Title: Mize v. North Big Horn Hosp. Dist.

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Mize v. North Big Horn Hosp. Dist.1997 WY 11931 P.2d 229Case Number: 96-8Decided: 01/23/1997Supreme Court of Wyoming

Thomas L. MIZE and Robin Crowley-Mize, Appellants 
(Plaintiffs),

v. 

NORTH BIG HORN HOSPITAL DISTRICT, a Corporate Body; 
and L. Stanley Naramore, D.O., Appellees (Defendants).

 

                                  

Appeal from  
District Court of Goshen County, Keith G. Kautz, 
J.

   

 

James P. Castberg, Sheridan, 
for appellants. 

Michael K. Davis and John G. 
Fenn of Yonkee and Toner, Sheridan, for North Big Horn Hosp. 
Dist.

 Robert M. Shively of Shively Law Offices, P.C., 
Richard R. Jamieson, Casper, for L. Stanley Naramore, 
D.O.

 

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

   * Chief Justice at time of oral 
argument.

 

     TAYLOR, Chief 
Justice.  

 [¶1]         Late in 1993, Thomas L. Mize 
twice visited Stanley Naramore, D.O., complaining of back pain. Dissatisfied 
with the outcome, Mr. Mize and his wife sued Dr. Naramore and the hospital he 
worked for, alleging that Dr. Naramore's treatment left Mr. Mize a virtual 
cripple with an equally debilitating drug dependency. Unable to generate any 
genuine issue of material fact concerning the cause of Mr. Mize's ills, 
appellants saw their case succumb to 
summary judgment. We affirm.

 

I. ISSUES

 

 [¶2]         Appellants posit the 
following errors in the district court's handling of their 
case:

 

            I. The 
trial court erred in granting the defendants' motion for summary judgment, after 
entering a protective order 
preventing the plaintiffs from taking the deposition of defendant 
Naramore.

 

            II. The 
trial court erred in granting the defendants' motion for summary judgment in 
relying on Dr. Campbell's affidavit 
and supplemental affidavit and finding that the plaintiffs failed to 
establish causation.

 

            III. The 
trial court erred in granting the defendants' motion for summary judgment in 
that there were many genuine issues 
of material fact.

 

 [¶3]         Appellee, North Big Horn 
Hospital District (the hospital), presents a single issue for 
review:

 

Did the Trial Court properly grant summary judgment 
in this medical malpractice case when Appellants were unable to produce expert 
testimony to establish that errors claimed on the part of Dr. Naramore caused 
Plaintiff Tom Mize['s] injury?

 

 [¶4]         Appellee, L. Stanley 
Naramore, D.O. (Dr. Naramore), states the following 
issues:

 

            I. Whether 
the district court erred in considering the affidavit of Mark T. Murphy, 
M.D.?

 

            II. Whether 
the appellants failed to take advantage of court orders and court rules which 
would have allowed them to take the 
appellee Naramore's deposition prior to the hearing for 
summary judgment?

 

            III. 
Whether the trial court properly granted summary judgment for the reason that 
there was no genuine issue of 
material fact on the issue of causation and that appellees were entitled to 
judgment as a matter of 
law?

 

II. FACTS

 

[¶5]           Thomas L. Mize (Mize) 
suffered chronic back problems of an unspecified nature. Prior to seeing Dr. 
Naramore, Mize had been taking substantial amounts of analgesic medications. In 
November of 1993, Dr. Naramore examined 
Mize who was complaining of back pain occasioned by arising from a sofa. The 
nature and extent of that examination, as well as whether or not a follow-up 
visit was arranged, are matters of dispute between Dr. Naramore and appellants. 
The parties agree, however, that Dr. Naramore prescribed several medications for Mize's pain and 
ordered bed rest. Approximately one week later, Mize returned to his normal 
activities while continuing to use the medications prescribed by Dr. Naramore, 
who placed no restrictions on Mize's activities.  Mize continued to experience pain in his 
back and legs.

 

[¶6]           On December 29, 1993, 
Mize suffered increased pain in his back which radiated down his legs following 
strenuous exertion. The next day, Mize saw Dr. Naramore and was admitted to the 
hospital.  The nature of Dr. 
Naramore's treatment and Mize's compliance with Dr. Naramore's directions are in 
dispute. Suffice it to say that Mize left the hospital one day later of the 
opinion that he was deriving no benefit from hospitalization and would feel more 
comfortable at home.

 

 [¶7]         Three months later, Mize saw 
a medical doctor who diagnosed chronic back pain with signs and symptoms of a 
herniated disc, depression, and probable narcotic addiction. The medical doctor 
placed Mize on several medications, 
including pain medications which were similar to those prescribed by Dr. 
Naramore but not as addictive.

