Title: Holmes v. Eastern Maine Medical Center

State: maine

Issuer: Maine Supreme Court

Document:

MAINE SUPREME JUDICIAL COURT 
Reporter of Decisions 
Decision: 
2019 ME 84 
Docket: 
Pen-18-283 
Argued: 
April 10, 2019 
Decided: 
May 30, 2019 
 
Panel: 
SAUFLEY, C.J., and ALEXANDER, MEAD, GORMAN, JABAR, HJELM, and HUMPHREY, JJ. 
 
 
MICHAEL D. HOLMES et al. 
 
v. 
 
EASTERN MAINE MEDICAL CENTER et al. 
 
 
 
GORMAN, J. 
[¶1]  Michael D. and Debra A. Holmes appeal from a summary judgment 
entered by the Superior Court (Penobscot County, Anderson, J.) in favor of 
Spectrum Medical Group and one of its radiologists, Guillermo Olivos, M.D., on 
the Holmeses’ medical malpractice claims, as well as from the court’s judgment, 
entered on a jury verdict, for Eastern Maine Medical Center (EMMC) and one of 
its surgeons, Michael St. Jean, M.D., on those same claims.  We affirm the 
judgments. 
 
2 
I.  BACKGROUND 
A. 
Facts1 
[¶2]  On August 14, 2012, a surgical oncologist at EMMC removed a 
noncancerous polyp from Michael’s colon.  Michael was discharged from EMMC 
four days later, on August 18, 2012.   
[¶3]  On August 20, 2012, at approximately 5:00 p.m., Michael went to the 
EMMC emergency department complaining of abdominal pain.  At 7:00 p.m., 
Michael was seen by the on-call surgeon—St. Jean.  Because he believed Michael 
was suffering from a postoperative ileus,2 St. Jean ordered a CT scan of 
Michael’s abdomen to rule out the possibility of active bleeding or an 
anastomotic leak.3   
                                         
1  Because Olivos’s motion for summary judgment was granted and because St. Jean’s was denied 
and the claims against him proceeded to trial, there are two different standards by which we review 
the evidence on appeal.  With respect to the Holmeses’ appeal of the court’s grant of a summary 
judgment for Olivos, we view the undisputed material facts in the light most favorable to the 
nonprevailing party, here, the Holmeses.  See Grant v. Foster Wheeler, LLC, 2016 ME 85, ¶ 12, 
140 A.3d 1242.  With respect to the Holmeses’ appeal of the judgment in favor of St. Jean, however, 
we view the evidence in the record in the light most favorable to the jury’s verdict.  See Darling’s Auto 
Mall v. Gen. Motors LLC, 2016 ME 48, ¶ 2, 135 A.3d 819.  Because the facts established at trial are 
similar to the record at summary judgment and, more importantly, because this opinion focuses on 
the summary judgment issue, the facts we include below are undisputed material facts taken from 
the summary judgment record. 
2  An “ileus” was described by St. Jean as “when the intestinal track slows down due to some other 
condition.”   
3  The anastomotic leak described here was, in lay terms, “a leak of the bowel contents at the 
junction of the two portions of the bowel that were surgically reconnected” during surgery to remove 
the polyp.    
 
3 
[¶4]  Michael had a CT scan taken of his abdomen at 9:30 p.m.  
Approximately one hour later, a radiologist interpreted the results of the CT 
scan and concluded that there was evidence of moderate to severe abdominal 
ascites,4 which were “concerning for developing infection versus phlegmonous5 
changes.”  The  report was faxed to EMMC at 10:37 p.m.   
 
