Lead Opinion
Leslie Webb, Administratrix of the Estate of Robert B. Webb, III, (“Plaintiff’), filed a complaint against Wake Forest University Baptist Medical Center, University Dental Associates, North Carolina Baptist Hospital, Wake Forest University, Wake Forest University Physicians, Shilpa S. Buss, DDS, and Reena Patel, DDS (“Defendants”) on 13 July 2010. Plaintiff alleged that Robert B. Webb, III, (“the Decedent”) was under general anesthesia for oral surgery, teeth cleaning, and the extraction of four teeth performed on 13 March 2008. The Decedent was sent home the same day following the procedure. He became unresponsive at home on 14 March 2008 and was pronounced dead on 15 March 2008.
Defendants Wake Forest University Baptist Medical Center, North Carolina Baptist Hospital, Wake Forest University, Wake Forest University Physicians, Shilpa S. Buss, DDS, and Reena Patel, DDS, filed an answer on 30 September 2010. Defendant University Dental Associates filed a separate answer on 5 October 2010.
Defendants Wake Forest University Baptist Medical Center, North Carolina Baptist Hospital, Wake Forest University, Wake Forest University Physicians, Shilpa S. Buss, DDS, and Reena Patel, DDS, filed a motion for summary judgment on 26 July 2012. Defendant University Dental Associates filed a separate motion for summary judgment on 31 July 2012.
The trial court granted the motions for summary judgment as to “any and all allegations, claims, and causes of action involving the dental care provided to [the D]ecedent.” The trial court also granted the motion for summary judgment “as to any and all allegations, claims, and causes of action that relate to the dental care provided to [the DJecedent involving the alleged negligence of [Defendants Wake Forest University Baptist Medical Center, North Carolina Baptist Hospital, Wake Forest University, and Wake Forest University Physicians.” The trial court denied Defendants’ summary judgment motion relating to anesthesia care.
Plaintiff appeals.
I. Summary Judgment Rule
Plaintiff argues the trial court erred in granting Defendants’ motions for summary judgment relating to dental care of Decedent. A trial court should grant a motion for summary judgment only “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that any party is entitled to a judgment as a matter of law.” N.C. Gen. Stat. § 1A-1, Rule 56(c) (2013); see also Lord v. Beerman,
Our Supreme Court has “emphasized that summary judgment is a drastic measure, and it should be used with caution. This is especially true in a negligence case[.]” Williams v. Power & Light Co.,
“The moving party carries the burden of establishing the lack of any triable issue.” Lord,
Once the moving party has met its initial burden, the nonmoving party must produce “a forecast of evidence demonstrating that the [non-moving party] will be able to make out at least a prima facie case at trial” in order to survive summary judgment. Diggs v. Novant Health, Inc.,
II Analysis
Plaintiffs complaint and Defendants’ answers show there are genuine issues of material fact in this matter. The complaint alleged the following:
XII. That the oral surgery performed on [the Decedent] lasted 8 hours and 20 minutes, approximately four times longer than the time for the procedure represented to the parents of [the Decedent]. The oral surgery consisted of teeth cleaning and the extraction of four teeth. The patient was under general anesthesia for over 8 hours....
XIV. That the oral surgeons and the anesthesia treatment team were aware of the fact that a known risk of having a patient under general anesthesia for an extensive period of time was that the patient could develop pneumonia.
XV. That in spite of the lengthy surgery and the expended period of time that the patient was under general anesthesia, upon information and belief, the anesthesia treatment team in consultation with the two oral surgeons made the*506 decision to send [the Decedent] home on March 13, 2008 post surgery.
XVI. On March 14, 2008, [the Decedent] became unresponsive at home. He was rushed by EMT to Moses Cone Hospital in Greensboro, North Carolina. At Moses Cone Hospital, [the Decedent] was diagnosed as having cerebral edema on CT, anoxic brain damage and cardiac arrest....
XVIII. An autopsy was performed, and the cause of death was determined to be bronchopneumonia following comprehensive dental care under general anesthesia.
Defendants Wake Forest University Baptist Medical Center, North Carolina Baptist Hospital, Wake Forest University, Wake Forest University Physicians, Shilpa S. Buss, DDS, and Reena Patel, DDS, denied all of the above allegations in their answer. Defendant University Dental Associates filed a separate answer in which it also denied the above allegations.
Defendants, in their briefs to this Court and at oral argument, focused on the admissibility of expert testimony under N.C. Gen. Stat. § 8C-1, Rule 702(b). The trial court also stated during the hearing that Plaintiff had “run squarely into a brick wall with Rule 702(b).”
However, we note that the record contains no motion to exclude Plaintiffs expert witnesses. Rather, at the hearing on Defendants’ motions for summary judgment, Defendants argued Plaintiff failed to show causation, as follows:
Your Honor ... we will concede that [Plaintiff has] three expert witnesses, all who have testified about standard of care issues. That is not what we’re arguing about. We are strictly arguing about whether or not they had made a causal link with these three experts to the dental care in the case.