 

 [¶8]         Appellants filed suit in Big 
Horn County, alleging seven counts of negligence on the part of Dr. Naramore and 
the hospital. Based upon adverse publicity in the Big Horn Basin, Dr. Naramore 
asked for and eventually received a 
transfer of trial. However, Dr. Naramore's civil problems in Wyoming remained 
marginal compared to pending homicide charges in Kansas, to which state he was 
extradited in mid-1994. Repeated efforts 
by appellants to depose Dr. Naramore were frustrated by the attorney 
representing Dr. Naramore in Kansas, notwithstanding the Wyoming court's efforts 
to insure that Dr. Naramore would not be prejudiced in the Kansas matter by 
submitting to a deposition in the instant case.

 

[¶9]           Notwithstanding his 
unavailability for deposition, Dr. Naramore filed a motion for summary judgment, 
supported by the affidavit of another Doctor of Osteopathy. The hospital joined 
in that motion and a supplemental affidavit was also filed, directly addressing 
the issue of causation. After asking for additional time in which to depose Dr. Naramore, appellants 
filed their response to appellees' motion for summary judgment, supported by 
affidavits of Mr. and Mrs. Mize, as well as that of the medical doctor who saw 
Mr. Mize three months after his hospitalization.  The district court denied appellants' 
request for additional time, while 
providing them the following accommodation:

 

            To the 
extent that any expert listed by the plaintiff in good faith believes that it 
requires testimony from the defendant L. 
Stanley Naramore, D.O. in order to support any opinion testimony that he might 
have, he shall so state by affidavit timely filed.

 

[¶10]        No such affidavit was 
filed and the district court granted summary judgment to Dr. Naramore and the 
hospital predicated upon appellants' failure to establish any material issue of 
fact as to the causation of Mr. Mize's medical problems. This timely appeal 
follows.

 

III. STANDARD OF REVIEW

 

 [¶11]      Little mystery remains 
concerning our willingness to affirm summary judgments, provided there is no 
genuine issue of material fact and the law clearly entitles the moving party to 
prevail.  Martin v. Farmers Ins. 
Exchange, 894 P.2d 618, 620 (Wyo. 1995).  
We consider summary judgment from the same perspective employed by the 
district court, using the same materials and standards, examining the record in 
a light most favorable to the party opposing summary judgment and giving that 
party the benefit of all favorable inferences fairly to be drawn from the 
record.  Martin v. Alley Const., 
Inc., 904 P.2d 828, 831 (Wyo. 1995).

 

[¶12]        The moving party bears 
the initial burden of establishing a prima facie case for summary judgment. 
Thereafter, the party opposing summary judgment becomes obliged to marshal 
specific facts, as contrasted with general or conclusory allegations, which 
establish a genuine issue of material fact. Tidwell v. HOM, Inc., 896 P.2d 1322, 1324-25 (Wyo. 
1995).

 

            A material 
fact has been defined as one having some legal significance, that is, under the 
law applicable to a given case, it 
would control in some way the legal relations of the parties; as one upon which 
the outcome of litigation depends in 
whole or in part; as one on which the controversy may be determined; as one 
which will affect the result or outcome of the case depending upon its 
resolution; and one which constitutes a part of the plaintiff's cause of action 
or of the defendant's defense.

 

Johnson v. Soulis, 542 P.2d 867, 871-72 (Wyo. 1975) (footnotes omitted).

 

IV. DISCUSSION

 

     A. INABILITY TO DEPOSE 
DR. NARAMORE

 

 [¶13]      Appellants claim that their 
case was prejudiced by their inability to depose Dr. Naramore prior to the 
summary judgment hearing. The hospital acknowledges that it is normal practice 
for plaintiffs in a malpractice case to depose a defendant physician, a 
proposition with which neither the district court nor this court has any difficulty. It was the plaintiffs, 
however, who initially pressed the issue, over Dr. Naramore's motion for stay in 
all proceedings, protesting that such a stay "would unduly delay, hinder, and 
handicap the Plaintiffs in the preparation for trial and the final determination 
of the issues in this matter."  
Although appellants finally relented, moving for a continuance pending 
Dr. Naramore's availability, the district court remained on the horns of a very real dilemma. To prevent the 
case from languishing indefinitely while insuring that appellants would have 
access to needed information, the district court afforded appellants an 
opportunity to demonstrate their need for Dr. Naramore's deposition in precisely 
that fashion prescribed by this 
court:

 

            Should it 
appear from the affidavits of a party opposing the motion [for summary judgment] 
that the party cannot for reasons 
stated present by affidavit facts essential to justify the party's 
opposition, the court may refuse 
the application for judgment or may order a continuance to permit affidavits to 
be      obtained or depositions 
to be taken or discovery to be had or may make such other order as is 
just.

