Title: Sayer v. Williams

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Sayer v. Williams1998 WY 92962 P.2d 165Case Number: 97-66Decided: 07/29/1998Supreme Court of Wyoming

Betty 
I. SAYER, Appellant (Plaintiff),

v.

William M. WILLIAMS, M.D., Appellee 
(Defendant).

 

Appeal from the District Court, Sheridan County, John 
C. Brackley, J.

 

James P. Castberg, Sheridan, 
for Appellant.

Robert M. Shively of Shively 
Law Offices, P.C., Casper, for Appellee.

 

Before LEHMAN, C.J., and 
THOMAS, MACY, GOLDEN and TAYLOR,* JJ.

 * Chief Justice at time of 
conference.

 

TAYLOR, Justice.

 [¶1] Finding that appellant failed to provide expert 
testimony to establish proximate cause in her medical malpractice case, the 
district court granted appellee's motion for judgment as a matter of law. 
Appellant brings this appeal arguing that her case is an extraordinary one which 
does not require expert testimony to prove that her injuries were caused by the 
doctor's medical negligence. We affirm.

 

                                             
I. ISSUE

 

[¶2] Appellant, Betty I. 
Sayer (Sayer), states one issue:

 

The trial court erred in granting the appellee's 
motion for directed verdict at the end of the appellant's case in chief under 
the Supreme Court's ruling in Harris v. Grizzle, 625 P.2d 747 (Wyo. 
1981).

 

[¶3] Appellee, William M. 
Williams, M.D. (Dr. Williams), presents the issue as:

 

Did the trial court err when it granted Dr. Williams' 
motion for directed verdict following Sayer's failure to elicit expert testimony 
establishing that the alleged negligence of Dr. Williams caused Sayer's 
injury?

 

                                             
II. FACTS

 

[¶4] In May 1993, Dr. 
Williams implanted a single chamber pacemaker in Sayer after she suffered a 
complete heart block and had to be resuscitated. Following this surgery, Sayer 
experienced dizziness and extreme fatigue. Approximately one month later, Sayer 
saw Dr. Robert Novick, a cardiologist. In July 1993, Dr. Novick removed the 
single chamber pacemaker and replaced it with a dual chamber pacemaker. Sayer 
subsequently filed a medical malpractice suit against Dr. Williams, claiming his 
insertion of the single chamber pacemaker caused her to suffer pacemaker 
syndrome.

 

[¶5] At trial, evidence was 
produced which showed that Sayer had suffered from high blood pressure and 
chronic fatigue for several years prior to the pacemaker operation. In 1991, her 
personal physician determined she had contracted Hepatitis C. In September 1991, 
Dr. Williams assisted Sayer in obtaining Social Security benefits. At that time, 
Sayer told Dr. Williams she experienced dizziness and was frequently so fatigued 
she could not complete small chores without resting. Based upon Dr. Williams' 
report to the Department of Social Security, Sayer began receiving full 
disability benefits approximately thirteen months before she suffered the 
heart blockage.

 

[¶6] Sayer's medical records 
were the subject of medical testimony during trial. The records revealed that 
Sayer continued to suffer dizziness and fatigue from the time of implant up to 
the time of trial. Sayer's personal physician testified that dizziness and 
fatigue become more acute when Hepatitis C flares up. The medical records 
further indicated that Sayer had failed to take her blood pressure medicine on a 
consistent basis and may have been abusing alcohol which could exacerbate her 
symptoms.

 

[¶7] Dr. Randolph Martin, a 
cardiologist from Illinois, testified as an expert witness on Sayer's behalf. 
Dr. Martin stated his opinion that Dr. Williams' use of a single chamber 
pacemaker fell below the standard of care for the medical community. He also 
described for the jury the symptoms of pacemaker syndrome, which primarily 
consist of feeling tired. He did not, however, state an opinion that Sayer 
suffered from pacemaker syndrome in May and June of 1993. Nor did he state an 
opinion that Dr. Williams' substandard care had caused Sayer's dizziness and 
fatigue during that time.

 

[¶8] On cross-examination, 
Dr. Martin testified that he was aware of Sayer's high blood pressure at the 
time he reviewed her medical records and arrived at his opinions. However, he 
was not aware of her Hepatitis C and chronic fatigue syndrome diagnoses. Nor was 
he aware that Sayer was receiving Social Security benefits. Dr. Martin testified 
he had not been provided medical records or copies of the benefits applications 
which indicated that Sayer had suffered from these same symptoms prior to 
implantation of the single chamber pacemaker.

