IN THE SUPERIOR COURT OF THE STATE OF DELAWARE

CHARLES TROTT, )

)

Plaintiff, )

)

v. ) C.A. No. N20C-09-182 SPL

)

BAYHEALTH MEDICAL CENTER, )

INC., KENT GENERAL HOSPITAL, INC., )

BAYHEALTH NEUROSURGERY, JAMES )

MILLS, MD, NASAROLLAH FATEHI, MD,)

JOHN CHUKWUDIFU, PA-C, )

JULIA MATT, RN, TYLER BOHANON, )

RN,

1

and WHITNEY CESSNA, RN, )

)

Defendants. )

Submitted: November 27, 2023

Decided: February 16, 2024

MEMORANDUM OPINION AND ORDER

Upon Defendants Julia Matt and Tyler Bohanon’s

Motion for Summary Judgment, GRANTED.

Upon Defendant Whitney Cessna’s

Motion for Summary Judgment, GRANTED.

Upon Defendant Bayhealth Medical Center Inc.’s

Motion for Partial Summary Judgment, GRANTED.

1 Tyler Bohanon’s surname is spelled variously throughout the pleadings as 

Bohanon, Bohanan, and Bohannon. The Court will use the spelling provided in the 

complaint – Bohanon. To the extent that this is an incorrect spelling, the Court 

intends no disrespect.
Michael Mongeluzzi, Esquire (Argued), Joseph DeAngelo, Esquire, of BARRETT 

DEANGELO, LLC, West Chester, Pennsylvania; Linda Malkin, Esquire, of 

KIMMEL CARTER ROMAN PELTZ & O’NEIL, P.A., Wilmington, Delaware, 

Attorneys for Plaintiff, Charles Trott.

Joseph Drnec, Esquire (Argued), Phillip Casale, Esquire, of WHARTON LEVIN 

EHRMANTRAUT & KLEIN, P.A., Wilmington, Delaware; Attorneys for 

Defendants Bayhealth Medical Center, Inc., Julia Matt, RN and Tyler Bohanon, RN.

Bradley Goewert (Argued), Esquire, Thomas Marcoz, Jr., Esquire, of MARSHALL 

DENNEHEY, P.C., Wilmington, Delaware, Attorneys for Defendant Whitney 

Cessna, RN.

LUGG, J.
3

I. INTRODUCTION

Plaintiff, Charles Trott (“Trott”), sued Bayhealth Medical Center, Inc.

(“Bayhealth”), Kent General Hospital, Inc.,2 Bayhealth Neurosurgery, James Mills, 

M.D. (“Dr. Mills”), Nasrollah Fatehi, M.D. (“Dr. Fatehi”), John Chukwudifu, PA-C

(“PA Chukwudifu”), Whitney Cessna, RN (“Nurse Cessna”), Julia Matt, RN

(“Nurse Matt”), and Tyler Bohanon, RN (“Nurse Bohanon”), for medical negligence 

related to the December 2018 treatment of injuries to his spinal cord resulting in his 

quadriplegia.

3

 Nurses Cessna, Matt, and Bohanon have moved for summary 

judgment,

4

and Bayhealth seeks partial summary judgment to the extent it is alleged 

to be responsible for the negligence of Nurses Cessna, Matt, and Bohanon.5 Trott 

opposes these motions.6

In his complaint, Trott alleges that Nurses Cessna, Matt, and Bohanon were 

negligent and careless for:

a. Failing to provide and afford proper and careful medical and 

nursing care and treatment to [Mr. Trott] during his December 9, 

2018, admission;

2

In its answer to the complaint, Bayhealth asserted “Kent General, Inc.” and 

“Bayhealth Neurosurgery” are not properly named legal entities. D.I. 14 

(“Bayhealth Ans.) at n.1.

