Title: Crocker v. Roethling

State: north-carolina

Issuer: North Carolina Supreme Court

Document:

RONALD CROCKER and PAULETTE CROCKER as Co-Administrators of the
Estate of REAGAN ELIZABETH CROCKER v. H. PETER ROETHLING, M.D.
and WAYNE WOMEN’S CLINIC, P.A. 
No. 374PA07
FILED: 1 MAY 2009
Medical Malpractice–expert testimony–familiarity with community standard of care
The separate opinions of Justice Hudson and Justice Martin, when taken together,
constitute a majority of the Court in favor of reversing and remanding a decision of the Court of
Appeals that affirmed the trial court’s entry of summary judgment in favor of defendants in a
medical malpractice wrongful death action on the ground that plaintiffs’ only expert witness was
incompetent to testify because he failed to demonstrate in his deposition and affidavit that he
was sufficiently familiar with the relevant “same or similar community” standard of care. 
N.C.G.S. § 90-21.12.
Justice MARTIN concurring with separate mandate.
Justice EDMUNDS concurrs with concurring opinion.
Justice NEWBY dissenting.
Chief Justice PARKER and Justice BRADY join in dissenting opinion.
On discretionary review pursuant to N.C.G.S. § 7A-31 of
a unanimous, unpublished decision of the Court of Appeals, 184
N.C. App. 377, 646 S.E.2d 442 (2007), affirming an order granting 
summary judgment for defendants entered on 1 March 2006 by Judge
W. Russell Duke, Jr., in Superior Court, Johnston County.  Heard
in the Supreme Court 18 March 2008.
The McLeod Law Firm, P.A., by Joe McLeod; and Law
Offices of Wade E. Byrd, P.A., by Wade E. Byrd, for
plaintiff-appellants.
Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan,
L.L.P., by Samuel G. Thompson and William H. Moss, for
defendant-appellees.
Patterson Harkavy LLP, by Burton Craige, for North
Carolina Academy of Trial Lawyers, amicus curiae. 
HUDSON, Justice.
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In this medical malpractice case, we consider whether
the trial court properly excluded plaintiffs’ expert and granted
summary judgment for defendants when the expert’s opinions of his
familiarity with the community at issue and of defendants’ breach
of the standard of care satisfy the requirements of N.C.G.S. §
90-21.12.  We conclude that here, the expert’s deposition and
affidavit demonstrate “sufficient familiarity” with the “same or
similar” community and that the trial court erred by excluding
his testimony.  Because the expert’s evidence also provides
opinions that create a genuine issue as to the material fact of
defendants’ breach of the standard of care, summary judgment
should not have been granted.
Plaintiffs allege that their daughter, Reagan Elizabeth
Crocker, was born to them in September 2001 in Goldsboro and died
on 28 September 2003 due to severe, permanent birth-related
injuries.  Defendant H. Peter Roethling, M.D., an obstetrician
with defendant Wayne Women’s Clinic, delivered Reagan on 14
September 2001.  During delivery, Reagan’s shoulder became lodged
against her mother’s pelvis, preventing natural passage through
the birth canal.  This condition, called shoulder dystocia,
delayed Reagan’s birth and allegedly caused serious injuries. 
Plaintiffs contend that Dr. Roethling was negligent in failing to
perform various maneuvers, including the Zavanelli maneuver, to
dislodge Reagan’s shoulder and hasten her delivery. 
On 9 September 2004, plaintiffs, acting as co-
administrators of Reagan’s estate, filed a medical malpractice
action in the superior court in Johnston County against Dr.
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Roethling, Wayne Women’s Clinic, and other defendants later
dismissed from the action.  Plaintiffs sought damages for
wrongful death, based on the alleged negligence of Dr. Roethling
in delivering Reagan.  On 1 March 2006, the trial court entered
summary judgment for defendants after concluding that the
testimony of plaintiffs’ sole expert witness should be excluded. 
Plaintiffs appealed to the Court of Appeals, which filed a
unanimous, unpublished opinion on 3 April 2007 affirming the
trial court.  The Court of Appeals granted a petition for
rehearing on 6 June 2007 and reconsidered the case without
additional briefs and without oral argument.  The Court of
Appeals filed a unanimous, unpublished superseding opinion on 3
July 2007, again affirming the trial court.  That opinion stated
that “the record before [the Court of Appeals] does not include
sufficient facts tending to support [the expert’s]” assertion in
his 7 February 2006 affidavit “that he is ‘familiar with the
prevailing standard of care for handling shoulder dystocia in the
same or similar community to Goldsboro, North Carolina in 2001.’” 
Crocker v. Roethling, 184 N.C. App. 377, 646 S.E.2d 442, 2007 WL
1928681, at *3 (2007) (unpublished).  On 8 November 2007, this
Court allowed plaintiffs’ petition for discretionary review.  As
discussed below, we conclude that summary judgment for defendants
was not proper on this record.  We reverse and remand.
The standard for granting summary judgment is well
established.  Summary judgment is proper when “the pleadings,
depositions, answers to interrogatories, and admissions on file,
together with the affidavits, if any, show that there is no
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genuine issue as to any material fact and that any party is
entitled to a judgment as a matter of law.”  N.C.G.S. § 1A-1,
Rule 56(c) (2007).  The trial court must consider the evidence in
the light most favorable to the non-moving party.  E.g.,
McCutchen v. McCutchen, 360 N.C. 280, 286, 624 S.E.2d 620, 625
(2006) (citing Howerton v. Arai Helmet, Ltd., 358 N.C. 440, 470,
597 S.E.2d 674, 693 (2004)). 
“One of the essential elements of a claim for medical
negligence is that the defendant breached the applicable standard
of medical care owed to the plaintiff.”  Goins v. Puleo, 350 N.C.
277, 281, 512 S.E.2d 748, 751 (1999).  To meet their burden of
proving the applicable standard of care, plaintiffs must satisfy
the requirements of N.C.G.S. § 90-21.12, which states in full:
In any action for damages for
personal injury or death arising
out of the furnishing or the
failure to furnish professional
services in the performance of
medical, dental, or other health
care, the defendant shall not be
liable for the payment of damages
unless the trier of the facts is
satisfied by the greater weight of
the evidence that the care of such
health care provider was not in
accordance with the standards of
practice among members of the same
health care profession with similar
training and experience situated in
the same or similar communities at
the time of the alleged act giving
rise to the cause of action.
N.C.G.S. § 90-21.12 (2007) (emphasis added).  Plaintiffs must
establish the relevant standard of care through expert testimony. 
Ballance v. Wentz, 286 N.C. 294, 302, 210 S.E.2d 390, 395 (1974)
(citation omitted); Smith v. Whitmer, 159 N.C. App. 192, 195, 582
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S.E.2d 669, 671-72 (2003) (citations omitted).  When plaintiffs
have introduced evidence from an expert stating that the
defendant doctor did not meet the accepted medical standard,
“[t]he evidence forecast by the plaintiffs establishes a genuine
issue of material fact as to whether the defendant doctor
breached the applicable standard of care and thereby proximately
caused the plaintiffs’ injuries.”  Mozingo v. Pitt Cty. Mem’l
Hosp., Inc., 331 N.C. 182, 191, 415 S.E.2d 341, 346 (1992)
(citing Turner v. Duke Univ., 325 N.C. 152, 162, 381 S.E.2d 706,
712 (1989)).  This issue is ordinarily a question for the jury,
and in such case, it is error for the trial court to enter
summary judgment for the defendant.  Id.; see also Rouse v. Pitt
Cty. Mem’l. Hosp., Inc., 343 N.C. 186, 197, 470 S.E.2d 44, 50
(1996).
