Luis Cayamcela, M.D. v. Advocacy Trust, LLC et al and Hospitalist Services of Georgia P.C. v. Advocacy Trust, LLC et al
No. S26A0229, No. S26A0242
Supreme Court of Georgia
June 16, 2026
On Appeal from the Superior Court of Rockdale County No. 2021-CV-1902. Argued: February 3, 2026
PINSON, Justice.
Holly Baumstark died in the hospital after giving birth to her daughter by cesarean section. Her fiance (as administrator of her estate) and a conservator for her children sued several doctors and their medical practices, the hospital where Baumstark was treated, and other entities for medical malpractice resulting in wrongful death. Most of the defendants settled, leaving only one doctor and a medical staffing agency as defendants. After a trial, the jury found those defendants liable and awarded damages for pain and suffering to Baumstark‘s estate and damages for wrongful death to her children. On appeal, the defendants claim that an
I. Background
(a) In 2019, 27-year-old Holly Baumstark was pregnant with her second child. During her pregnancy, Baumstark was diagnosed with placenta previa, a condition where the placenta “covers all or part of the opening in the cervix.” This put her at a higher risk for developing another condition called placenta accreta spectrum (PAS) when “the placenta grows through the intrauterine wall,” essentially attaching to something outside of the uterus such as another organ. A patient with PAS is at risk for hemorrhaging.
That July, Baumstark gave birth to her daughter by cesarean section (or “C-section“) at Piedmont Rockdale Hospital. During delivery, it became clear that Baumstark had developed PAS and she suffered a “massive hemorrhage.” To control the bleeding, Dr. Meredith Delp, the obstetrician who performed Baumstark‘s C-section, proceeded with an emergent hysterectomy. After several hours of surgical repairs,1 Baumstark was moved to the intensive care unit for close monitoring.
(b) Baumstark‘s fiance, Lee Blasingame, sued (on behalf of his two children with Baumstark and as administrator of Baumstark‘s estate) in Rockdale County Superior Court for medical malpractice resulting in wrongful death. Later, appellee Advocacy Trust, LLC, was appointed as limited conservator for the children and was substituted as party plaintiff for the children‘s claims in lieu of Blasingame. At the time of trial, the only remaining defendants were appellants Cayamcela and Hospitalist Services of Georgia.2
At trial, the plaintiffs presented expert witness testimony about the ways Cayamcela violated the standard of care as Baumstark‘s doctor, including failing to ensure that additional IV access was obtained and that an arterial line was placed, failing to administer sufficient IV fluids, blood products, and medications, failing to monitor and treat Baumstark‘s electrolyte imbalance, and failing to recognize and inform other doctors of Baumstark‘s need to return to surgery due to her continued bleeding. The jury found Cayamcela and Hospitalist Services liable for Baumstark‘s death and returned a $42 million verdict in favor of plaintiffs. In accordance with the verdict, the trial court entered a judgment awarding $10 million to Baumstark‘s estate for pain and suffering
After trial, the defendants moved for a new trial on several grounds, including that the trial court erred by excluding certain expert testimony, and incorrectly instructing the jury on the plaintiffs’ burden of proof and proximate causation. They also moved in the alternative to amend the judgment in accordance with the $350,000 cap on noneconomic damages imposed by
For their part, the plaintiffs sought attorney fees under
The defendants appealed to this Court, invoking our exclusive jurisdiction over cases in which the constitutionality of a law
II. Analysis
The defendants raise four claims on appeal. They claim that the trial court erred in failing to grant them a new trial on two different bases: that the trial court erred in excluding certain expert testimony, and that it erred in giving a jury charge that shifted the burden to defendants to disprove liability. They claim that the trial court erred in declining to apply the $350,000 cap on noneconomic damages imposed by
A. Expert Testimony
The defendants claim that the trial court erred by excluding as unreliable certain testimony of one of their experts, Dr. Steven Clark, under
1. About a week before trial began, the defendants identified for plaintiffs several portions of deposition testimony from Clark that they wanted to use at trial. In response, plaintiffs moved to exclude or limit the use of Clark‘s testimony. Clark, a full-time faculty member at Baylor College of Medicine specializing in obstetrics and gynecology, was originally retained as an expert by a co-defendant doctor. After that co-defendant settled and was dismissed from the case, Cayamcela identified Clark as a possible witness for trial.