3 See generally Pl.’s Compl. (D.I. 1) (“Compl.”).

4 D.I. 111 (“Cessna Mot.”); D.I. 110 (“Matt & Bohanon Mot.”).

5 D.I. 113 (“Bayhealth Mot.”).

6 D.I. 116 (“Ans. Matt & Bohanon”); D.I. 117 (“Ans. Cessna”); D.I. 118 (“Ans. 

Bayhealth”).
4

b. Providing medical and nursing care and treatment to [Mr. Trott] 

which was below the standard of care in the community, 

increasing the risk of harm to Mr. Trott’s well-being;

c. Failing to properly evaluate Mr. Trott during his December 9, 

2018, presentation to Kent General Hospital;

d. Failing to properly communicate Mr. Trott’s condition amongst 

his healthcare providers on December 9, 2018;

e. Failing to perform proper neurological assessments on December 

9, 2018;

f. Failing to perform proper neurological checks on December 9, 

2018; and

g. Permitting Mr. Trott’s spinal cord injury to progress to 

quadriplegia on December 9, 2018.7

 

Trott contends that the nurses’ carelessness and negligence caused his:

serious, disabling and permanent personal injuries, including, but not 

limited to: the development and progression of a spinal cord injury; 

spinal cord contusion; spinal cord edema; permanent paralysis of the 

upper extremities; permanent paralysis of the lower extremities; 

quadriplegia; neurogenic bladder, tracheostomy, PEG tube placement 

and feedings; respiratory distress; acute ventilator dependent 

respiratory failure; pneumonia; fracture of the ribs; the need to undergo 

extensive medical and surgical care; the need to undergo extensive 

therapy and rehabilitation; he has suffered extreme anxiety, pain and 

suffering, loss of life’s pleasures, and other emotional distress due to 

the devastating physical and emotional sequelae associated with the 

spinal cord injury; he has been caused to require significant amounts of 

medications; he has suffered other medical and psychological injuries, 

the full extent of which have yet to be determined; he has been forced 

to undergo extensive hospitalization and physical/occupational therapy; 

he suffered other orthopedic, spinal, neurological, psychological and 

psychiatric injuries, the full extent of which have yet to be determined; 

he has in the past and may in the future continue to require medicines, 

medical aid, medical care, treatment and rehabilitation; he has incurred 

significant medical expenses, he has in the past and will in the future 

continue to suffer agonizing aches, pains, suffering and mental anguish; 

he has in the past and will in the future continue to be permanently 

7 Compl. ¶ 115.
5

disabled from performing his usual duties, occupations and avocations, 

all to his great loss and detriment; he has sustained a loss of earnings 

and a loss of future earning capacity; he has endured and continues to 

endure pain and suffering; and he has in the past and will in the future 

continue to suffer loss of life’s pleasures as a result of his injuries.8 

Trott offered Edward N. Shradar, RN, MSN, CEN, (“Nurse Shradar”) as an 

expert on nursing standards of care,

9

and Dr. James Holsapple (“Dr. Holsapple”) as 

a medical expert to opine on causation.

10

 The parties deposed both experts and, 

following his deposition,11 Dr. Holsapple offered a supplemental letter to clarify his 

deposition testimony.12

With the medical expert testimony fully developed, Nurses Cessna, Matt, and 

Bohanon moved for summary judgment.

13 They argue that Trott has failed to offer

expert testimony establishing a causal link between their alleged negligence and his 

injuries.

14

 Trott opposes the motions and posits that the opinions offered by Nurse 

Shradar (on negligence) and Dr. Holsapple (on causation) establish that the nurses

8

Id. ¶ 116.

9 Ans. Cessna, Ex. B (“Shradar Rpt.”).

10 Ans. Matt & Bohanon, Ex. B (D.I. 116) (“Holsapple Rpt.”); Ans. Cessna, Ex. C 

(“Holsapple Rpt.”).

11 Ans. Matt & Bohanon, Ex. F (“Holsapple Dep.”),

12 Ans. Matt & Bohanon, Ex. C (“Holsapple Supp. Rpt.”); Ans. Cessna, Ex. D

(“Holsapple Supp. Rpt.”). 

13 Matt & Bohanon’s Mot.; Cessna Mot.

14 Matt & Bohanon Mot. ¶ 16; Cessna Mot. ¶ 10. 
6

breached the applicable standard of care thereby “causing the tragic outcome of Mr. 

Trott’s condition.”15 

II. FACTUAL AND PROCEDURAL BACKGROUND

On December 2, 2018, Trott sustained a spinal cord injury in a motor vehicle 

accident and was transported to Kent General Hospital by ambulance for treatment.

