability.
The trial court granted summary disposition for the defendants, holding there was insufficient evidence that Dr. Shulak's alleged breach proximately caused the injuries.
On appeal, the Michigan Court of Appeals reversed, finding a genuine issue of material fact regarding proximate causation to be resolved by a jury.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether expert causation testimony supports proximate cause between Dr. Shulak’s conduct and the implant’s rupture	Washburn’s testimony and implant photos infer the biopsy caused the rupture	No direct image of needle inside the implant; causation testimony speculative	Genuine issue of material fact; jury must decide
Admissibility of circumstantial expert evidence	Circumstantial evidence and expert opinion suffice under law	Only direct evidence should be considered; photos are not authentic/evidence inadmissible	Circumstantial evidence and photo are plausibly admissible in summary judgment context
Causal nexus between rupture and plaintiff’s pain	Expert and lay testimony show rupture caused ongoing pain	Plaintiff’s pain not proven to be from the rupture or breach	Genuine issue of material fact; sufficient evidence for jury
Summary disposition appropriateness	Factual dispute precludes summary judgment	No material issue as to causation, so summary disposition proper	Trial court erred; summary disposition inappropriate

Elher v. Misra, 499 Mich 1 (Mich. 2016) (medical malpractice plaintiff must show breach of standard of care proximately caused injury)
Wischmeyer v. Schanz, 449 Mich 469 (Mich. 1995) (elements of medical malpractice: standard of care, breach, injury, proximate causation)
Skinner v. Square D Co, 445 Mich 153 (Mich. 1993) (distinguishes reasonable inference from conjecture for causation)
Craig v. Oakwood Hosp, 471 Mich 67 (Mich. 2004) (sets forth components of proximate cause: cause in fact and legal cause)
Maiden v. Rozwood, 461 Mich 109 (Mich. 1999) (de novo review and standards for summary disposition)