[¶5]  At approximately 8:00 the following morning, August 21, 2012, 
Olivos reviewed the CT scan of Michael’s abdomen taken the previous night.  In 
his report, Olivos identified pelvic ascites, noted some dots of air in the ascites 
near the liver, and also stated that “[t]here [were] no findings to suggest an 
anastomotic leak.”   
[¶6]  At approximately 9:40 p.m. on August 21, 2012, Michael was 
observed by a second surgeon—one of St. Jean’s partners—to have fast, shallow 
breathing, pain, and a distended and tender abdomen; based on these 
symptoms, this second surgeon determined that Michael’s condition warranted 
immediate exploratory surgery.  She began the surgery at 10:55 p.m. and, in the 
course of that surgery, discovered a small anastomotic leak, which she believed 
                                         
4  “Ascites” is an “[a]ccumulation of serous fluid in the peritoneal cavity.”  Ascites, Stedman’s 
Medical Dictionary (27th ed. 2000). 
5  A “phlegmon” is an “[a]cute suppurative inflammation of the subcutaneous connective tissue.”  
Phlegmon, Stedman’s Medical Dictionary (24th ed. 1982). 
 
4 
had infected the fluid and blood in the abdomen, causing Michael’s “septic 
state.”   
[¶7]  After this second surgery, Michael was hospitalized until 
October 1, 2012.  While hospitalized, Michael was intubated for a prolonged 
period of time and eventually underwent a tracheostomy.  Michael also 
developed deep venous thrombosis and was diagnosed with a stroke during the 
hospitalization at EMMC.    
B. 
Procedure 
[¶8]  In May of 2015, the Holmeses filed notice of their professional 
negligence claim against EMMC, St. Jean, Northeast Surgery of Maine, Spectrum, 
and Olivos6 in the Superior Court (Penobscot County) pursuant to the Maine 
Health Security Act (MHSA), 24 M.R.S. §§ 2501-2988 (2018), alleging one count 
of medical malpractice in connection with the complications that Michael 
suffered after he arrived at EMMC on August 20, 2012.  See 24 M.R.S. §§ 2853, 
2903; M.R. Civ. P. 80M(b).  On November 18, 2016, a hearing was held before 
                                         
6  For simplicity’s sake, in the remainder of this opinion we will refer only to the physicians, and 
not to the institutions employing them, because (1) all claims against Northeast Surgery were 
dismissed by agreement of the parties before closing arguments; (2) the issue of whether Spectrum 
was vicariously liable for the actions of Olivos was never determined because the court granted 
summary judgment on these claims; and (3) the issue of whether EMMC was vicariously liable for the 
actions of St. Jean was never determined by the jury. 
 
5 
the prelitigation screening panel at which all parties introduced evidence and 
presented expert witnesses.  See 24 M.R.S. § 2854; M.R. Civ. P. 80M(g).7 
[¶9]  On December 15, 2016, the Holmeses filed their complaint for 
medical malpractice against St. Jean and Olivos in the Superior Court.  See 24 
M.R.S. § 2859.  After the completion of discovery, Olivos and St. Jean each 
separately moved for summary judgment.  See M.R. Civ. P. 56.  In the documents 
filed in support of, and in opposition to, the motions, the parties referred to the 
deposition testimony of the general surgeon and neurologist whom the 
Holmeses had designated as expert witnesses.    
[¶10]  At his deposition, the general surgeon testified that had the 
anastomotic leak been identified and treated during the evening of 
August 20, 2012, some harm to Michael could have been avoided, including the 
prolonged hospitalization, prolonged intubation, tracheostomy, and deep 
venous thrombosis.  Specifically, he testified that it was “more likely than not” 
that Michael “would have had fewer postoperative complications” had the 
second surgery occurred twenty-four hours earlier, at approximately 8:00 p.m. 
                                         
7 Because all proceedings before prelitigation screening panels are generally “private and 
confidential,” and because those proceedings do not affect this opinion, we do not discuss the panel’s 
final determinations.  See 24 M.R.S. § 2857 (2018); M.R. Civ. P. 80M(g)(10). 
 