16

On December 4, 2018, Dr. Mills surgically placed an odontoid screw to address 

Trott’s spinal cord injury.

17 A physician’s assistant cleared Trott for discharge on 

December 5, 2018, and directed Trott to follow-up with medical staff in two weeks.18 

A few days after his discharge home, Trott “experienced increased pain in his 

neck and sudden numbness in his extremities; he called 911 and emergency medical 

services (“EMS”) arrived” and documented his condition.19 EMS personnel 

transported Trott to Kent General Hospital by ambulance on December 9, 2018.

20

 

Upon Trott’s arrival at approximately 1:20 a.m., an Emergency Department 

15 Ans. Matt & Bohanon at 6; Ans. Cessna at 5-6.

16 Compl. ¶ 60.

17 Id. ¶¶ 65-66.

18 Id. ¶¶ 69-70.

19 Id. ¶ 72.

20 Id. ¶ 72.
7

physician noted that he was “suffering from sudden and severe neck pain with 

moderate weakness.”21

Around 1:30 a.m., the Emergency Department’s triage nurse noted Trott’s 

numbness in all extremities.22 At 2:00 a.m., Nurse Cessna assumed care of Trott in 

the Emergency Department, where Trott’s neck and back pain escalated to a level of 

9 out of 10.

23

 A 2:06 a.m. CT scan revealed that the odontoid screw had shifted.24

Around 2:30 a.m., Defendant John Chukwudifu, PA-C (“PA Chukwudifu”), 

conducted a neurosurgical evaluation of Trott in the Emergency Department.25 He 

diagnosed Trott with a spinal cord injury and documented his impression that the 

odontoid screw had shifted.26 PA Chukwudifu admitted Trott to the Neurological 

Intensive Care Unit (“Neuro ICU”) and ordered hourly neurological evaluations and 

an MRI.27 At 4:58 a.m., Nurse Cessna noted an increase in Trott’s neck pain to a 

21 Id. ¶ 73.

22 Id. ¶ 74.

23 Id. ¶¶ 74-75.

24 Id. ¶ 76.

25 Id. ¶ 77.

26 Id.

27 Id.
8

level of 10 out of 10.

28

 No records indicate whether Nurse Cessna “communicated 

Mr. Trott’s condition to an appropriate healthcare provider.”

29

 

At 6:45 a.m., Trott moved from the Emergency Department to the Neuro 

Intensive Care Unit where Nurse Matt assumed his care.

30

 At 7:00 a.m., Nurse Matt 

performed a neurological evaluation on Trott, recording that he was awake, alert, 

and oriented, but only had “flicker of muscle” movement in his extremities.31 The 

records do not indicate Nurse Matt informed anyone of Trott’s condition.

32

At 8:00 a.m., Nurse Bohanon performed a neurological evaluation of Trott 

and noted “weakness” in his extremities.33 The records do not indicate Nurse 

Bohanon alerted any other healthcare provider of Trott’s condition.

34

 At 8:55 a.m.,

PA Chukwudifu evaluated Trott, observed “no antigravity movement in any of his 

extremities,” and notified Dr. Mills of Trott’s “neurologic deterioration.”35

28 Id. ¶¶ 78-79.

29 Id. ¶ 79.

30 Id. ¶¶ 80-81.

31 Id. ¶ 81.

32 Id. ¶ 82.

33 Id. ¶ 83.

34 Id. ¶ 84.

35 Id. ¶ 85.
9

Nurse Bohanon evaluated Trott at about 9:32 a.m. and noted that “during the 

0900 neuro check, [Trott] tolerated HOB elevation of approximately 2 – 3 inches.”36 

Around 10:00 a.m., Nurse Bohanon performed another neurological evaluation and 

noted that Trott “[w]as awake, alert, and oriented” and “suffering from diminished 

motor and sensory functions” with “flicker of muscle movement” in his 

extremities.37 The records do not indicate Nurse Bohanon informed any other 

healthcare provider of Trott’s condition.38 But, at Dr. Fatehi’s direction, Nurse 

Bohanon “entered a verbal order for hourly neuro checks.”