Here, the trial court appears to have granted summary
judgment to defendants on grounds that plaintiffs’ only proposed
medical expert, John P. Elliott, M.D., was insufficiently
familiar with Goldsboro and was applying a national standard of
care, thus requiring exclusion of his evidence.  Having excluded
the doctor from testifying, the court granted summary judgment
for defendants.  Ordinarily, we review the decision to exclude or
admit expert testimony for an abuse of discretion.  DOT v.
Haywood Cty,, 360 N.C. 349, 351, 626 S.E.2d 645, 646 (2006); see
also N.C.G.S. § 8C-1, Rule 104 (2007).  “[T]his Court has
uniformly held that the competency of a witness to testify as an
expert is a question primarily addressed to the court, and his
discretion is ordinarily conclusive, that is, unless there be no
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evidence to support the finding, or unless the judge abuse his
discretion.”  State v. Moore, 245 N.C. 158, 164, 95 S.E.2d 548,
552 (1956).  However, here, the pertinent inquiry is whether the
trial court properly applied the statutory requirements of
N.C.G.S. § 90-21.12 and the Rules of Evidence in considering Dr.
Elliott’s opinions at this stage of the proceedings.  If we
determine that the exclusion was erroneous, we then consider
whether this testimony sufficiently forecast a genuine issue of
material fact under Mozingo.  
We note that the ruling at issue here occurred at the
hearing solely calendared for the motion for summary judgment,
not for a motion to exclude testimony.  In fact, our review of
the record reveals no motion to exclude, written or oral, nor was
any motion to exclude listed on the calendar notice.  Moreover,
the reasons given in the transcript for the ruling (none appear
in the order) include:  that Dr. Elliott’s information about
Goldsboro showed that its hospital was different from the one in
Phoenix where he practices; that all of the hospitals where Dr.
Elliott has practiced are larger than the one in Goldsboro; and
that “the Court finds that the [witness] was testifying . . . to
a national standard of care and will exclude the evidence of that
expert.”  We conclude that this ruling and the order based
thereupon result from a misapplication of Rule 702 and N.C.G.S. §
90-21.12.
The trial court must decide the preliminary question of
the admissibility of expert testimony under the three-step
approach adopted in State v. Goode, 341 N.C. 513, 461 S.E.2d 631
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(1995).  The trial court thereunder must assess:  1) the
reliability of the expert’s methodology, 2) the qualifications of
the proposed expert, and 3) the relevance of the expert’s
testimony.  Id. at 527-29, 461 S.E.2d at 639-41).  Applying Goode
in the context of N.C.G.S. § 90-21.12, we note that North
Carolina law has established a “workable” and “flexible system
for assessing” the admissibility of expert testimony under Rule
702.  Id. at 469, 597 S.E.2d at 692.  Here, the first two steps
of the Goode analysis are not at issue; there is no controversial
or novel “proffered scientific or technical method of proof”
which defendants challenge as unreliable, nor have they
questioned Dr. Elliott’s qualifications as a medical expert.  358
N.C. at 460-61, 597 S.E.2d at 687-88.  Instead, defendants in
essence dispute the relevance of Dr. Elliott’s testimony, arguing
that his testimony was not admissible because it did not address
the relevant standard of care:  that of Goldsboro or similar
communities.    
Dr. Elliott, plaintiffs’ sole expert witness, practiced
obstetrics in Phoenix, Arizona.  In the hearing on the motion for
summary judgment, counsel for defendants indicated he did not
dispute Dr. Elliott’s other qualifications, but that “the key
issue” was whether he had “‘sufficient familiarity’ with the
standards of practice” in Goldsboro or similar communities.  We
note Dr. Elliott gave this testimony at a discovery deposition,
conducted by the defense attorney, and not in response to direct
examination by plaintiffs, who would later have the burden of
tendering the qualifications of the expert.  At such a discovery
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deposition, plaintiffs’ attorney had no obligation to expand upon
or clarify any of Dr. Elliott’s qualifications or opinions;
rather, the deposition was the defendants’ opportunity to learn
what they could about the other side’s expert and his opinions. 
Even so, at his deposition on 30 August 2005, Dr. Elliott was
able to accurately describe a number of features of the community
at issue here, including the location and population of
Goldsboro, and the number of obstetricians privileged at Wayne
Memorial Hospital.  He did testify that he believed a physician
in either Phoenix or Goldsboro would have the “same” knowledge,
but also correctly described the applicable standard of care as
“that of a reasonably trained physician practicing in the same or
similar circumstances.” 
On 10 February 2006, prior to the hearing on
defendants’ motion for summary judgment, plaintiffs filed Dr.
Elliott’s affidavit, which stated, in pertinent part:
3. I am familiar with the
training, education and experience
of Dr. Peter Roethling and have
reviewed the transcript of Dr.
Roethling’s deposition wherein he
discusses his training, education
and experience and his practice in
Goldsboro, North Carolina. . . .
4. I have reviewed information
about the community of Goldsboro,
North Carolina, Wayne County and
Wayne Memorial Hospital for the
period 2001 and am familiar with
the size of the population, the
level of care available at the
hospital, the facilities and the
number of health care providers for
obstetrics.  I am familiar with the
prevailing standard of care for
handling shoulder dystocia in the
same or similar community to
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Goldsboro, North Carolina in 2001
by a physician with the same or
similar training, education and
experience as Dr. Roethling.  The
applicable standard in Goldsboro in
2001 for a board certified
obstetrician such as Dr. Roethling
who is also a clinical teacher
required, among other things, that
when progress is not made in
delivery of a shoulder dystocia
using standard maneuvers, the
Zavenelli [sic] maneuver should be
used. 
The affidavit was discussed by plaintiffs’ counsel at the
argument on defendants’ motion for summary judgment on 13
February 2006.
As noted above, the record does not reflect a written
or oral motion to exclude the testimony of Dr. Elliott, but
nevertheless defense counsel argued to the trial court, at the
Court of Appeals, and again here that the doctor’s testimony
should be excluded because it was either based on a national
standard or failed to “demonstrate that [Dr. Elliott] really
[was] familiar with the standard of practice for similar
communities,” citing Purvis v. Moses H. Cone Mem’l Hosp. Serv.
Corp., 175 N.C. App. 474, 624 S.E.2d 380 (2006), Smith v.
Whitmer, 159 N.C. App. 192, 582 S.E.2d 669, and Henry v. Se.
OB-GYN Assocs., 145 N.C. App. 208, 550 S.E.2d 245, aff’d, 354
N.C. 570, 557 S.E.2d 530 (2001).  On the other hand, plaintiffs’
counsel has argued at every level that Dr. Elliott’s affidavit,
particularly paragraphs three and four quoted above, should put
the issue of familiarity with the same or similar community “to
rest” if viewed according to the appropriate legal standard.  