Medical malpractice encompasses actions arising from the performance of dental care. “[T]he term ‘medical malpractice action’ means a civil action for damages for personal injury or death arising out of the furnishing or failure to furnish professional services in the performance of medical, dental, or other health care by a health care provider.” N.C. Gen. Stat. § 90-21.11 (2009).
In the present case, Plaintiff forecast evidence showing that the treatment administered by Defendants was in negligent violation of the accepted standard of care in the community. Dr. Behrman, a Doctor of Dental Medicine, testified on behalf of the Decedent in a deposition that “[t]here was no clearance obtained on a significantly medically compromised person by the physician of record, the physician caring for him[.]” Dr. Behrman testified as follows regarding the necessity to consult with the physician of record prior to the dental procedure:
This is bread and butter of training programs, the way we teach the residents, the way we’ve been taught; using the medical providers, obtaining the consult and such. This is what we do and what we’re trained to do, what I expect my residents to do, what I have to demonstrate during accreditation visits within a residency program.
Plaintiff also forecast evidence, in depositions and in the complaint, of the proximate cause of death. The portion of Dr. Behrman’s deposition relevant to causation is quoted below:
[Plaintiff’s attorney]. In your expert opinion was the violation of the standard of care that you testified about here today a proximal contributing cause to [Decedent] developing bronchopneumonia?
[Dr. Behrman]. Within my knowledge as an oral and maxil-lofacial surgeon, yes.
As stated above, the trial court should grant a motion for summary judgment only “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that any party is entitled to ajudgment as a matter of law.” N.C.G.S. § lA-l,Rule 56(c); see also Lord,
Plaintiff contends that she “presented a two-tier approach on causation.” First, Dr. Behrman opined that the violation of the standard of care caused the Decedent’s bronchopneumonia; second, the broncho-pneumonia caused the death of the Decedent. Defendants contend the testimony of Dr. Behrman fails to establish proximate cause because his testimony fails to satisfy N.C.G.S. §8C-1, Rule 702 (2009).
III. Admissibility of Expert Testimony
Despite the fact that this matter is before us on appeal from the grant of summary judgment, we address the admissibility of expert testimony because of our Supreme Court’s analysis in Crocker v. Roethling,
The decision in Crocker was composed of three opinions from the Supreme Court. All three opinions analyze the admissibility of expert testimony, regardless of the facts that the appeal was from an order granting summary judgment and the record indicated no motion to exclude expert testimony. Crocker,
“The trial court must decide the preliminary question of the admissibility of expert testimony under the three-step approach adopted in State v. Goode,
A. Reliability of the Expert’s Methodology
As to the first step in the Goode analysis of the admissibility of expert testimony, Plaintiff contends that Dr. Behrman “is unquestionably qualified as an expert in the field of oral surgery.” Defendants contend Plaintiff’s expert testimony is “not sufficiently reliable to be admissible[,]” citing Asar v. Presbyterian Hosp.,
However, as discussed above, the opinions of Dr. Behrman and Dr. Gaffney-Kraft were not based merely upon speculation or conjecture. Neither Dr. Behrman nor Dr. Gaffney-Kraft used the words “probably” or “possibly” or otherwise indicated that their opinions were speculative or conjectural. Rather, Dr. Behrman answered the question as to his opinion on causation in the affirmative. Similarly, Dr. Gaffney-Kraft stated that “it is [her] opinion within reasonable medical certainty that the
B. Qualifications of the Proposed Expert
As to’ the second step in the Goode analysis of the admissibility of expert testimony, Plaintiff contends that, because Dr. Behrman is an oral surgeon who performs surgical operations on patients, and the practice of medicine includes surgery, “there is an overlap between” statutes regulating the practice of medicine and the practice of dentistry. Defendants contend Plaintiff’s experts “cannot be qualified to render expert opinions on medical causation pertaining to areas of the body outside the oral cavity.”