39

 Around 11:00 a.m., 

Nurse Bohanon evaluated Trott and reported a total loss of movement in his

extremities.40 

Following Nurse Bohanon’s 11:00 evaluation, based on the allegations in 

Trott’s complaint, it appears that Nurses Cessna, Matt, and Bohanon were relieved 

of Trott’s care. “The records indicate that, at or about 1:00 [p.m., Trott] suffered 

further respiratory distress and required endotracheal intubation and mechanical 

ventilation.”41 Trott remained under evaluation at Kent General Hospital until 

36 Id. ¶ 86.

37 Id. ¶ 88.

38 Id. ¶ 89.

39 Id. ¶ 90. 

40 Id. ¶ 91.

41 Id. ¶ 93.
10

January 2, 2019 when he was discharged to Magee Rehabilitation Hospital in 

Philadelphia, Pennsylvania.42 The following day, Magee Rehabilitation Hospital 

transferred Trott to Thomas Jefferson University Hospital (“Jefferson Hospital”), 

where he underwent emergency surgery on January 8, 2019.43 Jefferson Hospital 

discharged Trott to a rehabilitation hospital on January 9, 2019.

44

 

Trott offered Nurse Shradar to establish the standard of care required of

Nurses Cessna, Matt, and Bohanon. After reviewing available material, Nurse 

Shradar concluded that each nurse deviated from the standard of care required under 

the circumstances.45 Nurse Shradar concluded that Nurse Cessna failed to follow a 

documented order directing regular neurological checks, failed to document Trott’s 

neurological decline, and failed to notify appropriate healthcare providers of Trott’s 

decline.46 Further, Nurse Shradar opined that Nurses Matt and Bohanon failed to 

notify appropriate healthcare providers of changes in Trott’s condition.47 

Trott offered Dr. Holsapple to establish the causal connection between all 

defendants’ (nurses, physician’s assistants, and doctors) negligence and Trott’s 

42 Id. ¶ 101.

43 Id. ¶¶ 102. 107.

44 Id.

45 Shradar Rpt. at 6.

46 Id. at 5.

47 Id. at 5-6.
11

injury. After reviewing the medical records and depositions of the defendant 

healthcare providers, Dr. Holsapple opined:

1) The standard of care requires that appropriate imaging be obtained 

to determine the cause of progressive neurological signs and symptoms 

suggesting spinal cord compression.

2) More likely than not, Mr. Trott’s neurological condition declined 

significantly between 3:25 AM and 7 AM on 12/9/18.

3) More likely than not, Mr. Trott’s neurological condition declined 

significantly between 3:25 AM and 7 AM on 12/9/18 as a result of 

spinal cord compression and spinal cord injury. 

4) The standard of care requires that new and significant neurological 

deficits observed by hospital nursing staff be reported promptly to the 

primary team physicians and/or their designated assistant providers.

5) Upon learning of a progression of his neurological symptoms the 

standard of care required appropriate imaging be obtained to rule out 

clinically significant cord compression and/or instability. 

6) The standard of care requires that upon learning of new and 

significant neurological deficits the primary team physicians and/or 

their designated assistant providers perform a prompt beside 

evaluation. 

7) In the setting of suspected acute and/or worsening symptomatic 

spinal cord compression, the standard of care requires that appropriate 

and timely spinal imaging be obtained and reviewed.

8) More likely than not had spinal imaging been obtained in the 

morning (AM) on 12/9/19, significant spinal cord compression and 

evidence of spinal cord injury would have been demonstrated.

9) In the setting of spinal instability, progressive symptomatic acute 

spinal cord compression and incomplete spinal cord injury, timely 

spinal decompression and possible definitive stabilization are indicated. 
12

10) Acute and progressively symptomatic spinal cord compression due 

to spinal column instability is treatable. Timely decompression and 

stabilization can be associated with an increased probability of 

functional recovery. Delay may be associated with poorer outcomes 

and permanent neurological deficits. 