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We agree with plaintiffs that the cases cited by
defendants are distinguishable.  In Purvis, the Court of Appeals
held that an expert’s testimony was properly excluded when his
only stated knowledge of the community pertained to a period more
than four years after the alleged injury occurred.  175 N.C. App.
at 480-81, 624 S.E.2d at 385.  Here, in contrast, Dr. Elliott
specifically referred to the standard in effect at the time of
the alleged negligence.  In Smith, the expert “offered no
testimony regarding defendants’ training, experience, or the
resources available in the defendants’ medical community.”  159
N.C. App. at 196, 582 S.E.2d at 672.  The expert further
testified that “the sole information he received or reviewed
concerning the relevant standard of care in [the relevant
community] was verbal information from plaintiff’s attorney
regarding ‘the approximate size of the community and what goes on
there’” and that he could not even recall what he had been told. 
Id. at 196-97, 582 S.E.2d at 672.  He then stated that, in any
event, there was a national standard of care.  Id.  Henry
involved an expert who testified that he knew nothing about the
community at issue, but gave an opinion that the standard of care
for the particular procedure was the same across the nation.  145
N.C. App. at 210, 550 S.E.2d at 246-47.  In none of these cases
did the plaintiffs have a qualified expert like Dr. Elliott
produce an affidavit clearly stating that he was familiar with
the training and experience of the defendant physician and with
the specific standard of care in the relevant community at the
time of the alleged injury.
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We conclude that, unlike the experts in Purvis, Smith,
and Henry, Dr. Elliott demonstrated specific familiarity with and
expressed unequivocal opinions regarding the standard of care in
Goldsboro and similar communities, as well as in Dr. Roethling’s
own practice.  While Dr. Elliott did state in his deposition that
he expected “a physician in Phoenix [Arizona] to have the same
knowledge as Dr. Roethling irrespective of their location,” his
subsequent affidavit expanded and clarified his familiarity with
Dr. Roethling’s obstetrical practice and with Goldsboro and Wayne
County.  The trial court may not automatically disqualify an
expert witness simply because the witness indicates reliance on a
national standard of care during a discovery deposition.  Where,
as here, the basis of the opinion and the expert’s familiarity
with the same or a similar community is undeveloped, the
proponent must be given an opportunity to establish the witness’s
competency.  However, the proponent does not have the duty to do
so at the discovery deposition.
Dr. Elliott’s sworn affidavit states that he had
reviewed information about obstetrical care in Goldsboro and
Wayne County and about Dr. Roethling’s background and practice. 
Dr. Elliott also stated that he was familiar with the standard of
care for handling shoulder dystocia in the community in 2001. 
Any questions as to whether Dr. Elliott had actually reviewed
such information or whether he was truthful in stating that he
was familiar with the relevant standard of care go to the
credibility of the witness.  Nothing in our statutes or case law
suggests that a prospective medical expert must produce
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documentation of his research or attempt to explain to the trial
judge how his knowledge about the community enabled him to
ascertain the relevant standard of care.  Nor do they prescribe
any particular method by which a medical doctor must become
“familiar” with a given community.  Many methods are possible,
and our jurisprudence indicates our desire to preserve
flexibility in such proceedings.  The witness must show only that
“other specialized knowledge will assist the trier of fact to
understand the evidence or to determine a fact in issue.” 
N.C.G.S. § 8C-1, Rule 702(a).  
Further, the dissent suggests that Dr. Elliott was
required to explicate the basis for his opinion of the applicable
standard of care before it could be admissible.  Evidence Rule
705, “Disclosure of facts or data underlying expert opinion,”
provides in pertinent part: 
The expert may testify in terms of
opinion or inference and give his
reasons therefor without prior
disclosure of the underlying facts
or data, unless an adverse party
requests otherwise, in which event
the expert will be required to
disclose such underlying facts or
data on direct examination or voir
dire before stating the opinion.
N.C.G.S. § 8C-1, Rule 705 (2007).  Here, defense counsel did not
request the underlying basis for the opinion at the deposition. 
It appears that defense counsel began to ask about the basis, but
then withdrew the question.  After Dr. Elliott gave his opinion
on the standard of care, defense counsel stated the following: 
“Q:  And what is it that allows you – well, strike that.”  As
such, Dr. Elliott was not required, under our Rules, to state the
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basis for his opinion prior to the court’s ruling on its
admission.
As noted in the dissent, matters of credibility are for
the jury, not for the trial court.  Queen City Coach Co. v. Lee,
218 N.C. 320, 323, 11 S.E.2d 341, 343 (1940).  We have cautioned
trial courts against “asserting sweeping pre-trial ‘gatekeeping’
authority . . . [which] may unnecessarily encroach upon the
constitutionally-mandated function of the jury to decide issues
of fact and to assess the weight of the evidence.”  Howerton, 358
N.C. at 468, 597 S.E.2d at 692 (citing, inter alia, N.C. Const.
art I, § 25 and Daubert v. Merrell Dow Pharm., Inc., 509 U.S.
579, 125 L. Ed. 2d 469 (1993)).  
Here, the trial court exceeded its limited function
under Rule 104 by making a credibility determination about Dr.
Elliott’s testimony.  Although the trial court’s summary judgment
order states that Dr. Elliott’s affidavit was among the items
reviewed, it appears from the transcript that the trial court did
not properly consider the affidavit’s content according to the
requirements of N.C.G.S. § 90-21.12 and our Rules of Evidence, as
interpreted by this Court.  In the transcript of the summary
judgment hearing, the judge refers only to Dr. Elliott’s
deposition and never acknowledges the affidavit’s substantive
content.  Specifically, he referred to parts of Dr. Elliott’s
deposition that led him to conclude that Dr. Elliott would be
“testifying in affect [sic] to a national standard of care.”  In
the affidavit, Dr. Elliott states that he has reviewed
information about Goldsboro and the level of hospital care there. 
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Dr. Elliott’s affidavit further states that he is “familiar with
the prevailing standard of care for handling shoulder dystocia in
the same or similar community to Goldsboro, North Carolina in
2001 by a physician with the same or similar training, education
and experience as Dr. Roethling.”  Dr. Elliott’s affidavit and
deposition comply with the requirements of N.C.G.S. § 90-21.12
and demonstrate “sufficient familiarity” with the community at
issue, rendering Dr. Elliott competent to testify on the relevant
standard of care pursuant to Rule 702.  
In his affidavit, Dr. Elliott stated:  “Based on my
review of the labor and delivery records . . . for Reagan
Crocker, it is my opinion within a reasonable degree of medical
certainty that Dr. Roethling breached the standard of care which
caused Reagan to suffer hypoxic injury that ultimately led to her
death.”  This statement, when considered in the light most
favorable to plaintiffs, creates a genuine issue of material fact
for the trier of fact under N.C.G.S. § 90-21.12 and Rule 56
regarding whether defendants breached the applicable standard of
care, resulting in the injury to and death of Reagan Crocker. 
Summary judgment is not proper when a medical expert gives
evidence tending to show that the defendant failed to meet the
standard of care in the relevant community.  Mozingo, 331 N.C. at
191, 415 S.E.2d at 346.  Any question as to the credibility of
Dr. Elliott’s testimony on the standard of care is a matter for
the jury.  See N.C.G.S. § 90-21.12 (“[T]he defendant shall not be
liable for the payment of damages unless the trier of the facts
is satisfied by the greater weight of the evidence that the care
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of such health care provider was not in accordance with the
standards of practice among members of the same health care
profession with similar training and experience situated in the
same or similar communities . . . .”)  The trial court thus erred
in granting summary judgment for defendants.  