After some back and forth, the defendants indicated that they would seek to introduce only two parts of Clark‘s testimony that plaintiffs took issue with. The first portion of that testimony was Clark‘s answer to a compound question about when the standard of care required taking Baumstark back into surgery while in the ICU, and whether she was stable enough to do so. The second portion of that testimony was Clark‘s statement that he knew “[Delp‘s] violations of the standard of care and nothing else” “resulted in the death of Ms. Baumstark.” The trial court granted the plaintiffs’ motion to exclude the testimony, concluding that the testimony was not supported by sufficient evidence of reliability because Clark testified that he hadn‘t reviewed parts of Baumstark‘s ICU records “well enough” to “know enough information” to answer questions about details of her care in the ICU.
The defendants also contend that the trial court erred in excluding the evidence as unreliable under Rule 702(b) because plaintiffs never challenged the expert‘s reliability under that subsection. But the plaintiffs’ motion in limine expressly identified Rule 702 as one basis for its objections to Clark‘s testimony, and in doing so, they argued that this specific testimony was not supported by sufficient evidence of reliability.
On the merits, the defendants contend that the trial court should not have excluded Clark‘s testimony as unreliable.
Rule 702 requires a trial court to “assess the reliability of proposed expert testimony.” Dubois v. Brantley, 297 Ga. 575, 580 (2015). See also Am. Gen. Life Ins. Co. v. Schoenthal Fam., LLC, 555 F.3d 1331, 1338 (11th Cir. 2009) (explaining that a trial court must “determine that proffered expert testimony is both reliable and relevant“). In doing so, the trial court must ask whether the testimony of the expert is “based upon sufficient facts or data” and “the product of reliable principles and methods,” and whether the expert “has applied the principles and methods reliably to the facts of the case.”
The trial court here did not abuse its broad discretion when it excluded the challenged portions of Clark‘s testimony under Rule 702(b). The trial court explained in its order that Clark‘s testimony lacked a sufficient basis in facts and data and pointed to
B. Instructional Error
The defendants claim that the trial court erred by charging the jury with an instruction that improperly shifted the burden of proof from plaintiffs to defendants. That instruction told the jury that “[t]here may be more than one proximate cause of an injury or death,” and that “[t]he Defendants bear the burden of proof on their contention as to whether or not the negligence of other medical professionals was the sole proximate cause of Holly Ann Baumstark‘s injuries and death.”
Because the defendants failed to object to this instruction at trial, our review on appeal is limited to whether there has been a “substantial error in the charge which was harmful as a matter of law.”
The defendants here affirmatively waived this instructional error. Before the charge conference, the defendants had proposed an instruction that stated essentially the opposite of the challenged instruction: that the defendants did not have any burden of proof as to whether someone else‘s conduct caused Baumstark‘s death.7 And then, during a colloquy with the trial court, defense counsel withdrew all the defendants’ proposed instructions, including that one. When the trial court asked defense counsel if he wanted to add any pattern instructions from the defendants’ proposed charges; if any non-pattern charges from the defendants’ list needed to be discussed; and finally, if the defendants had “anything to add to what we‘ve have already approved,” defense counsel indicated that they did not have anything to add from the defendants’ proposed instructions, and he told the court that he thought their charges were “covered by the patterns.” Nor
C. Damages Cap
The defendants raise a number of claims of error related to application of the statutory damages cap,
Under our decision in Clark v. Leigh, ___ Ga. ___ (2026), S26A0349, slip. op. at 47, 52 (June 16, 2026), the damages cap of
[T]he cap statute‘s damages cap applies using a single operative mechanism: combine all the noneconomic damages awarded to all the parties into a single number and then limit that number to $350,000. No statutory text permits doing so only for some parties and some damages. So, in a case like this — where noneconomic damages to which the right to trial by jury applies are awarded as part of a jury‘s verdict in a medical malpractice action — there is simply no way to apply the statute‘s cap on noneconomic damages as written without violating the right to trial by jury.
