169 So. 3d 814
La. Ct. App.2015Background
- Donald Fields Sr., a 56-year-old renal transplant patient, presented with two weeks of diarrhea to Dr. Smith’s clinic but was seen by nurse practitioner Patricia McGovern, who consulted Dr. Smith and prescribed metronidazole (Flagyl).
- Fields called nine days later reporting worsening symptoms and allegedly was told to continue the medication; no follow-up appointment was made.
- Fields collapsed the next day and died; Arkansas death certificate listed cause as “acute cardiovascular event” (no autopsy performed).
- Plaintiffs (Fields’s children) brought a medical-malpractice claim; a medical review panel (MRP) found no breach of care and no causation because the patient failed to follow up within 48 hours.
- Plaintiffs submitted an expert affidavit (Dr. Blanche Borzell) that identified breaches (failure to order basic metabolic panel, stool studies, schedule follow-up, and improper prescription of Flagyl) and asserted those breaches caused or contributed to Fields’s death.
- The district court granted summary judgment for Nurse McGovern and Dr. Smith, finding Dr. Borzell’s causation opinion conclusory and insufficient to overcome the death certificate; the appellate court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Adequacy of expert causation evidence to defeat summary judgment | Dr. Borzell’s affidavit established breach and stated those breaches caused or contributed to death | Dr. Borzell’s causation statement is conclusory and fails to connect breaches to the listed cardiac cause of death | Held: Expert affidavit insufficient on causation; summary judgment proper |
| Burden at summary judgment when expert shows breach but not causation | Plaintiffs need not anticipate defendant’s asserted cause of death; expert linkage to death is adequate | Defendant need not disprove negligence; plaintiff must produce evidence on essential elements (including causation) | Held: Plaintiff must produce admissible evidence on causation to survive motion |
| Reliance on death certificate as evidence of cause of death | Plaintiff disputed heart attack verbally but offered no evidence to rebut certificate | Defendants rely on death certificate listing acute cardiovascular event as cause | Held: Death certificate stands uncontested by admissible evidence and supports summary judgment |
| Legal sufficiency of MRP finding versus competing expert affidavit | Plaintiffs argue MRP’s conclusion is not dispositive and expert shows genuine issue on breach | Defendants cite MRP and argue absence of causation evidence is fatal | Held: MRP and lack of causation evidence together permit summary judgment despite dispute over breach |
Key Cases Cited
- Pfiffner v. Correa, 643 So.2d 1228 (La. 1994) (elements of medical-malpractice claim: standard of care, breach, causation)
- Samaha v. Rau, 977 So.2d 880 (La. 2008) (expert testimony generally required to establish medical standard and breach)
- Independent Fire Ins. Co. v. Sunbeam Corp., 755 So.2d 226 (La. 2000) (expert opinion must be more than conclusory to defeat summary judgment)
- Foster v. Patwardhan, 132 So.3d 495 (La. App. 2 Cir. 2014) (affidavit concluding causation without underlying facts insufficient to oppose summary judgment)