In sum, we hold that in a medical malpractice case:  1)
gaps in the testimony of the plaintiff’s expert during the
defendant’s discovery deposition may not properly form the basis
of summary judgment for the defendant; 2) the trial court should
consider affidavits submitted by the plaintiff or his witnesses
in opposition to the defendant’s motion for summary judgment in
accordance with Rule 56; 3) to determine whether the plaintiff
has presented evidence admissible to meet his burden under
N.C.G.S. § 90-21.12 and Rule 702, the trial court should apply
the test set forth in State v. Goode; 4) to determine whether an
expert’s testimony satisfies the third prong under Goode of
familiarity with the “same or similar community” standard of
care, the trial court should apply well-established principles of
determining relevancy under Evidence Rules 401 and 701; and, 5)
once the plaintiff raises a genuine issue as to whether the
defendant’s conduct breached the relevant standard of care, the
resolution of that issue is for the trier of fact, usually the
jury, per N.C.G.S. § 90-21.12.  We reverse and remand to the
Court of Appeals for further remand to the trial court for
further proceedings not inconsistent with this opinion.
REVERSED AND REMANDED.
Justice MARTIN, concurring, with separate mandate.
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In Howerton v. Arai Helmet, Ltd., this Court examined
and explained the standard for “ruling on the admissibility of
expert testimony” in North Carolina.  358 N.C. 440, 455, 597
S.E.2d 674, 684 (2004).  We acknowledged, on the one hand, that
“trial courts must decide preliminary questions concerning the
qualifications of experts to testify or the admissibility of
expert testimony,” and we reaffirmed that such decisions will
generally be reviewed on appeal for abuse of discretion.  Id. at
458, 597 S.E.2d at 686.  We emphasized, on the other hand, that
the trial court’s preliminary assessment should not “go so far as
to require the expert’s testimony to be proven conclusively
reliable or indisputably valid before it can be admitted into
evidence.”  Id. at 460, 597 S.E.2d at 687.  Evidence may be
“‘shaky but admissible,’” and it is the role of the jury to make
any final determination regarding the weight to be afforded to
the evidence.  Id. at 460-61, 597 S.E.2d at 687-88 (quoting
Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 596 (1993)).  
This Court took great care in Howerton to distinguish
our approach to expert qualification and admissibility of expert 
testimony from the federal court procedures described in Daubert
v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). 
Howerton, 358 N.C. at 469, 597 S.E.2d at 692-93.  We stated that
“application of the North Carolina approach is decidedly less
mechanistic and rigorous than the ‘exacting standards of
reliability’ demanded by the federal approach.”  Id. at 464, 597
S.E.2d at 690 (quoting Weisgram v. Marley Co., 528 U.S. 440, 455
(2000)).  Our concern was that “trial courts asserting sweeping
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pre-trial ‘gatekeeping’ authority under Daubert may unnecessarily
encroach upon the constitutionally-mandated function of the jury
to decide issues of fact and to assess the weight of the
evidence.”  Id. at 468, 597 S.E.2d at 692.
In the context of medical malpractice cases, our
General Assembly has expressed a similar sentiment regarding the
jury’s function in weighing expert testimony.  See N.C.G.S. §
90-21.12 (2007).  Assuming expert testimony is properly qualified
and placed before the trier of fact, section 90-21.12 reserves a
role for the jury in determining whether an expert is
sufficiently familiar with the prevailing standard of medical
care in the community.  See id.  Under the statute, “the trier of
the facts” must be “satisfied by the greater weight of the
evidence that the care of [the] health care provider was not in
accordance with the standards of practice among members of the
same health care profession with similar training and experience
situated in the same or similar communities.”  Id.
In the instant case, the record before this Court
appears to present a close question as to whether plaintiffs’
proffered expert, Dr. Elliott, was sufficiently familiar with the
standard of care in Goldsboro.  Dr. Elliott’s deposition
testimony tended not to support the admission of his testimony at
trial.  For instance, he did not know the designation of Wayne
Memorial Hospital (in which plaintiffs’ daughter was born) or the
number of labor and delivery suites it had.  He demonstrated
little familiarity with Goldsboro or Wayne County beyond a basic
estimate of population and general location within the state.  He
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testified that most of his obstetrics career was spent in
Phoenix, a metro area he believed had more than twenty times the
number of obstetricians than Goldsboro and a population exceeding
that of Goldsboro by over four million people.  Dr. Elliott
himself had never performed the Zavanelli maneuver, nor had he
ever observed it performed during his twenty-four years of
practice in Phoenix.  Moreover, at several points during his
deposition, he appeared to be applying a national standard of
care rather than the “same or similar community” standard
required by our General Assembly in section 90-21.12.  See § 90-
21.12. 
Dr. Elliott’s affidavit, on the other hand, indicated
that he had researched and was knowledgeable about the standard
of care in Goldsboro.  For example, Dr. Elliott stated that after
reviewing various materials, he was familiar with “the training,
education and experience of Dr. Peter Roethling,” “the size of
the population [of Goldsboro], the level of care available at the
hospital, the facilities and the number of health care providers
for obstetrics,” and “the prevailing standard of care for
handling shoulder dystocia in the same or similar community to
Goldsboro.” 
Our statutes and case law do not require an expert to
have actually practiced in the community in which the alleged
malpractice occurred, or even to have practiced in a similar
community.  See § 90-21.12; see also N.C.G.S. § 8C-1, Rule 702(b)
(2007) (indicating that an expert in a medical malpractice case
need not be licensed in North Carolina so long as the expert is
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licensed in some other state).  In this regard, I agree with
Justice Hudson’s opinion that our law does not “prescribe any
particular method by which a medical doctor must become
‘familiar’ with a given community.”  Book or Internet research
may be a perfectly acceptable method of educating oneself
regarding the standard of medical care applicable in a particular
community.  See, e.g., Coffman v. Roberson, 153 N.C. App. 618,
624, 571 S.E.2d 255, 259 (2002) (holding medical expert
demonstrated sufficient familiarity with applicable standard of
care when that familiarity was gained in part from “Internet
research about the size of the hospital, the training program,
and the AHEC (Area Health Education Center) program”), disc. rev.
denied, 356 N.C. 668, 577 S.E.2d 111 (2003).
Although the trial court appropriately considered both
Dr. Elliott’s deposition testimony and his affidavit in
determining whether to admit his expert opinion at trial, these
discovery materials did not adequately convey a complete picture
of Dr. Elliott’s qualifications or the reliability of his
proposed testimony.  Defendants’ deposition of plaintiffs’
proposed expert suggested a lack of relevant knowledge about
Goldsboro, while the expert’s affidavit asserted his familiarity
without explaining what materials he reviewed or the way in which
those materials influenced his determination of the applicable
standard of medical care.  Moreover, the trial court based its
decision to exclude Dr. Elliott primarily on a paper record,
considering the video deposition transcript, the affidavit, and
brief oral argument by counsel.  Thus, the trial court was in no
-20-
better position than this Court to review the record and to
assess Dr. Elliott’s qualifications and the reliability of his
proposed testimony.  See In re Greene, 306 N.C. 376, 380, 297
S.E.2d 379, 382 (1982) (explaining that “[t]his Court, unlike a
trial court, is ill-equipped to resolve disputed questions of
fact” because we “do not hear live testimony of sworn witnesses
and are required to rely exclusively upon written records”).