 
6 
on August 20, 2012.  The neurologist testified at his deposition that had the 
second surgery occurred sooner, it was more likely than not that Michael could 
have avoided the stroke.   
[¶11]  After a hearing, by order dated May 21, 2018, the court denied 
St. Jean’s motion, but granted Olivos’s motion.  In its order granting a summary 
judgment for Olivos, the trial court referred to the deposition testimony from 
the Holmeses’ expert witnesses.  It stated: 
Here, Dr. Olivos did not become involved in the matter until 
well after the time [the surgical expert] testified was critical to 
avoiding . . . some of the significant complications suffered by Mr. 
Holmes.  On this record, the Court concludes that plaintiffs cannot 
adequately establish through expert testimony that it is more likely 
than not that any negligence attributable to Dr. Olivos and 
Spectrum Medical Group caused harm to Mr. Holmes. . . .  
 
To be clear, however, the Court does not accept, and does not 
rule, that the passage of 8:00 pm on August 20, 2012 was an 
absolute “cut off” point for the establishment of adequate 
causation.  The standard to be applied is “more likely than not.”  
Sepsis brought on by the kind of bowel leak at issue here is clearly 
a progressive condition with worsening effects, as plaintiffs’ expert 
has testified, and medical intervention would be warranted sooner 
than later.  The Court simply concludes that the involvement of Dr. 
Olivos is too removed in space and time, well after a period 
plaintiffs’ expert testified was a critical juncture, such that it is 
unreasonable to allow a jury to make the requisite finding of 
proximate cause.  The Court believes a jury’s deliberation on the 
involvement of Dr. Olivos would venture into the realm of 
conjecture or speculation disapproved of in Merriam.  See Merriam 
[v. Wanger], 2000 ME 159, ¶ 10, 757 A.2d 778 (“Proximate cause is 
generally a question of fact [f]or the jury, but the court has a duty 
 
7 
to direct a verdict for the defendant if the jury’s deliberation rests 
only on speculation or conjecture[.]”) (citations omitted). 
 
Here, the Court concludes that the required expert testimony 
falls short of the necessary legal threshold of proximate cause with 
respect to Dr. Olivos and Spectrum Medical Group.   
 
[¶12]  Thereafter, in June of 2018, the court conducted a nine-day jury 
trial on the Holmeses’ malpractice claim against St. Jean.  On June 21, 2018, the 
jury returned a verdict for St. Jean,8 and one week later the court entered a 
judgment on the verdict.  The Holmeses timely appealed.  See 14 M.R.S. § 1851 
(2018); M.R. App. P. 2B(c)(1). 
II.  DISCUSSION 
[¶13]  The Holmeses argue that the court erred in granting Olivos’s 
motion for summary judgment.9  Specifically, the Holmeses assert that there 
was “evidence in the record upon which a factfinder could reasonably decide 
that Dr. Olivos’[s] negligent reading of the critical CT scan caused delay in 
                                         
8  The jury delivered its verdict via a special verdict form that asked, “Was Dr. St. Jean negligent, 
and was the negligence a cause of injury and damage to Mr. Holmes?”  The jury answered “no” to this 
question and thus did not complete the rest of the form.   
9  The Holmeses also assert that the court erred in its determinations concerning (1) expert 
witness fees; (2) the use of panel findings at trial; (3) expert witness testimony at trial; and (4) the 
“lost chance” doctrine.  Because we do not find any of these arguments persuasive, we do not discuss 
them further. 
 
8 
necessary treatment” and that this delay was a proximate cause of Michael’s 
injuries.   
[¶14]  “We review the grant of a motion for summary judgment de novo, 
and consider both the evidence and any reasonable inferences that the 
evidence produces in the light most favorable to the party against whom the 
summary judgment has been granted in order to determine if there is a genuine 
issue of material fact.”  Grant v. Foster Wheeler, LLC, 2016 ME 85, ¶ 12, 
140 A.3d 1242 (quotation marks omitted); M.R. Civ. P. 56(c).  Our review of the 
evidence is a narrow one, focused on “the parties’ statements of material facts 
and the record evidence to which the statements refer.”  Remmes v. Mark Travel 
Corp., 2015 ME 63, ¶ 18, 116 A.3d 466; see also Alexander, Maine Appellate 
Practice § 512 at 431 (5th ed. 2018). 
[¶15]  “A fact is material if it has the potential to affect the outcome of the 
suit, and a genuine issue of material fact exists when a fact-finder must choose 
between competing versions of the truth, even if one party’s version appears 
more credible or persuasive.  However, when the matter remains one of pure 
speculation or conjecture, or even if the probabilities are evenly balanced, a 
defendant is entitled to a [summary] judgment.”  Grant, 2016 ME 85, ¶ 12, 
140 A.3d 1242 (citations omitted) (quotation marks omitted). 
 
