Swanigan v. Avenues Healthcare, 524 P.3d 173

Carl Swanigan was a long‑term resident of Avenues Healthcare; he repeatedly refused wound care; by Oct 2013 he had severe infections in both feet and was hospitalized for likely bilateral amputation.
Swanigan died of a heart attack before surgery; autopsy showed an occlusive thrombus in the proximal left anterior descending coronary artery.
The Estate sued Avenues (and parent Ensign) for medical malpractice/wrongful death, designating a medical expert (Expert) who opined infection → inflammation → thrombosis → myocardial infarction.
Expert conceded his causation theory was not generally accepted and relied mainly on a 2004 NEJM article showing association (not causation); he admitted the theory was untested.
The district court struck Expert under Utah R. Evid. 702 for lack of general acceptance or other demonstrated reliability, and found the Estate had no admissible expert causation evidence.
The court granted summary judgment for Avenues on malpractice and wrongful death claims because no admissible expert evidence established proximate causation; other designated witnesses did not offer causation opinions.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the court abused its discretion by excluding Expert’s testimony under Utah R. Evid. 702	Expert’s opinion required only a threshold showing of reliability; exclusion improperly demanded scientific certainty	Expert’s theory was untested, not generally accepted, and lacked sufficient facts/data to be reliable	Affirmed: exclusion proper — testimony lacked general acceptance and sufficient reliable basis
Whether summary judgment was improper because other designated experts showed causation	Estate argued other experts/facts showed poor care and supported causation	Avenues argued no admissible expert connected any breach to the heart attack or other injuries	Affirmed: summary judgment proper — no admissible expert causation; other witnesses did not establish proximate cause

State v. Lopez, 417 P.3d 116 (Utah 2018) (trial judges act as gatekeepers to exclude unreliable expert testimony)
Taylor v. University of Utah, 438 P.3d 975 (Utah Ct. App. 2019) (expert opinion admissible only after threshold showing of reliable principles/facts and reliable application)
State v. Wall, 460 P.3d 1058 (Utah Ct. App. 2020) (abuse‑of‑discretion review of expert‑testimony evidentiary rulings)
Butterfield v. Okubo, 831 P.2d 97 (Utah 1992) (medical malpractice requires expert proof of proximate cause)
Kent v. Pioneer Valley Hosp., 930 P.2d 904 (Utah Ct. App. 1997) (complex medical causation requires expert testimony)
Ruiz v. Killebrew, 459 P.3d 1005 (Utah 2020) (plaintiffs must produce expert testimony to avoid speculative proximate cause)
Cruzan v. Director, Mo. Dep’t of Health, 497 U.S. 261 (U.S. 1990) (competent adults have a liberty interest to refuse medical treatment)