491 P.3d 1115
Ariz.2021Background
- Four-year-old Amaré Burks underwent routine tonsillectomy/adenoidectomy at the Surgery Center of Peoria and was discharged from the PACU about 61 minutes after surgery; he was unresponsive and died about two hours after discharge.
- Plaintiff Michelle Sampson retained Dr. Greenberg as her expert; he opined the appropriate post-op observation could be one to three hours (especially with sleep-apnea history) and that longer observation "could have" allowed resuscitation but did not testify that inadequate observation was the probable cause of death.
- The Surgery Center and anesthesiologist moved for partial summary judgment arguing plaintiff lacked expert causation evidence; the trial court granted the motion, finding causation required medical expertise and was not within lay knowledge.
- The court of appeals reversed, concluding a jury could infer causation from a violation of an alleged three-hour observation standard even though the expert gave a one- to three-hour range and did not opine probable causation.
- The Arizona Supreme Court granted review and held that where cause of death is disputed and not obvious to laypersons, expert testimony establishing probable causation is required; it affirmed the trial court and vacated the court of appeals decision.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether expert causation testimony is required in medical malpractice when cause is disputed and not obvious | Sampson: breach of standard (Dr. Greenberg) makes causation inferable by jury as obvious | Surgery Center: expert did not show probable proximate cause; causation requires expert proof | Expert causation is required unless causation is "readily apparent" to lay jurors; where cause is disputed/medical, jury cannot infer causation |
Key Cases Cited
- Rasor v. Northwest Hosp., LLC, 243 Ariz. 160 (recognizes causation-expert requirements; jury may infer only when readily apparent)
- Seisinger v. Siebel, 220 Ariz. 85 (expert testimony normally required to establish standard of care and causation)
- Barrett v. Harris, 207 Ariz. 374 (defines proximate cause as a natural, continuous sequence and limits jury inference)
- Spielman v. Industrial Comm'n of Ariz., 163 Ariz. 493 (expert's failure to commit to causation requires dismissal; lay inference insufficient)
- Morrison v. Acton, 68 Ariz. 27 (example where negligence and causation were grossly apparent and jury could infer causation)
- Robertson v. Sixpence Inns of Am., Inc., 163 Ariz. 539 (causation must be probable, not speculative)