11) More likely than not had Mr. Trott undergone appropriate and 

prompt bedside evaluation and spinal imaging in the AM of 12/9/19, 

progressive and treatable spinal cord compression would have been 

identified and decompression-stabilization surgery recommended to 

increase the chance of meaningful neurological recovery.48

In his August 1, 2023, deposition, Dr. Holsapple testified that it was unclear 

what, if anything, the nurses did after noticing Trott’s decline around 7:00 a.m.49 

But Dr. Holsapple could not say “more likely than not an earlier notification from 

nursing staff would have impacted the outcome in this case.”50 He continued:

I don’t think I could say at the level of more likely than not, that 

confusion or some potential delay in communication from the nurses to 

whoever and most importantly Dr. Mills is linkable at the level of more 

likely than not – so with certainty – to a difference in outcome. It 

certainly isn’t a good thing if it’s true that the nurses didn’t let people 

know that this guy, that Mr. Trott was now essentially quadriplegic.

I mean, if that’s true, that’s a deviation, no question about it. You don’t 

not report that kind of information immediately, right? So if they didn’t 

– and again, that’s an “if” there, there are variable accounts on this, 

right – but if that’s true, that’s a deviation. Is that a deviation in a very 

clear-cut and direct more-likely-than-not way associated with the worst

outcome? I don’t think I can say that.51

48 Holsapple Rpt. at 6-8.

49 Holsapple Dep. at 118-121.

50 Id. at 128.

51 Id. at 128-29.
13

So, I mean, I may express that in some way, but I wouldn't express it as 

I think the nurses or some other providers deviated from the standard 

of care, and more likely than not because of the deviation, you know, 

things turned out, you know, worse. I won't say those things. I might 

allude to what I am saying right now, which is sort of like that. I mean, 

it's a little uncomfortable, right, that this kind of went on for so long. 

But I couldn't say that, and I don't think that I will say such a thing.52

When specifically asked about Nurse Cessna, Dr. Holsapple explained, “I don’t see 

any evidence that that nurse, Ms. Cessna, deviated from the standard of care and that 

that deviation is linked to some sort of aspect of the bad outcome.”

53

Perceiving some confusion over his deposition testimony, Dr. Holsapple 

provided clarification to Trott’s counsel by letter.54 Dr. Holsapple explained, as he 

did during his deposition, that “there does not appear to be any communication of

the progression of neurological symptoms and deficits by nursing [between 3:25 

52 Id. at 132-33.

53 Id. at 133-34.

54 Holsapple Supp. Rpt. The Court understands that defendants object to its 

consideration of Dr. Holsapple’s Supplemental Correspondence as having been 

provided after an established discovery deadline. The Court considers this 

document, together with Dr. Holsapple’s report and deposition, in the light most 

favorable to Trott as the non-moving party. The Court declines to reject this 

document on procedural or other grounds. But see, e.g., Estate of Stone v. Bayhealth 

Medical Center, Inc., 2023 WL 7018404 (Del. Super. Ct. Oct. 24, 2023) (declining 

to consider post-deposition affidavit of medical witness under the sham affidavit 

doctrine).
14

a.m. and 7:00 a.m.].”55 In his view, the applicable nursing standard of care required 

notification to other medical professionals, but he could not:

say whether or not the neurological team would have so acted in 

accordance with the standard of care if provided with this information 

sooner given that the standard of care was violated in this case, 

including following the discovery of the progressive compromise by 

the physician’s assistant at about 8:45 to 9:00 a.m.56

He concludes his correspondence by noting that all his opinions “have been stated 

to a reasonable degree of medical probability.”57

III. STANDARD OF REVIEW

Under Superior Court Civil Rule 56, summary judgment will be granted 

where “the pleadings, depositions, answers to interrogatories, and admissions on file, 

together with the affidavits, if any, show that there is no genuine issue as to any 

material fact and that the moving party is entitled to a judgment as a matter of law.”58 

“A material issue of fact exists if ‘a rational finder of fact could find some material 

fact would favor the moving party in a determinative way.’”59 On a motion for 

summary judgment, this Court “(i) construes the record in the light most favorable 

55 Holsapple Supp. Rpt.

56 Id.

57 Id.

58 Super. Ct. Civ. R. 56(c).

59 Estate of Moulder v. Park, 2022 WL 4544837, at *3 (Del. Super. Ct. Sept. 28, 

2022) (quoting Deloitte LLP v. Flannagan, 2009 WL 5200657, at *3 (Del. Ch. Dec. 

