The estate of Roddy Lee Patterson appeals the Fulton County Superior Court’s grant of summary judgment to the defendant-appellee Fulton-DeKalb Hospital Authority (“Hospital Authority”) in this medical malpractice action. We affirm.
The evidence shows that, on June 30, 1994, decedent Patterson presented himself to Grady Memorial Hospital, which is operated by the Hospital Authority. Patterson was 46 years old and complained of weakness on his left side; he reported that he had suffered a blow to his head two weeks earlier. Patterson’s health history indicated that he had been taking aspirin for pain, was a long-term smoker, and had a history of heavy alcohol consumption. The neurology attending physician directed a resident physician to administer Heparin, a blood-thinning agent. Later the same day, Patterson developed an intracerebral hemorrhage and died.
Patterson’s estate and the legal guardian of his two minor children (“the Pattersons”) filed suit against the hospital on June 20, 1996, alleging that the administration of Heparin deviated from a minimal standard of care and caused Patterson’s death. Attached to the complaint was an affidavit from Richard D. Franco, M. D., a neurologist, who stated that he had reviewed Patterson’s medical file; such files were not attached to the affidavit and are not included in the record. However, based solely upon his review of the medical files, Dr. Franco concluded that the use of Heparin “may have contributed” to Patterson’s death.
The Hospital Authority moved for summary judgment on June 10,1997, asserting that the Pattersons had failed to present evidence *707 that any alleged negligence on the part of the Hospital Authority or its agents was the proximate cause of the decedent’s death. The Hospital Authority attached to its motion an affidavit from the attending physician which affirmatively stated that the administration of Heparin was consistent with the standard of care ordinarily exercised by physicians under similar conditions and, farther, that such administration did not proximately cause or contribute to Patterson’s death. Finally, the Hospital Authority also claimed that Dr. Franco’s affidavit was without probative value on a motion for summary judgment, as the medical records upon which his conclusions were based were not attached to the affidavit, as required by OCGA § 9-11-56 (e).
In response, the Pattersons relied upon their pleadings and Dr. Franco’s affidavit and did not submit any additional evidence for consideration. On January 15, 1998, the trial court granted summary judgment to the Hospital Authority, finding that the Pattersons had failed to establish the required element of causation. This appeal followed. Held:
1. In the first enumeration of error, the Pattersons assert that the trial court erred in failing to consider Dr. Franco’s affidavit when ruling upon the summary judgment motion. This enumeration lacks merit. As shown in Division 2, infra, it is clear from the order that the trial court did, in fact, consider the affidavit in reaching its conclusion that the Pattersons had failed to establish causation. Accordingly, there was no error.
However, this Court notes that the medical records upon which Dr. Franco reached his conclusions were not attached to his affidavit or included in the record. Therefore, even though the affidavit may have been sufficient for pleading purposes under OCGA § 9-11-9.1 (a), the affidavit was insufficient under OCGA § 9-11-56 (e) to meet the evidentiary standards on a motion for summary judgment and, as a matter of law, lacked any probative value. See
Goring v. Martinez,
2. In the remaining enumerations of error, the Pattersons assert that the trial court misinterpreted this Court’s holding in
Abdul-Majeed v. Emory Univ. Hosp.,
“In order for a plaintiff to recover for malpractice, there must be sufficient evidence that the physician’s alleged failure to use the requisite degree of skill and diligence in treatment either proximately caused or contributed to plaintiff’s injury. [Cit.]”
McClure v. Clayton County Hosp. Auth.,
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The standard of proof in a civil case, even a medical malpractice action, is by a preponderance of the evidence. OCGA §§ 24-1-1; 24-4-3;
Life Ins. Co. of Ga. v. Lawler,
Thus, “reasonable medical probability” has no greater meaning than a preponderance of the evidence, and the standard of proof is preponderance of the evidence as to medical causation. “Moreover, we note that although we have frequently used the phrase ‘reasonable medical certainty,’ [cit.], it is neither magic nor particularly helpful. [Cit.] What courts and juries need from medical experts is not a simple recitation of these words, but a realistic assessment of the likelihood that the alleged negligence caused the injury or death.”
Abdul-Majeed,
supra at 609. See also
Ga. Cas. &c. Co. v. Jernigan,
“The above medical evidence is sufficient to establish the
possibility
of a causal relation, even if it falls short of showing
probability.
The cases requiring affirmative medical evidence of
probability,
[cits.], are distinguishable in that they involved issues of causation which, by the nature of the situation, could be resolved solely by expert medical evidence standing alone, in which cases the evidence must naturally be based at least on reasonable probability. ‘It appears to be well settled that medical testimony as to the
possibility
of a causal relation between a given accident or injury and the subsequent death or impaired physical or mental condition of the person injured is not sufficient,
standing alone,
to establish such relation.’
There is an often cited quotation “ ‘that a physician may have been negligent is not sufficient to render him liable, and the complaining patient must prove that the injury complained of proximately resulted from such want of care or skill. A bare possibility of such result is not sufficient.’ 61 AmJur2d 348, Physicians, Surgeons, and Other Healers, § 210 and cits.”
Parrott v. Chatham County Hosp. Auth.,
Where, as here, the defendant hospital makes a motion for summary judgment and the attending physician gives a medical affidavit that states a medical opinion that the alleged deviation from the standard of care has no causal connection with the injury or aggravated a pre-existing condition, such motion has pierced the plaintiff’s pleadings, refuted causation, and shifted the burden to the plaintiff of coming forward with some evidence to create a material issue of fact, because the defendant hospital has disproved the essential ele
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ment of causation. OCGA § 9-11-56 (e). When causation is involved, plaintiff has a more complex dilemma where the defendant has given expert testimony that there was no proximate cause, because to merely show a causal link does not refute the defendant’s denial of causation and leaves an examination upon the entire record that the evidence does not create a triable issue as to the essential elements of causation, requiring the grant of summary judgment. See
Lau’s Corp. v.
Haskins,
In this case, the trial court found that Dr. Franco’s assertion that the alleged negligence “may have contributed” to the decedent’s injury and subsequent death was legally insufficient to establish causation that the probability was such that negligence was the proximate cause of injury or death, i.e., by a preponderance of evidence or “a realistic assessment of the likelihood that the alleged negligence caused injury or death” from all the evidence. Abdul-Majeed, supra at 609. There was no error as to this conclusion of law under the facts and circumstances of this case.
Further, the Pattersons failed to present any other evidence of causation to support their medical expert’s opinion as to causation. See
Nat. Dairy &c. Corp. v. Durham,
supra at 422-423. When presented with the attending physician’s affidavit, the Pattersons could not rest on their pleadings, but had to come forward with competent expert counter-evidence, medical records, or other non-medical evidence that together created a genuine issue of fact as to causation to rebut the Hospital Authority’s affidavit as to the absence of causation. OCGA § 9-11-56 (e);
Lau’s Corp. v. Haskins,
supra;
Williams v. Hajosy,
supra at 638 (2);
Savannah Valley &c. Assn. v. Cheek,
Judgment affirmed.