146 Conn. App. 485
Conn. App. Ct.2013Background
- Decedent underwent PEG tube placement by Dr. William Ramsey; the tube perforated the small bowel and decedent later developed sepsis and died.
- Plaintiff (administrator) alleged Ramsey negligently failed to monitor postprocedure and obtain timely surgical consult, causing delay, sepsis, multiorgan failure and death.
- Plaintiff disclosed Dr. William Bisordi, a board‑certified gastroenterologist, to testify on standard of care and causation; Bisordi opined Ramsey’s failure to recognize a bowel perforation and obtain timely surgery more likely than not caused death.
- Defendants moved to preclude Bisordi’s causation testimony, arguing only a surgeon could opine on surgical outcome; the trial court granted the motion and ruled a surgical expert was required.
- The trial court then granted summary judgment for defendants based on absence of an expert on proximate causation; plaintiff appealed.
- Appellate court held the trial court abused its discretion by excluding Bisordi’s causation testimony and reversed, finding Bisordi’s gastroenterology expertise was directly applicable to causation here.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a non‑surgeon (gastroenterologist) may testify as to proximate causation where injury followed a bowel perforation from PEG placement | Bisordi’s training/experience gives him direct knowledge of bowel perforation, its progression to sepsis, and the effect of delayed surgical intervention; he can opine to a reasonable degree of medical probability | A surgeon is required to testify about surgical options, timing, likely outcomes, and whether timely surgery would have changed survival | Court: Bisordi was qualified; exclusion (and resulting summary judgment) was abuse of discretion—gastroenterologist’s expertise was sufficient here |
| Whether absence of a surgeon expert mandates summary judgment for defendant | Plaintiff: no statutory requirement that causation testimony come from same specialty; expert qualifications depend on knowledge/applicability | Defendant: this is a “surgical outcome” case requiring a surgical expert for causation | Court: rejected per se rule; causation expert need not be surgeon if witness has direct, applicable expertise |
| Whether plaintiff’s expert testimony would be speculative without surgical testimony | Plaintiff: undisputed perforation and known progression to sepsis give a sufficient factual basis for opinion | Defendant: without surgeon testimony on timing/outcome, causation opinions are speculative | Court: factual record (perforation, sepsis, autopsy, Bisordi’s familiarity) provided substantial basis for non‑surgeon opinion |
| Scope of trial court’s gatekeeping re: expert qualifications | Plaintiff: trial court must assess witness’s actual knowledge/experience, not title alone | Defendant: expert must have specific surgical competence to opine on outcomes | Court: gatekeeping should examine expertise breadth; title alone cannot bar admissibility here |
Key Cases Cited
- Grenier v. Commissioner of Transportation, 306 Conn. 523 (2012) (summary judgment standard and plenary appellate review)
- Monk v. Temple George Associates, LLC, 273 Conn. 108 (2005) (proximate cause: harm must be of same general nature as foreseeable risk)
- Wallace v. St. Francis Hosp. & Med. Ctr., 44 Conn. App. 257 (1997) (trial court may exclude non‑surgeon on surgical outcome where no factual basis supports opinion)
- Marshall v. Hartford Hospital, 65 Conn. App. 738 (2001) (expert admissibility governed by scope of witness’s knowledge, not title alone)
- Sargis v. Donahue, 142 Conn. App. 505 (2013) (reasonable‑probability standard for medical causation testimony)