When the proffered expert’s familiarity with the
relevant standard of care is unclear from the paper record, our
trial courts should consider requiring the production of the
expert for purposes of voir dire examination.  In such
situations, particularly when the admissibility decision may be
outcome-determinative, the expense of voir dire examination and
its possible inconvenience to the parties and the expert are
justified in order to ensure a fair and just adjudication.  Voir
dire examination provides the trial court with the opportunity to
explore the foundation of the expert’s familiarity with the
community, the method by which the expert arrived at his
conclusion regarding the applicable standard of care, and the
link between this method and the expert’s ultimate opinion. 
Moreover, unlike the nonadversarial discovery process, counsel
for both parties may participate equally in a voir dire hearing
and help elicit all information relevant to the expert’s
qualifications and the admissibility of the proposed testimony.   
 
Perhaps most importantly, voir dire examination
provides the trial court with an informed basis to guide the
-21-
exercise of its discretion.  It is precisely because the trial
court “‘has the advantage of seeing and hearing the witnesses’”
that the trial court’s discretionary decision is entitled to
deference on appeal.  State v. Lasiter, 361 N.C. 299, 305, 643
S.E.2d 909, 912 (2007) (quoting State v. Little, 270 N.C. 234,
240, 154 S.E.2d 61, 66 (1967)) (explaining further that the trial
court’s firsthand observations of jury voir dire enable it to
“‘gain a “feel” of the case which a cold record denies to a
reviewing court’” (quoting Little, 270 N.C. at 240, 154 S.E.2d at
66)). 
I do not suggest that voir dire examination is
necessary in every case in which opposing counsel challenges a
proffered expert’s qualifications or proposed testimony.  In
light of the emphasis Howerton places on the jury’s role in
evaluating expert testimony, however, voir dire examination may
be prudent in close cases.  In Howerton, this Court expressed
concern with “the case-dispositive nature of Daubert proceedings,
whereby parties in civil actions may use pre-trial motions to
exclude expert testimony under Daubert to bootstrap motions for
summary judgment that otherwise would not likely succeed.” 
Howerton, 358 N.C. at 467, 597 S.E.2d at 691 (stating further: 
“[A] party may use a [pre-trial] hearing to exclude an opponent’s
expert testimony on an essential element of the cause of action. 
With no other means of proving that element of the claim, the
non-moving party would inevitably perish in the ensuing motion
for summary judgment.”  Id. at 468, 597 S.E.2d at 692.).  
-22-
The same concern is implicated in the instant case, in
which defendants sought and received summary judgment immediately
after the trial court’s exclusion of plaintiffs’ tendered expert. 
At the end of counsels’ arguments, following discussion about Dr.
Elliott’s deposition testimony and affidavit, plaintiffs’ counsel
noted to the trial court that “[t]his is not the cross-
examination of Dr. Elliott at a voir dire [examination].”  As
counsel’s remark implies, here, and in similar cases, the voir
dire procedure provides a more reliable assessment mechanism than
discovery depositions or conclusory affidavits, protecting the
jury from unreliable expert testimony yet preserving the jury’s
role in weighing the credibility of expert testimony when
appropriate. 
For the foregoing reasons, this case is reversed and
remanded to the Court of Appeals for further remand to the trial
court with instructions to conduct a voir dire examination of
plaintiffs’ proffered expert and, based on this evidentiary
foundation, to determine the admissibility of the proposed expert
testimony.  See Marks v. United States, 430 U.S. 188 (1977). 
Justice EDMUNDS concurs in this opinion.
Justice NEWBY dissenting.
In my view, this case presents the issue of whether a
tendered expert’s unsubstantiated statements of familiarity with
the applicable standard of care in a medical malpractice action
mandate a voir dire examination to determine whether the expert
-23-
1 The separate opinions of Justice Martin and Justice
Hudson, when taken together, constitute a majority of the Court
in favor of reversing and remanding.  Justice Martin’s opinion,
having the narrower directive, is the controlling opinion, cf.
Marks v. United States, 430 U.S. 188, 193, 97 S. Ct. 990, 993, 51
L. Ed. 2d 260, 266 (1977) (“When a fragmented [Supreme Court of
the United States] decides a case and no single rationale
explaining the result enjoys the assent of five Justices, ‘the
holding of the Court may be viewed as that position taken by
those Members who concurred in the judgments on the narrowest
grounds . . . .’” (quoting Gregg v. Georgia, 428 U.S. 153, 169
n.15, 96 S. Ct. 2909, 2923, 49 L. Ed. 2d 859, 872 (1976) (opinion
of Stewart, Powell, and Stevens, JJ.))), and requires the trial
court to conduct a voir dire examination of the proffered expert
witness.  References in this dissenting opinion to “the majority”
denote matters as to which the opinions of Justices Martin and
Hudson seem to agree.  When responding to one of those opinions
separately, this dissenting opinion will refer to the authoring
Justice by name.
is competent to testify at trial.1  While I agree that the trial
court in its discretion could have conducted a voir dire of the
proffered expert, under the facts of this case and the long-
established deferential standard of review, I do not believe the
trial court’s decision not to do so was an abuse of discretion
requiring this Court to intervene and direct the proceedings of
the trial court.  I therefore respectfully dissent.
Plaintiffs brought this action alleging that defendants
committed medical malpractice during the delivery of plaintiffs’
daughter Reagan at Wayne Memorial Hospital in Goldsboro. 
Plaintiffs sought to contend at trial that defendant H. Peter
Roethling, M.D. breached the applicable standard of care while
delivering Reagan by failing to perform what is known as the
Zavanelli maneuver.  The Zavanelli maneuver is a medical
procedure by which a baby suffering shoulder dystocia is pushed
back into the mother’s uterus, relieving compression on the
umbilical cord and enabling the baby to receive sufficient
-24-
oxygen.  Delivery is thus delayed until an emergency cesarean
section can be performed.
Plaintiffs tendered John P. Elliott, M.D. as their only
expert witness.  He intended to testify that the Zavanelli
maneuver was part of the standard of care applicable to a board-
certified obstetrician in Goldsboro at the time of Reagan’s birth
and, therefore, that defendant Roethling breached the standard of
care in failing to perform the maneuver.  As will be detailed
more fully below, Dr. Elliott had no experience practicing in
Goldsboro or any similar community and, when he formed his
opinion, had very little knowledge of defendant Roethling’s
training, of the Goldsboro community in general, or of the
medical facilities at Wayne Memorial Hospital.
Defendants sought to exclude Dr. Elliott’s testimony
and, based upon the possible exclusion, moved for summary
judgment on 1 February 2006.  After a hearing on the motion, the
trial court found that Dr. Elliott had impermissibly based his
opinion on a national standard of care, and on 1 March 2006, the
court entered an order excluding Dr. Elliott’s testimony and
granting summary judgment in favor of defendants.  Plaintiffs
appealed, and the Court of Appeals affirmed the trial court. 
This Court allowed discretionary review to determine whether it
was proper for the trial court to exclude Dr. Elliott’s testimony
and grant defendants’ motion for summary judgment.
Section 90-21.12 of the General Statutes, entitled
“Standard of health care,” provides:
In any action for damages for personal
injury or death arising out of the furnishing
-25-
or the failure to furnish professional
services in the performance of medical,
dental, or other health care, the defendant
shall not be liable for the payment of
damages unless the trier of the facts is
satisfied by the greater weight of the
evidence that the care of such health care
provider was not in accordance with the
standards of practice among members of the
same health care profession with similar
training and experience situated in the same
or similar communities at the time of the
alleged act giving rise to the cause of
action.