 

W.R.C.P. 56(f). The district 
court's invitation to appellants to file affidavits evidencing their need for 
Dr. Naramore's deposition went unheeded. Under such circumstances, we can find 
no abuse of discretion in the district court's refusal to allow appellants' 
request for a further continuance and decision to proceed with appellees' motion 
for summary judgment. Brown v. Avery, 850 P.2d 612, 616 (Wyo. 
1993).

 

 [¶14]      Appellants also suggest that 
they were hampered by an implied failure of appellees to provide all of Dr. 
Naramore's medical charts with respect to Mr. Mize. If, indeed, such a problem 
existed, there is nothing in the record to suggest that it was raised in the 
district court. In fact, the affidavit of appellants' medical expert indicates 
that he only formed his opinions after reviewing the records of the hospital and 
Dr. Naramore concerning Mr. Mize. In 
conducting appellate review of a summary judgment, we may go no further than 
consideration of the record as it existed at the time the district court ruled, 
and we decline appellants' invitation to consider arguments never presented to 
the district court based upon matters not included in the record. Pekas v. Thompson, 903 P.2d 532, 535 
(Wyo. 1995).

 

     B. 
CAUSATION

 

 [¶15]      Citing numerous issues of 
fact in the record concerning Dr. Naramore's examination and treatment of Mr. 
Mize as well as whether or not Dr. Naramore's treatment departed from the 
accepted standard of medical care or treatment, appellants are incredulous that 
the district court could possibly have granted summary judgment. It is hardly a secret, however, 
that a malpractice plaintiff seeking to avoid summary judgment "`has the 
obligation to establish (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.'" Harris v. Grizzle, 625 P.2d 747, 
751 (Wyo. 1981) (quoting Orcutt v. Miller, 95 Nev. 408, 595 P.2d 1191, 1193 
(1979)).

 

 [¶16]     In Wyoming, it is virtually 
axiomatic that a plaintiff hoping to surmount summary judgment must present 
evidence indicating that it was the medical practitioner's departure from a 
recognized standard which was the proximate cause of the plaintiff's injury. 
Havens v. Hoffman, 902 P.2d 219, 222 (Wyo. 1995) (quoting Roybal v. Bell, 778 P.2d 108, 112-14 (Wyo. 1989)).

 

[¶17]        Dr. Naramore's 
memorandum in support of his motion for summary  judgment, supported by affidavit, 
reiterated his affiant's expert medical opinion:

 

            [T]hat Mr. 
Mize's back complaint, as well as his usage of painkillers and other drugs was 
of a long-standing nature and that 
nothing done by Dr. Naramore in any way contributed to, exacerbated 
or caused any of Mr. Mize's 
complaints, additional back injury, or additional usage of pain killers and 
other drugs.

 

A supplemental affidavit 
filed by the medical expert specified records from thirty-six separate health 
care providers and pharmacies which had been reviewed in formation of his 
opinion as to the long-standing nature of the problems which appellants 
attribute to the negligence of appellees.

 

[¶18]        Clearly, appellees had 
created a prima facie case in support of summary judgment, refuting the claim 
that their negligence, if any, was the cause of Mr. Mize's problems. Appellants, 
thereafter, simply failed to produce any expert medical evidence which would 
establish a causal connection between the conduct of appellees and appellants' complaints. The gist of 
appellants' argument to this court is the proposition that a jury should be permitted to infer causation from 
evidence of Mr. Mize's problems and evidence of Dr. Naramore's substandard care. 
In Wyoming, however, the rule is quite clear. "In medical malpractice cases we 
require expert opinion to prove proximate cause. Harris, 625 P.2d  at 753 (citing 
Keller v. Anderson, 554 P.2d 1253 (Wyo. 
1976))." Meyer v. Mulligan, 889 P.2d 509, 516 (Wyo. 1995).

 

[¶19]        The logic behind this 
rule is articulated in the hospital's appellate brief:

 

            The human 
body is a wondrously complex machine which is constantly subjected to a variety 
of external forces, the effects of 
heredity, and the ravages of time. All of these factors are sometimes 
compounded by bad habits or bad 
luck. It is very reasonable to require the plaintiff in a malpractice case 
to            isolate the 
medical care he criticizes from the universe of potential causes of pain and 
addiction.

 

V. CONCLUSION

 

[¶20]        Granting, as we must, 
appellants' case the benefit of every favorable inference to be drawn from the 
record, it is clear that factual disputes abound as to the exact definition of a 
standard of care in this case as well as whether Dr. Naramore met that standard 
in his care and treatment of Mr. Mize. Appellants, however, failed to marshal any specific facts from 
which the district court could find a genuine issue of material fact as to the 
cause, proximate or otherwise, of Mr. Mize's ills. Causation is a sine qua non 
for maintenance of a malpractice case, leaving resolution of every other factual 
dispute in appellants' favor insufficient to avoid summary judgment. The 
decision of the district court is, therefore, affirmed.