245 So. 3d 58
La. Ct. App.2018Background
- Plaintiff sued multiple healthcare providers after Mr. Smallwood died of a pulmonary embolism, alleging failure to prevent, diagnose, and treat post-operative deep vein thrombosis (DVT).
- Plaintiff's expert was Dr. Leo Frangipane, a board‑certified general (and grandfathered vascular) surgeon, who testified defendants breached the standard of care by not providing pharmacologic DVT prophylaxis.
- Defendants argued Dr. Frangipane was not qualified to opine as to the standards of care for specialists (orthopedics, hospital medicine, nurse practitioner, rehab medical director) and moved for directed verdicts.
- Trial court admitted Dr. Frangipane as an expert in general surgery/medicine and granted directed verdicts for all defendants except Dr. Hawawini; on appeal the court reviewed those rulings.
- Appellate court held Dr. Frangipane was admissible despite not sharing each defendant’s specialty (discipline overlap and subject‑matter knowledge can suffice), reversed directed verdicts for all defendants except Dr. Hawawini, and remanded for trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of expert testimony | Dr. Frangipane, as a general/vascular surgeon, is qualified to state standards for DVT care across specialties | Experts must share the same specialty as each defendant to testify on standard of care | Admissible: court has broad discretion; cross‑specialty testimony allowed if expert has requisite subject‑matter knowledge |
| Whether negligence standard was established | Frangipane testified defendants failed to provide pharmacologic prophylaxis and missed/failed to diagnose DVT | Defendants contended Frangipane lacks specialty expertise and his opinions are not binding | Evidence sufficient to defeat directed verdicts as to most defendants; factual issues for jury |
| Causation (did breach cause death) | Frangipane opined breach was responsible for pulmonary embolism and death | Defendants argued causation not proven by expert | Expert testimony met preponderance standard to submit causation to jury |
| Directed verdict re: medical director (Dr. Hawawini) | Plaintiff argued systemic/director responsibility for DVT care standards | Defendants noted lack of evidence Dr. Hawawini had direct patient care duties or breached director duties | Directed verdict for Dr. Hawawini upheld (no evidence of applicable standard or breach) |
Key Cases Cited
- Pfiffner v. Correa, 643 So.2d 1228 (La. 1994) (expert testimony generally required to prove standard of care and causation; obvious negligence exception)
- Johnson v. Morehouse Gen. Hosp., 63 So.3d 87 (La. 2011) (district court has broad discretion to admit expert testimony)
- Minor v. Bryan, 206 So.3d 1070 (La. App. 4 Cir. 2016) (restating plaintiff’s burden in medical malpractice: standard, breach, causation)
- Soteropulos v. Schmidt, 556 So.2d 276 (La. App. 4 Cir. 1990) (specialist may testify outside specialty where standards overlap)
- Smith v. Juneau, 642 So.2d 860 (La. 1994) (physician in one specialty may testify about standards common to multiple disciplines, e.g., skin care/pressure ulcers)