N.C.G.S. § 90-21.12 (2007).  Under this statute, the plaintiff in
a medical malpractice suit bears the burden of proving the
defendant failed to comply with the applicable standard of care. 
To do so, the plaintiff must first establish the content of that
standard by providing evidence of “the standards of practice
among members of the same health care profession with similar
training and experience situated in the same or similar
communities at the time of the alleged act giving rise to the
cause of action.”  Id.  Due to the specialized nature of the
standard of care in medical malpractice cases, the content and
meaning of the standard must be demonstrated by expert testimony. 
See id. § 1A-1, Rule 9(j) (2007); id. § 8C-1, Rule 702(a) (2007);
Ballance v. Wentz, 286 N.C. 294, 302, 210 S.E.2d 390, 395 (1974).
Regardless of context, the decision whether to admit
expert testimony lies within the province of the trial court. 
N.C.G.S. § 8C-1, Rule 104(a) (2007).
“[A] trial court’s ruling on the
qualifications of an expert or the
admissibility of an expert’s opinion will not
be reversed on appeal absent a showing of
abuse of discretion.”  Howerton v. Arai
Helmet, Ltd., 358 N.C. 440, 458, 597 S.E.2d
674, 686 (2004).  “A ruling committed to a
-26-
trial court’s discretion is to be accorded
great deference and will be upset only upon a
showing that it was so arbitrary that it
could not have been the result of a reasoned
decision.”  White v. White, 312 N.C. 770,
777, 324 S.E.2d 829, 833 (1985).
N.C. Dep’t of Transp. v. Haywood Cty., 360 N.C. 349, 351, 626
S.E.2d 645, 646 (2006) (alteration in original).  The abuse of
discretion standard is firmly entrenched in our caselaw for
appellate review of trial courts’ discretionary decisions, and
the implication by a majority of this Court that abuse of
discretion does not apply here thus represents a sharp departure
from precedent.  In stating that “the pertinent inquiry is
whether the trial court properly applied the statutory
requirements of N.C.G.S. § 90-21.12 and the Rules of Evidence,”
moreover, Justice Hudson’s opinion fails to set forth any real
standard of review to fill the void.  Justice Martin likewise
neglects to state the standard under which he deems a voir dire
examination necessary.  The statutory provisions to which Justice
Hudson refers do indeed contain standards that the trial court
must apply, but those standards simply define inquiries and
determinations that are left to the discretion of the trial
court.  Abuse of discretion therefore remains the proper standard
for our review of the trial court’s decision to exclude Dr.
Elliott’s testimony.
Although the jury is entrusted with weighing the
credibility of expert testimony that has been deemed admissible,
the abuse of discretion standard affords the trial court wide
latitude in performing the preliminary function of evaluating
whether the expert in question is competent to testify.  Queen
-27-
City Coach Co. v. Lee, 218 N.C. 320, 323, 11 S.E.2d 341, 343
(1940) (“The competency, admissibility, and sufficiency of the
evidence is a matter for the court to determine.  The
credibility, probative force, and weight is a matter for the
jury.  This principle is so well settled we do not think it
necessary to cite authorities.”).  In this case, prior to stating
his opinions before a jury, Dr. Elliott was required to
demonstrate to the trial court his competency to testify
regarding the applicable standard of care.
As the General Statutes reflect, the trial court’s
traditional duty to determine the admissibility of expert
testimony is particularly important in the medical malpractice
context.  In medical malpractice suits in which the plaintiff
does not rely on the doctrine of res ipsa loquitur, our Rules of
Civil Procedure require the trial court to determine whether the
plaintiff’s pleading asserts that an expert witness will “testify
that the medical care did not comply with the applicable standard
of care” and, if the pleading fails to do so, to dismiss the
complaint.  N.C.G.S. § 1A-1, Rule 9(j); id. § 90-21.12. 
Similarly, a witness can testify to the “scientific, technical or
other specialized knowledge” that is crucial in medical
malpractice cases only after the trial court is satisfied that
the witness is “qualified as an expert by knowledge, skill,
experience, training, or education.”  Id. § 8C-1, Rule 702(a). 
This consistent interposition of the trial court between
potential expert witnesses and the jury represents sound
legislative policy, as lay jurors will naturally accord great
-28-
weight to expert testimony.  Billips v. Commonwealth, 274 Va.
805, 809, 652 S.E.2d 99, 101-02 (2007) (“Advancements in the
sciences continually outpace the education of laymen, a category
that includes judges, jurors and lawyers . . . .  Consequently,
there is a risk that those essential components of the judicial
system may gravitate toward uncritical acceptance of any
pronouncement that appears to be ‘scientific,’ . . . .”).
In determining whether an expert’s testimony is
sufficiently reliable for admission, the trial court must make “a
preliminary, foundational inquiry into the basic methodological
adequacy of [the] expert testimony.”  Howerton, 358 N.C. at 460,
597 S.E.2d at 687 (citing Queen City Coach Co., 218 N.C. at 323,
11 S.E.2d at 343).  Notwithstanding Justice Hudson’s intimation
to the contrary, an expert’s methodology need not be especially
“controversial or novel” for its reliability to come under
scrutiny.  Just as it must do in cases involving expert testimony
derived from complex scientific methods, the trial court in a
medical malpractice action must examine the process by which the
expert arrived at the proffered opinion on the content of the
applicable standard of care.  The court must be able to determine
which information the expert used in forming the opinion as well
as how the expert used that information.
I agree with Justice Martin’s view that when opposing
counsel challenges an expert’s competency to testify to the
applicable standard of care, and it is a close case as to whether
the expert is sufficiently familiar with that standard, the best
practice is for the trial court to conduct a voir dire
-29-
examination of the proffered expert witness.  In fact, had the
trial court elected to hold a voir dire hearing to determine Dr.
Elliott’s competency to testify, I would find no abuse of
discretion in that decision.  However, when the record alone
demonstrates that the expert lacks the required familiarity, a
voir dire hearing is not required as a matter of law.  In the
instant case, the record reveals that while Dr. Elliott asserted
his familiarity with the applicable standard, he had minimal
knowledge of Goldsboro or any similar communities and was simply
applying a national standard of care when he formed his opinion. 
Moreover, despite his years of practice in a large metropolitan
area, Dr. Elliott had no personal experience with the procedure
about which he sought to testify and knew of no specific
instances of its use.  In such cases the trial court may properly
deem the proffered expert witness incompetent to testify without
the expense and inconvenience of a voir dire examination.
In challenging Dr. Elliott’s familiarity with the
applicable standard of care, defendants questioned not only the
relevance of his opinions but also the reliability of the methods
he used to formulate those opinions.  In so doing, defendants
disputed the accuracy, not the truthfulness, of Dr. Elliott’s
conclusion that he was familiar with the standard applicable to
Goldsboro or a similar community.  In other words, defendants
challenged Dr. Elliott’s competency, not his credibility.  As
noted by Justice Hudson, both the relevance of an expert’s
testimony and the reliability of the expert’s methodology are
questions of law to be determined by the court in its
-30-
admissibility inquiry.  Id. at 458, 597 S.E.2d at 686 (citing
State v. Goode, 341 N.C. 513, 527-29, 461 S.E.2d 631, 639-41
(1995)).  Questions of the relevance of Dr. Elliott’s testimony
and the reliability of his methods cannot simply be decided by
Dr. Elliott.  The court must look beyond his bare assertions and
decide these issues for itself.
