419 P.3d 956
Ariz. Ct. App.2018Background
- Karyn Rasor developed a stage IV pressure (decubitus) ulcer after open-heart surgery and ICU care at Northwest Medical Center, including use of an intra-aortic balloon pump and prolonged immobilization.
- The Rasors sued the hospital for malpractice, alleging failure to off-load pressure and timely discover/intervene, retaining one expert, Julie Ho, a board-certified wound-care registered nurse.
- The trial court initially allowed Ho to testify on standard of care but expressed concerns about causation; nonetheless it later granted summary judgment for Northwest and denied the Rasors leave to obtain a new expert.
- This court (Rasor I) held Ho unqualified to testify to the standard of care and vacated summary judgment; the Arizona Supreme Court (Rasor II) agreed Ho was not a standard-of-care expert but remanded to decide whether Ho could nonetheless testify on causation or whether causation expert testimony was unnecessary.
- On remand this court concluded causation in this case is not "readily apparent" and therefore expert causation testimony was required, and that under Rule 702 and Arizona law a nurse (Julie Ho) may be qualified to offer causation opinion based on specialized knowledge, training, and experience.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether causation is a matter fit for lay juror inference or requires expert testimony | Rasor: pressure-over-bone mechanism is readily apparent; no expert needed | Northwest: causation is complex and multifactorial | Held: expert causation testimony required (not "readily apparent") |
| Whether a nurse can qualify as a causation expert in medical malpractice cases | Rasor: Nurse Ho's wound-care training/ICU experience qualifies her under Rule 702 | Northwest: nurses lack education/legal authority to render medical causation; should be barred | Held: No bright-line ban; Rule 702 governs and nurses may testify on causation if qualified |
| Whether Julie Ho was qualified to testify to causation under Rule 702 | Rasor: Ho's wound-care certification, ICU experience, review of records, and role justify qualification | Northwest: Ho failed to review full record, disclaimed considering comorbidities, thereby lacking sufficient foundation | Held: Ho is qualified to testify as a causation expert; deficiencies go to weight, not admissibility |
| Appropriate remedy and next steps after earlier vacatur of summary judgment | Rasor: opportunity to obtain a qualified standard-of-care expert under Rule 56(d) | Northwest: summary judgment previously proper based on lack of qualified expert | Held: Vacate summary judgment; remand for trial court to consider Rasors' Rule 56(d) motion and other proceedings; allow limiting measures if testimony conflates causation and standard of care |
Key Cases Cited
- Rasor v. Nw. Hosp., LLC, 239 Ariz. 546 (App. 2016) (prior panel opinion finding proffered expert unqualified on standard of care)
- Rasor v. Nw. Hosp., LLC, 243 Ariz. 160 (2017) (Arizona Supreme Court remand instructing appellate court to address causation expert issues)
- Salica v. Tucson Heart Hosp.-Carondelet, L.L.C., 224 Ariz. 414 (expert testimony required unless causal link is readily apparent)
- Seisinger v. Siebel, 220 Ariz. 85 (discussing heightened statutory standard for standard-of-care experts under § 12-2604)
- Bernstein, 237 Ariz. 226 (Rule 702’s gatekeeping purpose and flexibility in close cases)
- Frausto v. Yakima HMA, LLC, 393 P.3d 776 (Wash. 2017) (permitting nurses as causation experts; discussing jurisdictions’ approaches)
- Lohmeier v. Hammer, 214 Ariz. 57 (nurse may testify on causation if possessing specialized knowledge helpful to jury)