Moore v. Singh
326 Ga. App. 805
| Ga. Ct. App. | 2014Background
- Rosemary Moore (ESRD on dialysis) fell Dec. 23, 2008; initial ER x-ray read no fracture; diagnosed with ankle sprain and knee contusion but could not bear weight.
- She was admitted again Dec. 24 and treated by nephrologist Dr. Sonu Singh through Jan. 5, 2009; persistent left-leg pain noted but no CT/MRI/orthopedic consult ordered.
- Physical therapy documented pain localized to the tibial tuberosity/kneecap area on Dec. 27–29; Singh did not follow up with imaging or orthopedics.
- In late Feb.–Apr. 2009, other physicians diagnosed a healed displaced tibial fracture; orthopedist Dr. Orcutt performed corrective surgery April 2, 2009 (re-breaking and fixing the bone).
- Plaintiffs presented expert testimony that Singh’s exam/charting failed to localize symptoms and that a nondisplaced fracture should have been in the differential and could have been detected by CT/MRI, so earlier diagnosis might have avoided or lessened surgery.
- Trial court granted defendants’ motion for directed verdict finding insufficient expert proof of causation; Court of Appeals reversed, finding triable issues on breach and causation and ruling certain excluded expert percentage testimony should have been admitted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether directed verdict was proper on causation | Moore: expert proof linked Singh’s charting/exam breach to missed nondisplaced fracture that later displaced and required surgery | Defs: plaintiffs failed to show to a reasonable degree of medical probability that breach caused the injury or required surgery | Reversed—evidence created jury issue on whether breach led to missed diagnosis and more complicated/required surgery; directed verdict improper |
| Whether plaintiff presented adequate expert testimony of causation | Moore: combined experts (nephrology, orthopedics) supplied opinion beyond mere possibility linking breach to outcome | Defs: experts lacked required reasonable medical probability/used speculative language | Court: experts need not utter ‘‘magic words’’; Georgia requires more than possibility but reasonable medical probability/certainty language not mandatory—testimony sufficient to create jury question |
| Admissibility of orthopedic testimony giving 20–30% displacement probability | Moore: Orcutt’s percentage estimate (20–30%) on risk of displacement was a proper expert opinion | Defs: testimony was speculative and inconsistent with earlier deposition equivocation | Court: exclusion of the percentage estimate abused discretion; contradictions go to credibility for jury to weigh |
| Standard for reviewing directed verdict | N/A (procedural) | Defs: trial court properly applied standard and granted verdict | Court: directed verdict requires that all evidence demand a particular verdict; where evidence supports contrary verdict, motion should be denied—de novo review applies; any-evidence rule cannot justify grant here |
Key Cases Cited
- Zwiren v. Thompson, 276 Ga. 498 (Georgia 2003) (expert must state causation in terms stronger than mere possibility; reasonable medical probability acceptable)
- Knight v. Roberts, 316 Ga. App. 599 (Ga. Ct. App. 2012) (standards for causation/expert proof in malpractice cases)
- Walker v. Giles, 276 Ga. App. 632 (Ga. Ct. App. 2005) (questions of causation are typically for the jury; directed verdict standards)
- Ladner v. Northside Hosp., 314 Ga. App. 136 (Ga. Ct. App. 2012) (expert causation and directed verdict principles)
- Carden v. Burckhalter, 214 Ga. App. 487 (Ga. Ct. App. 1994) (discussion of directed verdict review standard in Georgia)
- Naik v. Booker, 303 Ga. App. 282 (Ga. Ct. App. 2010) (contradictions in expert testimony affect credibility, not admissibility)