29, 2009)).
15

to the non-moving party; (ii) detects, but does not decide, genuine issues of material

fact; and (iii) denies the motion if a material fact is in dispute.”60 

“The moving party bears the initial burden to demonstrate that there is no 

genuine dispute as to any material fact and that the movant is entitled to judgment 

as a matter of law.”61 “Once the movant meets its burden, then the burden shifts to 

the non-movant to demonstrate sufficiently an existence of one or more genuine 

issues of material fact.”62 Summary judgment will not be granted if there is a 

material fact in dispute or if it “seems desirable to inquire thoroughly into [the facts] 

in order to clarify the application of the law to the circumstances.”63

While the Court will consider all facts and reasonable inferences in a light 

most favorable to the non-moving party,64 it must not “indulge in speculation and 

conjecture; a motion for summary judgment is decided on the record presented and 

not on evidence potentially possible.”65 Summary judgment is also appropriate 

60 US Dominion, Inc. v. Fox News Network, LLC, 2023 WL 2730567, at *17 (Del. 

Super. Ct. Mar. 31, 2023) (quoting CVR Refin., LP v. XL Specialty Ins. Co., 2021 

WL 5492671, at *8 (Del. Super. Ct. Nov. 23, 2021) (cleaned up)).

61 Estate of Moulder, 2022 WL 4544837, at *4 (citing Rice v. Rice, 2020 WL 

4908096, at *1 (Del. Super. Ct. 2020)).

62 Quality Elec. Co., Inc. v. E. States Const. Serv., Inc., 663 A.2d 488 (Del. 1995);

see also Super. Ct. Civ. R. 56(e); Moore v. Sizemore, 405 A.2d 679, 681 (Del. 1979).

63 Ebersole v. Lowengrub, 180 A.2d 467, 470 (Del. 1962).

64 Nutt v. A.C. & S. Co., 517 A.2d 690, 692 (Del. Super. Ct. 1986).

65 In re. Asbestos Litig., 509 A.2d 1116, 1118 (Del. Super. 1986), aff’d sub. nom.

Nicolet, Inc. v. Nutt, 525 A.2d (Del. 1987).
16

where a non-moving party that bears the burden of proof at trial fails to establish the 

existence of an element essential to that party’s case.66 In a medical malpractice 

action, “a defendant is entitled to summary judgment if, after adequate time for 

discovery, the record unambiguously demonstrates that the plaintiff's allegations are 

not and will not be supported by expert medical testimony.”

67

 

IV. ANALYSIS

To sustain a claim of healthcare medical negligence, “a plaintiff must present 

expert medical testimony as to: 1) the applicable standard of care; 2) the alleged 

deviation from that standard; and 3) the causal link between the breach of the 

standard of care and the alleged injury.”68 Under Delaware’s Healthcare Medical 

Negligence Insurance and Litigation statute, “[n]o liability shall be based upon 

asserted negligence unless expert medical testimony is presented as to the alleged 

deviation from the applicable standard of care in the specific circumstances of the 

case and as to the causation of the alleged personal injury or death.”69 From this it 

flows that expert medical testimony is required to support proximate causation.70 

66 Vick v. Khan, 2019 WL 2177114 (Del. Super. Ct. May 17, 2019).

67 Froio v. Du Pont Hosp. for Children, 816 A.2d 784, 786 (Del. 2003) (cleaned up).

68 Signey v. Pfaff, 2023 WL 6449153, at *1 (Del. Super. Ct. Oct. 2, 2023) (cleaned 

up).

69 18 Del. C. § 6853(e). 

70 Signey, 2023 WL 6449153, at *1 (cleaned up).
17

“Proximate cause is a necessary element of any tort claim.”71 “[A] proximate cause 

is one which in natural and continuous sequence, unbroken by any efficient 

intervening cause, produces the injury and without which the result would not have 

occurred.”72 A plaintiff must present expert medical testimony as to both (i) the

alleged deviation from the applicable standard of care, and (ii) the causal connection 

between the wrongful conduct and the alleged injury.