9 
[¶16]  Where, as here, “the moving party is the defendant, the burden 
rests on that party to show that the evidence fails to establish a prima facie case 
for each element of the cause of action.”  Budge v. Town of Millinocket, 
2012 ME 122, ¶ 12, 55 A.3d 484 (quotation marks omitted).  If the defendant 
succeeds, “[i]t then becomes the plaintiff’s burden to make out the prima facie 
case and demonstrate that there are disputed facts.”  Estate of Cabatit v. 
Canders, 2014 ME 133, ¶ 8, 105 A.3d 439. 
[¶17]  “In order to establish liability in a medical malpractice case, the 
plaintiff must show that the defendant’s departure from a recognized standard 
of care was the proximate cause of the injury.”  Phillips v. E. Me. Med. Ctr., 
565 A.2d 306, 307 (Me. 1989).  “Proximate cause is that cause which, in natural 
and continuous sequence, unbroken by an efficient intervening cause, produces 
the injury, and without which the result would not have occurred.”  Merriam v. 
Wanger, 2000 ME 159, ¶ 8, 757 A.2d 778 (quotation marks omitted).  Evidence 
is sufficient to support a finding of proximate cause in the medical malpractice 
context if the evidence and inferences that may reasonably be drawn from it 
indicate that (1) the defendant’s negligent conduct played a substantial part in 
causing the injury, and (2) the injury was either a direct result or a reasonably 
foreseeable consequence of that conduct.  Id. ¶¶ 8, 17. 
 
10 
[¶18]  Here, the trial court correctly determined that, based on the 
undisputed facts, the Holmeses failed to establish a prima facie case for 
negligence against Olivos.  Michael’s anastomotic leak began before he arrived 
at EMMC’s emergency room on August 20, 2012.  Olivos did not review the CT 
scan of Michael’s abdomen until 8:00 a.m. on August 21, 2012; this was 
approximately fifteen hours after Michael arrived at EMMC and approximately 
twelve hours after the time identified by the Holmeses’ surgical expert—
8:00 p.m. on August 20, 2012—when the surgery needed to have been 
completed in order to avoid Michael’s postoperative complications.   
[¶19]  Although the trial court, quite properly, did not take 8:00 p.m. on 
August 20, 2012, as the absolute point in time for the establishment of adequate 
causation, the experts’ opinions—including the statements by the Holmeses’ 
surgical expert—informed the court’s decision and must inform ours.  In the 
Holmeses’ opposing statements of material facts filed in response to Olivos’s 
statements of material facts and motion for summary judgment, the Holmeses 
repeatedly referred to their own surgical expert’s deposition.  In those 
statements, the Holmeses asserted as undisputed facts that   
[the expert] clearly testified that, more likely than not, 
because the medical condition was progressive and developing, 
effectively a sliding scale applied wherein surgery performed 
earlier than [the second surgeon’s] actual surgery would have had 
 
11 
some benefit in terms of improving the potential for a better 
outcome, or as [the expert] stated, the “sooner the better.”  
 