 

[¶9] At the close of Sayer's 
evidence, Dr. Williams moved for a judgment as a matter of law because Sayer had 
failed to provide expert opinion that her problems were caused by his 
implantation of the single chamber pacemaker. Although Sayer argued that her 
case was so extraordinary that such testimony was not needed, the district court 
granted Dr. Williams' motion. Assuming that the doctor's care was negligent, the 
district court noted that the case would still fail for a lack of evidence on 
the issue of causation. Since Sayer's high blood pressure and Hepatitis C could 
very well have caused the symptoms of which she complained, expert testimony 
remained essential to the establishment 
of proximate cause. Citing our opinion in Harris v. Grizzle, 625 P.2d 747 (Wyo. 
1981), the district court determined it had no choice but to enter judgment for 
Dr. Williams as a matter of law. We agree.

 

                                      
III. STANDARD OF REVIEW

 

[¶10] W.R.C.P. 50(a)(1) 
provides:

 

          
(a) Judgment as a matter of law.

 

(1) If during a trial by jury a party has been fully 
heard on an issue and there is no legally sufficient evidentiary basis for a 
reasonable jury to find for that party on that issue, the court may determine 
the issue against that party and may grant a motion for judgment as a matter of 
law against that party with respect to a claim or defense that cannot under the 
controlling law be maintained or defeated without a favorable finding on that 
issue.

 

Despite the fact that 
judgment as a matter of law should be granted cautiously and sparingly, the 
district court has an obligation to direct entry of such a judgment where there 
is legally insufficient evidence to support a verdict on a particular issue. The 
decision to grant or deny a motion for a judgment as a matter of law is reviewed 
de novo. Harvey v. First Nat. Bank of Powell, 924 P.2d 83, 86 (Wyo. 1996) 
(quoting Del Rossi v. Doenz, 912 P.2d 1116, 1118-19 (Wyo. 
1996)).

 

                                          
IV. DISCUSSION

 

[¶11] A medical malpractice 
plaintiff has the burden to prove. " ' "(1) the accepted standard of medical 
care or practice, (2) that the doctor's conduct departed from the standard, and 
(3) that his conduct was the legal cause of the injuries suffered." ' " Mize v. 
North Big Horn Hosp. Dist., 931 P.2d 229, 233 (Wyo. 1997) (quoting Harris, 625 
P.2d at 751). In granting the motion for judgment as a matter of law, the 
district court quoted the following from our opinion in 
Harris:

 

It 
is well settled that in all but the extraordinary medical malpractice case, the 
plaintiff has the burden of producing expert testimony to support a prima facie 
case of negligence. If the origin of the injury is obscure and not readily 
apparent to a layman, or if there are several equally probable causes of the 
condition, testimony of a qualified physician is essential to establish a 
reasonable probability that the physician's negligence caused the 
injury.

 

Harris, 625 P.2d  at 
752.

 

[¶12] There is no dispute 
that Sayer did not produce medical expert testimony on the issue of causation. 
Her only argument on appeal is that her case is extraordinary because of the 
amount of evidence from which a jury could infer that Dr. Williams' substandard 
care caused her dizziness and fatigue for a few weeks in 1993. Certainly, this 
would be a reasonable inference. But equally reasonable would be an inference 
that her problems were a continuation of those she experienced due to her high 
blood pressure and Hepatitis C. This is 
particularly true in light of the evidence that she has continued to suffer 
these symptoms from time to time since the dual chamber pacemaker was implanted, 
and her own testimony that she continues to be so fatigued as to be eligible for 
full disability social security benefits.

 

[¶13] This is precisely the 
type of case in which causation must be proved by expert testimony. There were 
"several equally probable causes" of Sayer's dizziness and fatigue. Harris, 625 P.2d  at 752. The district court was correct in granting judgment as a matter of 
law on the basis that Sayer failed to offer medical expert testimony on the 
issue of causation.

 

                                
          V. 
CONCLUSION

 

[¶14] Since medical expert 
testimony was required but not offered, there was no legally sufficient 
evidentiary basis upon which the jury could have based a verdict in Sayer's 
favor. The judgment of the district court is affirmed.