Stokes v. Baker, 248 Cal. Rptr. 3d 174

Background

On May 25, 2014 Ms. Stokes presented to Torrance Memorial ED with sudden severe headache and neck pain; CT was negative and Dr. Baker (ED physician) discharged her with neurology follow-up; no lumbar puncture was performed.
On June 4, 2014 Ms. Stokes suffered a ruptured cerebral aneurysm with significant morbidity; plaintiffs sued Dr. Baker for medical negligence alleging failure to diagnose a subarachnoid hemorrhage and to perform a lumbar puncture.
Plaintiffs offered: Dr. Ritter (EM physician) on standard of care, and Dr. Rappard (neurointerventional surgeon) on causation and likely better outcome with timely aneurysm repair.
Defendant moved for summary judgment and argued plaintiffs’ causation expert (Rappard) was barred by Health & Safety Code §1799.110(c) because he lacked recent ED experience; trial court struck Rappard, found Ritter’s causation opinion reliant on Rappard hearsay, and granted summary judgment.
The Court of Appeal reviewed de novo and considered statutory text, legislative history, Evidence Code §720, and practical consequences of a literal reading of §1799.110(c).

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Scope of §1799.110(c) expert-qualification requirement: does it bar all medical experts in suits against ED physicians or only those testifying about standard of care?	§1799.110(c) should be limited to experts testifying about the ED physician's standard of care; causation/damages experts need not have recent ED experience.	§1799.110(c) applies to any expert medical testimony in negligence actions against ED physicians because statute covers "any action for damages involving a claim of negligence."	The statute applies only to standard-of-care testimony. The trial court erred in striking the neurointerventional surgeon’s causation declaration.
Effect of a literal construction on Evidence Code §720 and trial fairness	Literal construction would bar qualified non-ED specialists (e.g., neurosurgeons) from testifying on causation/damages, producing absurd results and conflict with §720.	Literal reading is consistent with text and thus acceptable.	Literal reading would produce absurd and unintended results; §1799.110(c) should be harmonized with legislative intent and §720.
Whether plaintiffs raised a triable issue of causation after excluding Rappard	Rappard’s declaration (and Ritter’s supplemental reliance) supported a triable causation issue that should remain.	Trial court: without Rappard, plaintiffs lacked admissible causation proof; Ritter’s causation reliance was impermissible hearsay.	Because Rappard should not have been excluded on §1799.110(c) grounds, the causation issue remains triable.
Qualifications required for causation experts under Evidence Code §720	Causation experts must possess special knowledge/experience on the medical issues (e.g., aneurysm management), not necessarily ED assignment experience.	§1799.110(c) supplants or adds a general ED-experience requirement to all medical testimony.	Experts on causation must meet §720; they need expertise in the relevant specialty (neurosurgery/neurointervention) even if they lack recent ED assignment.

Key Cases Cited

Miranda v. National Emergency Services, Inc., 35 Cal.App.4th 894 (Cal. Ct. App. 1995) (statute’s expert-experience inquiry aims to ensure ED treatment is judged by ED standards)
James v. St. Elizabeth Community Hospital, 30 Cal.App.4th 73 (Cal. Ct. App. 1994) (ED physicians must be judged against emergency-care standards; emergency context matters)
Jutzi v. County of Los Angeles, 196 Cal.App.3d 637 (Cal. Ct. App. 1987) (legislative purpose: prevent second-guessing ED decisions by specialists in nonemergency settings)
Simpson Strong-Tie Co., Inc. v. Gore, 49 Cal.4th 12 (Cal. 2010) (courts may depart from literal text to avoid absurd results and effectuate legislative purpose)
Younger v. Superior Court, 21 Cal.3d 102 (Cal. 1978) (statutory language should not be given a literal meaning if it leads to absurd consequences)