Defendants cite Martin v. Benson,
“If scientific, technical or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion.” N.C.G.S. § 8C-1, Rule 702(a). “[T]he opinion testimony of an expert witness is competent if there is evidence to show that, through study or experience, or both, the witness has acquired such skill that he is better qualified than the jury to form an opinion on the particular subject of his testimony.” Terry v. PPG Indus., Inc.,
This Court in Martin considered “Rule 702 in light of this State’s statutes defining the practice of ‘psychology.’ ” Martin, 125 N.C. App. at
“The essential question in determining the admissibility of opinion evidence is whether the witness, through study or experience, has acquired such skill that he was better qualified than the jury to form an opinion on the subject matter to which his testimony applies.” Diggs,
Dr. Behrman earned a Doctor of Dental Medicine degree, completed an internship in anesthesia and a residency in oral and maxillofacial surgery, is licensed by the New York Board of Dentistry, and has been certified by the American Board of Oral and Maxillofacial Surgeons since 1986. As Chief of the Division of Dentistry, Oral and Maxillofacial Surgery since June 1996, Dr. Behrman oversees residency programs that provide over 10,000 patient visits each year. He is the Chair of the Institutional Review Board of a medical center in New York. In the past, he has held appointments with the University of Pennsylvania School of Dental Medicine and Memorial Sloan-Kettering Cancer Center and Hospital. Focusing on the qualifications of Dr. Behrman in particular, as opposed to the qualifications of licensed dentists in general, Dr. Behrman’s knowledge, skill, experiénce, training, and education qualify him to opine as to the causation of bronchopneumonia. Dr. Behrman has “acquired such skill that he was better qualified than the jury to form an opinion” on the causation of bronchopneumonia. Diggs,
We note that Defendants do not challenge the qualification of Dr. Gaffney-Kraft to offer her expert opinion that bronchopneumonia was the Decedent’s cause of death.
C. Relevance of the Expert’s Testimony
Defendants do not challenge the third step of the Goode analysis, namely, the relevance of the expert’s testimony.
The depositions, affidavits, and pleadings show that Plaintiff, the nonmoving party, forecast evidence showing that Defendants’ treatment proximately caused the Decedent’s death and that there are genuine issues of material fact to be determined by the jury. The evidence constitutes a sufficient forecast of evidence for presentment of the case to the jury. The trial court erred in granting Defendants’ motions for summary judgment relating to dental care.
Reversed.
Notes
. Our General Assembly amended this statute in 2011. 2011 N.C. Sess. Laws ch. 400 § 5. The amendment applies “to causes of actions arising on or after” 1 October 2011. Id.
. Our General Assembly amended N.C.G.S. § 8C-1, Rule 702 in 2011.2011 N.C. Sess. Laws ch. 283 § 1.3. The amendments apply “to actions commenced on or after” 1 October 2011. Id. at § 4.2. The amendments are not applicable to the present case because the action was commenced on 13 July 2010.
Dissenting Opinion
dissenting.
At the summary judgment hearing below, Plaintiff relied on the opinions of two dentists — Dr. Thomas David and Dr. David Behrman — as her forecast of evidence to establish that (1) the provision of dental care by Defendants to Robert B. Webb, III, (Decedent) violated the standard of care for dental professionals; and that (2) this violation proximately caused Decedent to develop bronchopneumonia.
Here, Plaintiff bore the burden of producing a forecast of evidence demonstrating “(1) the applicable standard of care; (2) a breach of such standard of care by [Defendants]; (3) [that] the injuries suffered by [Decedent] were proximately caused by such breach; and (4) the damages resulting to [Decedent].” Weatherford v. Glassman,
The parties do not dispute that Plaintiff’s burden was to forecast evidence in the form of expert testimony to lay a proper foundation from which a jury could determine the cause of Decedent’s bronchopneumo-nia. The admissibility of expert testimony on the issue of medical causation is governed by Rule 702(a) of our Rules of Evidence, the relevant version
In the context of a medical malpractice action, Rule 702(a) appears less restrictive as to the qualifications of a witness to provide an expert opinion on medical causation than Rule 702(b) as to the qualifications of a witness to provide an expert opinion on the appropriate standard of care. For instance, while an expert testifying as to the standard of care must generally be “a licensed health care provider,” this Court has held, in a medical malpractice case, that a witness need not be a licensed medical doctor in order to offer an expert opinion as to medical causation, Diggs v. Novant Health,
While it is true that the trial court is “afforded ‘wide latitude of discretion when making a determination about the admissibility of expert testimony[,]’ ”Howerton v. Arai Helmet, Ltd.,
Likewise, Dr. Behrman stated in response to a question from Plaintiff’s counsel that it was his opinion that the standard of care violation caused Decedent’s bronchopneumonia; however, he qualified his response in stating that his opinion was “[w]ithin [his] knowledge as an oral and maxillofacial surgeon” and that he “would defer [his] opinions related to the development of [Decedent’s] bronchopneumonia to a medical doctor.” Further Dr. Behrman acknowledged that Decedent was a medically complex patient.
The majority cites the three-pronged analysis set out by our Supreme Court in State v. Goode,
. Plaintiff relied upon the opinion of a medical doctor that Decedent’s broncho-pneumonia caused his death. However, this medical doctor never expressed an opinion as to the cause of the bronchopneumonia
. Likewise, Defendants do not contend that Plaintiff’s forecast of evidence regarding the causal connection between Decedent’s bronchopneumonia and his death was not sufficient to survive summary judgment, as this connection was established through the opinion of a medical doctor.
. Rule 702(a) was amended for actions commenced after October 1,2011 to provide a stricter standard on the admissibility of expert testimony. See State v. McCrady,_N.C. App. _, _ S.E.2d _ (2014).