73

 “Without the expert 

testimony, a jury is not permitted to connect the dots between a bare allegation of 

medical negligence and an injury.”74 

Delaware law mandates that such medical opinions “be based on a reasonable 

degree of medical probability.”75 Therefore, it is “strongly encouraged” that expert 

medical opinions “be stated in terms of a reasonable medical probability or a 

reasonable medical certainty.”76 The trial court retains discretion to determine 

whether an expert’s opinion, even if not articulated in the language of “reasonable 

medical probability” or “reasonable medical certainty,” satisfies the legal standard 

71 Doe v. Wildey, 2012 WL 1408879, at *4 (Del. Super. Ct. Mar. 29, 2012).

72 Id.

73 Burkhart v. Davies, 602 A.2d 56, 59 (Del. 1991); 18 Del C. § 6853(e).

74 Signey, 2023 WL 6449153, at *1 (cleaned up). 

75 Mammarella v. Evantash, 93 A.3d 629, 638 (Del. 2014).

76 Moses v. Drake, 109 A.3d 562, 568 (Del. 2015) (internal quotations omitted).
18

when viewed in the context of all evidence.77 However, expert medical opinion may 

not be premised on speculation and conjecture.78 An expert medical opinion 

regarding “what is possible is no more valid than the jury's own speculation as to 

what is or is not possible.”79 Therefore, an expert witness’s testimony “concerning 

‘possible medical consequences, rather than ... reasonable medical probability’ [is] 

impermissible speculation.”80 Opinions that a medical outcome was “feasible,”81 or 

even “likely” are not offered with a reasonable degree of medical probability.82 The 

absence of an expert opinion stated with reasonable medical probability as to 

negligence or causation warrants summary judgment.83 Such is the case here.

A. Expert Medical Testimony Establishes The Nurses Deviated From The 

Applicable Standard Of Care.

Nurse Shradar opined, within a “reasonable degree of professional certainty,” 

that “there were deviations from the standard of care by the nursing staff in the ED 

77 Id.

78 Id. (quoting O’Riley v. Rogers, 69 A.3d 1007, 1011 (Del. 2013)).

79 Mammarella, 93 A.3d at 635 (quoting Oxendine v. State, 528 A.2d 870, 873 

(Del.1987)).

80 O’Riley, 69 A.3d at 1011 (quoting Riegel v. Aastad, 272 A.2d 715, 718 (Del. 

1970)).

81 See, e.g., Moses, 109 A.3d at 568.

82 Mammarella, 93 A.3d at 636-37.

83 Russell v. Kanaga, 571 A.2d 724, 734 (Del. 1990) (“[A]s a matter of law, the 

Delaware Medical Malpractice statute requires direct expert medical testimony to 

support a jury’s finding of negligence and causation.”).
19

and Neuro ICU on December 9th, 2018.”

84

 Dr. Holsapple, for his part, concluded 

that he did not “see any evidence that nurse, Ms. Cessna, deviated from the standard 

of care.”85 For purposes of this motion, the nurses do not vigorously contest Nurse 

Shradar’s opinion on their failure to adhere to the applicable standard of care, and

Dr. Holsapple’s contrary conclusion as to Nurse Cessna merely creates an issue of 

fact. The Court finds that Trott has satisfied the first prong of 18 Del. C. § 6853(e);

he has offered expert medical testimony supporting the nurses’ deviation from of the 

applicable standard of care in the circumstances of this case.

B. Expert Medical Testimony Does Not Establish The Nurses’ Breaches Of 

The Standard Of Care Proximately Caused Trott’s Injury.

This case turns on whether expert testimony supports a causal connection 

between the nurses’ negligence and Trott’s injuries. In other words, did the nurses’ 

failure to communicate with medical professionals during the early morning hours 

of December 9, 2018, proximately cause Trott’s paraplegia. Nurses Matt and 

Bohanon contend that “[t]here is no expert medical opinion stating that any alleged 

failure timely to communicate the patient’s status to the Neurosurgical Providers 

proximately caused injury.”86 Nurse Cessna joins the motion of Nurses Matt and 

84 Shradar Rpt. at 6.

85 Holsapple Dep. at 133-34.

86 Matt & Bohanon Mot. at 6, ¶ 15; id. at 3, ¶ 10 (“Dr. Holsapple was unable to state, 

to a reasonable degree of medical probability, that the [Nurses’] alleged failure to 
20