I do not dispute the majority’s statement that there is
no “particular method by which a medical doctor must become
‘familiar’ with a given community.”  I do believe, however, that
in order for the trial court to properly decide Dr. Elliott was
competent to testify to the standard of care applicable in
Goldsboro or similar communities, Dr. Elliott was required to
demonstrate to the court some acceptable method by which he
arrived at his conclusion on the content of Goldsboro’s standard
of care.  The evidence before the court failed to establish such
a method.  Dr. Elliott was a member of the same health care
profession as defendant Roethling, both being board-certified
obstetricians.  He knew that defendant Roethling had completed a
residency in obstetrics and gynecology, but he demonstrated no
further knowledge of defendant Roethling’s training and
experience.  Dr. Elliott knew the approximate population of the
Goldsboro area and the number of obstetricians practicing there,
but he had no personal experience practicing in Goldsboro or any
similar community.  He recited basic facts about defendant
Roethling and about Goldsboro, but ultimately failed to clarify
how those facts served to familiarize him with the applicable
standard of care.  As defense counsel stated at the motion
-31-
hearing, Dr. Elliott simply failed to “connect the dots between
Goldsboro or a similar community” and the personal knowledge and
experience that resulted in the formulation of his opinion.
This Court has affirmed two Court of Appeals opinions
that upheld the trial court’s function of determining
admissibility by requiring expert witnesses to elucidate both the
facts underlying their proffered testimony and the logical link
between those facts and the experts’ opinions.  In Henry v.
Southeastern OB-GYN Associates, 145 N.C. App. 208, 550 S.E.2d
245, aff’d per curiam, 354 N.C. 570, 557 S.E.2d 530 (2001), the
Court of Appeals held an expert was properly excluded because his
assertion of familiarity with a national standard of care failed
to demonstrate sufficient knowledge of the standard of care in
Wilmington or a similar community.  Id. at 212-13, 550 S.E.2d at
248.  The court noted the lack of a meaningful connection between
the facts the expert used and his conclusion on the applicable
standard of care, stating there was no evidence that a national
standard applied to Wilmington or that the community in which the
expert practiced was similar to Wilmington.  Id. at 210, 550
S.E.2d at 246-47.  The Court of Appeals also upheld the trial
court’s refusal to allow the expert to testify at trial that he
was familiar with the standard of care applicable to Wilmington
or similar communities, because such testimony would have
contradicted the expert’s deposition testimony.  Id. at 217-20,
550 S.E.2d at 251-52 (Hudson, J., dissenting).
In Pitts v. Nash Day Hospital, Inc., 167 N.C. App. 194,
605 S.E.2d 154 (2004), aff’d per curiam, 359 N.C. 626, 614 S.E.2d
-32-
267 (2005), the Court of Appeals performed a similar analysis in
holding that an expert was improperly excluded.  The court found
that a number of strong similarities between the personal
experience of the expert and that of the defendant medical doctor
represented a reliable method for the expert to use in drawing
conclusions regarding the applicable standard of care. 
Specifically, the court noted the expert and the defendant doctor
had comparable “skill, training, and experience,” both having
practiced extensively in North Carolina; the expert had practiced
in communities throughout North Carolina and testified to their
similarity to the community in question “in terms of population
served, rural nature, depressed economy, and limitations on
resources”; and the expert “was familiar with the equipment [used
by the defendant doctor] because he used similar . . . equipment
in other communities in his medical practice.”  Id. at 198, 605
S.E.2d at 156-57.  The numerous similarities in the two doctors’
backgrounds gave the court sufficient grounds upon which to
conclude the expert’s method of forming an opinion on the
applicable standard of care was reliable.  Id. at 199, 605 S.E.2d
at 157.
These cases demonstrate that neither an expert’s bald
assertion of familiarity with the applicable standard of care nor
mere superficial statements of fact about the community in
question can give the trial court a sufficient basis to deem the
expert’s methods reliable or the resulting testimony relevant. 
When challenged, the expert must not only state with specificity
the facts that contributed to the proffered opinion, but also
-33-
make clear to the court how those facts enabled the expert to
arrive at a conclusion.  This latter step must be performed most
explicitly when, as in the instant case, the expert has no
personal experience in the community at issue or any similar
community.
The record reflects that at the time of his testimony,
Dr. Elliott was licensed to practice medicine in Arizona,
California, and Colorado, but not in North Carolina.  He gave his
deposition testimony from Phoenix, Arizona via videoconference. 
His practice at the time was at Good Samaritan Regional Medical
Center (“Good Samaritan”) in Phoenix, and he had spent his career
practicing in Phoenix and in various Army hospitals, none of
which were located in North Carolina.  According to Dr. Elliott,
Good Samaritan services the Phoenix metropolitan area, the
population of which he estimated at “about four and a half
million,” and also draws patients from across Arizona and
throughout the country.  In contrast, Dr. Elliott estimated the
population of the Goldsboro area at “a little over 100,000
people.”  He further approximated that there were “in excess of
200” obstetricians practicing in the Phoenix metropolitan area,
compared to a total of 8 obstetricians in the Goldsboro area. 
Dr. Elliott had never practiced in Goldsboro and admitted in his
deposition that he had never even practiced in a community
similar to Goldsboro.
Dr. Elliott’s deposition is devoid of specific facts
pertaining to defendant Roethling’s training and experience,
aside from the basic knowledge that defendant Roethling had
-34-
completed a residency in obstetrics and gynecology.  He also did
not know how long defendant Roethling had been in practice.  As
discussed above, Dr. Elliott’s deposition testimony does reveal
some secondhand knowledge of the Goldsboro community.  He had
familiarized himself with the total population of the Goldsboro
area and Wayne County’s relative location in North Carolina.  He
also knew the number of obstetricians practicing in Goldsboro at
the time of Reagan Crocker’s birth.  Nonetheless, his knowledge
of the facilities available at Wayne Memorial Hospital was vague
at best:  he “believe[d] they [did] not have a neonatal intensive
care unit,” and he did not know how many labor and delivery
suites they had.  At no point in his deposition or his affidavit
did Dr. Elliott explain how the basic facts he knew about
defendant Roethling and the Goldsboro community enabled him to
conclude that the standard of care applicable to an obstetrician
in Goldsboro or any similar community required use of the
Zavanelli maneuver in Reagan Crocker’s case.
Dr. Elliott failed to articulate a proper basis for his
conclusions even though defense counsel fully explored his
familiarity with the community at issue, other similar
communities, and the applicable standard of care.  Defense
counsel repeatedly asked Dr. Elliott about specific facts
regarding Goldsboro that may have contributed to his testimony,
for instance by inquiring into his familiarity with the exact
medical facilities available at Wayne Memorial Hospital.  Counsel
also asked about Dr. Elliott’s experience in similar communities
and found he had none.  Perhaps most importantly, counsel
-35-
specifically requested that Dr. Elliott explain how he arrived at
his conclusion on the content of Goldsboro’s standard of care,
asking, “Why is it that you think that the Zavanelli maneuver is
something that a physician like Dr. Roethling should have
considered doing as opposed to perhaps something that you would
expect one of your colleagues in Phoenix to do?”  Dr. Elliott
responded:
Well, I expect Dr. Roethling reads the
same literature that I would or my colleagues
in Phoenix would.  The textbooks are the
same.  They are not written for, you know,
Goldsboro, North Carolina versus Cleveland,
Ohio or Phoenix, Arizona.  The information is
really very general information.  The
articles that are published are very general
information.  And the expected behaviors are
very similar.  So I would expect a physician
in Phoenix to have the same knowledge as Dr.