The Holmeses also referred to the deposition testimony of their neurology 
expert.  Crucially, however, the Holmeses do not cite to any record evidence 
showing that these experts explained what role, if any, Olivos’s allegedly 
negligent reading of the CT scan played in the development of Michael’s 
postoperative complications.  Although the Holmeses are correct that “absolute 
certainty” is not required, some evidence is, and the record presented is 
insufficient to provide any basis for a determination that Olivos’s conduct 
played a role in Michael’s injuries.   
[¶20]  Nearly twenty years ago, we stated, 
[R]easonable foreseeability does not equal causation.  To 
support a finding of proximate cause, there must be some evidence 
indicating that a foreseeable injury did in fact result from the 
negligence. 
Proximate cause is generally a question of fact for the jury, 
but the court has a duty to direct a verdict for the defendant if the 
jury’s deliberation rests only on speculation or conjecture. 
For purposes of our analysis here, [the doctor’s] negligence 
is established.  We assume also that [the doctor’s] negligence 
created a reasonably foreseeable risk of [the patient’s] damages.  
The issue is whether there is sufficient evidence to establish that it 
is more likely than not that [the doctor’s] negligence played a 
substantial part in bringing about [the patient’s] extended period 
of pain and [damages]. 
 
12 
Merriam, 2000 ME 159, ¶¶ 9-11, 757 A.2d 778 (citations omitted).  Here, the 
summary judgment record is devoid of evidence linking Olivos’s conduct to the 
injury sustained by Michael or evidence that might allow a jury to parse out to 
what degree the delay in time caused or exacerbated any of the complications 
he suffered.  See id. ¶¶ 8, 17; McAfee ex rel. McAfee v. Baptist Med. Ctr., 
641 So. 2d 265, 268 (Ala. 1994) (explaining that an expert’s opinion that “‘time 
is of the essence’” does not “rise to the level of substantial evidence” needed to 
prove causation); Maudsley v. Pederson, 676 N.W. 2d 8, 14 (Minn. Ct. App. 2004) 
(“The conclusory statements that generally earlier treatment results in better 
outcomes and that every hour counts fail to outline specific details explaining 
how and why [the] delay in treatment caused [the plaintiff’s injury]. . . .  [A] 
delay in diagnosis is not enough; if it were, expert testimony on causation would 
not be necessary.”).   
[¶21]  As the trial court correctly held, it would be “conjecture or 
speculation” to say that any negligence attributable to Olivos was the proximate 
cause of Michael’s injuries.  See Grant, 2016 ME 85, ¶ 12, 140 A.3d 1242; 
Merriam, 2000 ME 159, ¶¶ 8, 17, 757 A.2d 778; Phillips, 565 A.2d at 307; Kava v. 
Van Wagner, No. 1:07-CV-507, 2009 U.S. Dist. LEXIS 78905, at *20 (W.D. Mich. 
Sep. 3, 2009), aff’d sub nom. Kava v. Peters, 450 F. App’x 470 (6th Cir. 2011) 
 
13 
(“Plaintiffs’ evidence is too speculative because evidence of Plaintiff’s inability 
or loss of opportunity to obtain a ‘better outcome’ provides no basis for a jury 
to award damages.”).  The court did not err in granting a summary judgment 
for Olivos and Spectrum.  See Grant, 2016 ME 85, ¶ 12, 140 A.3d 1242; Estate of 
Cabatit, 2014 ME 133, ¶ 8, 105 A.3d 439; Budge, 2012 ME 122, ¶ 12, 
55 A.3d 484. 
[¶22]  There is no doubt that the Holmeses have suffered greatly from 
Michael’s various medical ailments.  It is a plaintiff’s burden, however, to make 
out a prima facie case for negligence; the Holmeses did not do so here, and thus 
they are not, as a matter of law, entitled to damages. 
The entry is: 
Judgments affirmed.  
 
 
 
 
 
 
 
 
John P. Flynn, III, Esq. (orally), Flynn Law Office, LLC, Bowdoinham, for 
appellants Michael D. and Debra A. Holmes 
 
Edward W. Gould, Esq. (orally), and Mariann Z. Malay, Esq., Gross, Minsky & 
Mogul, P.A., Bangor, for appellees Eastern Maine Medical Center and Michael St. 
Jean 
 
Mark G. Lavoie, Esq., Christopher C. Taintor, Esq. (orally), and Joshua D. 
Hadiaris, Esq., Portland, for appellees Spectrum Medical Group and Guillermo 
Olivos 
 
Penobscot County Superior Court docket number CV-2015-105 
FOR CLERK REFERENCE ONLY