Id. at 52. Just so here.
D. Attorney Fees
The defendants claim that the trial court erred in awarding attorney fees at all, because the plaintiffs did not make a valid offer of settlement under
1. Awarding Attorney Fees under OCGA § 9-11-68
Code section 9-11-68 was enacted to encourage tort litigants “to make and accept good faith settlement proposals [and so] avoid unnecessary litigation.” Ga. Dep‘t. of Corr. v. Couch, 295 Ga. 469, 471 (2014) (quotation marks omitted). Under that Code section, if a plaintiff makes a valid offer of settlement that is rejected by defendants and later “recovers a final judgment in an amount greater than 125 percent of such offer of settlement,” the plaintiff is entitled to recover “reasonable attorney‘s fees and expenses of litigation.”8
About a year after filing suit, the plaintiffs here served the defendants with an offer of settlement under
The defendants contend that the plaintiffs’ offer did not satisfy subsection (a)(7), which requires an offer to “[s]tate whether the proposal includes attorney‘s fees or other expenses and whether attorney‘s fees or other expenses are part of the legal claim.”
2. Amount of Attorney Fees
The defendants contend that the trial court also erred in calculating the amount of the roughly $11.8 million in fees. We review a trial court‘s decision as to the amount that comprises reasonable attorney fees for abuse of discretion. Simmons v. Cmty. Renewal and Redemption, LLC, 286 Ga. 6, 9 (2009)). If the court makes a legal error that “infect[s]” the exercise of its discretion, then the trial court has abused its discretion. Rockdale Hosp., LLC v. Evans, 306 Ga. 847, 851 (2019).
The defendants rest their claim of error on the dual premises that trial courts may not consider contingency fee agreements at all when awarding attorney fees, and that the trial court here relied “almost entirely” on the plaintiffs’ contingency fee agreement. But both premises are mistaken.
For their premise that trial courts may not consider contingency fee agreements at all when considering attorney fees, the defendants rely on
As for the defendants’ premise that the trial court relied “almost entirely” on the fee agreement, the trial court‘s order shows otherwise. The court explained that although the plaintiffs “prove[d] their total incurred fees by way of their fee agreement and testimony about their fee agreement,” they proved the reasonableness of their fees “not by way of their fee agreement or even testimony about the agreement,” consistent with
Judgment affirmed. All the Justices concur.
Notes
A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise, if:
- The expert‘s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;
- The testimony is based upon sufficient facts or data;
- The testimony is the product of reliable principles and methods; and
- The expert has reliably applied the principles and methods to the facts of the case.
If you find from all the evidence that Dr. Cayamcela was not guilty of any act of negligence or wrongdoing, a verdict in the Plaintiffs’ favor is unlawful, even if the Defendants have not satisfactorily accounted for the occurrence. In other words, it is not necessary for the Defendants to prove to you what may have caused Holly Baumstark‘s death. If the evidence fails to show by a preponderance that Dr. Cayamcela was negligent or breached a duty owed to Holly Baumstark, then it is your duty to return a verdict in favor of Defendants, although the cause of Holly Baumstark‘s death may still be a matter of speculation.
At any time more than 30 days after the service of a summons and complaint on a party but not less than 30 days (or 20 days if it is a counteroffer) before trial, either party may serve upon
- Be in writing and state that it is being made pursuant to this Code section;
- Identify the party or parties making the proposal and the party or parties to whom the proposal is being made;
- Identify generally the claim or claims the proposal is attempting to resolve;
- State with particularity any relevant conditions;
- State the total amount of the proposal;
- State with particularity the amount proposed to settle a claim for punitive damages, if any;
- State whether the proposal includes attorney‘s fees or other expenses and whether attorney‘s fees or other expenses are part of the legal claim; and
- Include a certificate of service and be served by certified mail or statutory overnight delivery in the form required by Code Section 9-11-5.