Roethling irrespective of their location.
Like the tendered expert in Henry v. Southeastern OB-GYN
Associates, Dr. Elliott essentially testified to a belief in a
national standard of care for obstetricians, yet failed to
demonstrate how his minimal knowledge of Goldsboro led to his
conclusion that such a standard applies to Goldsboro or any
similar community.
Furthermore, it is not even clear that Dr. Elliott used
reliable methods in concluding the Zavanelli maneuver is part of
the standard of care applicable to Phoenix.  Regarding his own
experience in dealing with shoulder dystocia, Dr. Elliott
testified that he had never himself performed or witnessed the
Zavanelli maneuver and was unaware of any member of his own
medical group, consisting of fifteen physicians who deliver
babies, ever using the maneuver while practicing in Phoenix. 
-36-
Although Good Samaritan services a much larger population and has
considerably more extensive facilities than Wayne Memorial
Hospital, Dr. Elliott could not recall any specific case during
his twenty-four years at Good Samaritan in which any obstetrician
attempted the maneuver.  The record also reflects that Dr.
Elliott’s opinion was based in part on a worldwide study that
found only about one hundred reported cases in which the
Zavanelli maneuver was used between 1985, when the maneuver was
first mentioned in medical literature, and 1997, four years
before Reagan’s birth.  If the reported usage of the Zavanelli
maneuver is, on average, fewer than ten times per year throughout
the world, it is unclear how Dr. Elliott could reliably conclude
the maneuver is part of the standard of care in Phoenix, let
alone Goldsboro.
The majority de-emphasizes the insufficiency of Dr.
Elliott’s deposition testimony by pointing to his affidavit.  In
so doing, I believe the majority places too much importance on
the affidavit.  Unlike a deposition, an affidavit gives the
opposing party no opportunity to cross-examine the affiant. 
Thus, crediting the affidavit over the deposition fails to give
due respect to the adversarial means by which our justice system
seeks to ascertain truth.  See In re Miller, 357 N.C. 316, 334,
584 S.E.2d 772, 785-86 (2003) (citations omitted).  In my view,
in deciding questions of reliability and relevance, courts should
endeavor to determine which facts the expert actually used when
forming the proffered opinion, rather than focusing on facts the
expert subsequently learned.  Cf. Henry, 145 N.C. App. at 217-20,
-37-
550 S.E.2d at 251-52 (Hudson, J., dissenting) (noting the court
in that case refused to allow an expert to testify at trial in a
manner that would have contradicted the expert’s deposition
testimony).  To do otherwise is to admit testimony that lacks the
foundation our General Assembly envisioned in enacting N.C.G.S. §
90-21.12.
Even if it were proper to ascribe greater worth to the
affidavit than the deposition, Dr. Elliott’s affidavit does not
sufficiently demonstrate that he is familiar with the applicable
standard of care.  The relevant portions of that affidavit,
quoted in full by Justice Hudson, baldly assert Dr. Elliott’s
familiarity with “the size of the population, the level of care
available at the hospital, the facilities and the number of
health care providers for obstetrics,” and with the standard of
care applicable to this case.  The affidavit contains no specific
information about the Goldsboro community or its medical
facilities that would support these assertions.  Our Rules of
Evidence seek to prevent, as unhelpful to the trier of fact,
testimony that simply speaks in the language of the applicable
legal standard and thus “merely tell[s] the jury what result to
reach.”  N.C.G.S. § 8C-1, Rule 704 official cmt. (2007). 
Similarly, Dr. Elliott should not be deemed competent to testify
based solely on his ability to essentially parrot the standard of
care language of section 90-21.12.
Neither Dr. Elliott’s deposition nor his affidavit
succeeded in demonstrating any nexus between, on the one hand,
his experience and his minimal knowledge of Goldsboro and, on the
-38-
other, the conclusion that a national standard of care including
the Zavanelli maneuver was applicable in Goldsboro or any similar
community.  In short, any proper basis he may have had to offer
an opinion that the Zavanelli maneuver was part of the standard
of care applicable to Goldsboro was not clear to the court.  As
observed by the Court of Appeals, “neither Dr. Elliott’s
affidavit nor the record before this Court includes sufficient
facts, as opposed to conclusions, to support Dr. Elliott’s
statements that he is familiar with the standard of care
applicable in communities similar to Goldsboro, North Carolina.” 
Crocker v. Roethling, 184 N.C. App. 377, 646 S.E.2d 442, 2007 WL
1928681, at *3 (2007) (unpublished).  Because Dr. Elliott failed
to sufficiently establish his familiarity with “the standards of
practice among members of the same health care profession with
similar training and experience situated in the same or similar
communities” as defendant Roethling at the time of Reagan’s
birth, see N.C.G.S. § 90-21.12, the trial court’s ruling that he
was incompetent to testify to those standards was not an abuse of
discretion “‘so arbitrary that it could not have been the result
of a reasoned decision,’” N.C. Dep’t of Transp. v. Haywood Cty.,
360 N.C. at 351, 626 S.E.2d at 646 (quoting White, 312 N.C. at
777, 324 S.E.2d at 833).
After reviewing the trial court’s exclusion of Dr.
Elliott’s testimony for abuse of discretion, this Court must
inquire separately into the trial court’s grant of summary
judgment in favor of defendants.  Bearing in mind that Dr.
Elliott’s testimony was properly deemed inadmissible and thus
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cannot be considered for summary judgment purposes, any competent
facts asserted by the nonmoving party must be “taken as true, and
their inferences must be viewed in the light most favorable to
that party.”  E.g., Dobson v. Harris, 352 N.C. 77, 83, 530 S.E.2d
829, 835 (2000) (citations omitted).
Dr. Elliott’s proffered testimony represented
plaintiffs’ only evidence of the applicable standard of care. 
Because Dr. Elliott was incompetent to testify on that matter,
plaintiffs were unable to satisfy N.C.G.S. § 90-21.12 by offering
competent proof that defendants failed to comply with the
standard of care.  Plaintiffs contend that even if Dr. Elliott
was incompetent to testify, defendant Roethling himself admitted
in his deposition that the Zavanelli maneuver was part of the
standard of care applicable to this case.  My review of the
deposition testimony reveals that while defendant Roethling
acknowledged the existence of the Zavanelli maneuver, he never
stated it was part of the applicable standard of care.  When the
plaintiff in a medical malpractice action lacks any competent
means of proving the defendant breached the applicable standard
of care, the governing statute dictates that “the defendant shall
not be liable.”  N.C.G.S. § 90-21.12.  Thus, even when viewed in
the light most favorable to plaintiffs, the case presented “no
genuine issue as to any material fact” and defendants were
“entitled to a judgment as a matter of law.”  Id. § 1A-1, Rule
56(c) (2007).  The trial court properly granted summary judgment
in defendants’ favor.
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I believe the result reached by the majority of the
Court fails to give proper deference to the trial court’s
reasonable decision not to conduct a voir dire examination of the
tendered expert witness.  While I do not contend that the trial
court would have been in error had it decided to hold a voir dire
hearing, the facts of this case are not such as to mandate voir
dire as a matter of law.  The trial court committed no abuse of
discretion, and its ruling should remain intact.  I would affirm
the judgment of the Court of Appeals and therefore respectfully
dissent.
Chief Justice PARKER and Justice BRADY join in this
dissenting opinion.