Bohanon and adds that Dr. Holsapple “will not opine that there is any connection 

between [her] care and Mr. Trott’s paralysis/paraplegia.”87 Trott counters that 

“[n]othing in Dr. Holsapple’s deposition testimony demonstrates that he cannot 

conclude that the negligence on part of the nurse defendants did not cause and/or 

contribute to Mr. Trott’s paraplegia.”88 But, Trott’s contention misses the mark. In 

the Rule 56 burden shifting equation, the defendant nurses have met their initial 

burden to show that no expert testimony exists to link their negligence to Trott’s 

injuries. Trott does not demonstrate an existence of one or more genuine issues of 

material fact. To survive summary judgment, Trott must point to some expert 

medical testimony beyond speculation that the nurses’ negligence proximately 

caused his injury. Dr. Holsapple offers none. Thus, summary judgment must be 

granted. 

Dr. Holsapple’s report, deposition, and supplemental correspondence fail to 

demonstrate with reasonable medical probability, that the alleged deviations by the 

Defendant Nurses proximately caused Trott’s injuries. Dr. Holsapple candidly, and 

report neurological changes to the Neurosurgical Providers caused or contributed to 

[Trott’s] outcome”) (citing Holsapple Dep. at 116-21; 124-20; 131-33; 152-55).

87 Cessna Mot. at 5, ¶ 7.

88 Ans. Matt & Bohanon at 6. The Court understands Trott’s argument to be that Dr. 

Holsapple can demonstrate a causal connection between the nurses’ negligence and 

Trott’s injury; however, Trott fails to offer record evidence or legal authority to

support his position.
21

repeatedly, testified that he could not opine that the nurses’ deviations from the 

standard of care more likely than not changed the outcome.89 Dr. Holsapple believed

the nurses should have done more;90 however, he could not offer an expert opinion 

that these failings proximately caused Trott’s injury.

Nurses Matt and Bohanon assert that “Dr. Holsapple’s testimony on the issue 

[of proximate causation] was equivocal at best and not sufficient to meet the 

standards set by Delaware law.”91 Trott replies that the use of the term “equivocal,” 

“demonstrate[s] a clear issue of material fact.”92 But this response misapprehends 

the standard of proof required in a medical negligence action. Dr. Holsapple 

expressed his general disapproval of the timeliness of the nurses’ responses to Trott’s 

condition.93 But, despite repeated questioning on the point, he would not offer an 

opinion within a reasonable degree of medical probability (or certainty) that the 

nurses’ negligence proximately caused Trott’s injury.94 The Court is mindful that 

89 Holsapple Dep. at 116-21; 129; 132-33; 152-54.

90 Id. at 124-29.

91 Matt & Bohanon Mot. at 4, ¶ 10.

92 Ans. Matt & Bohanon at 6.

93 Holsapple Dep. at 124-29.

94 See e.g., Mammarella, 93 A.3d at 636 (medical expert “testified that he could not 

opine on [plaintiff’s] diagnosis or treatment to a reasonable degree of medical 

probability, and that any opinion about those issues would be speculative”).
22

no talismanic phrase must be offered by an opining expert,95 but Dr. Holsapple’s 

“equivocation” amounts to speculation and falls short of the “expert medical 

testimony . . . as to the causation of the alleged personal injury or death” required by 

18 Del. C. § 6853(e).96

In his supplemental report, offered to clarify any confusion prompted by his 

deposition testimony, Dr. Holsapple explained that his deposition testimony was 

consistent with the opinions he rendered in his original report.97 But again, his 

report, deposition, and supplemental report fail to offer an expert opinion on 

causation. Contrary to Trott’s counsel’s assertion,

98 Dr. Holsapple’s supplemental 

report does not definitively state that the nursing delay caused Trott’s condition to 

worsen,

99 and counsel’s argument cannot supplant the expert testimony required to 

95 See Moses, 109 A.2d at 568 (trial courts are afforded discretion “to determine 

whether the opinion offered by an expert, when considered in light of all of the 

evidence, meets [the “reasonable medical probability” or “reasonable medical 

certainty”] standard”); Rizzuto v. Delaware Clinical and Laboratory Physicians, 

P.A., 2015 WL 3512369, at *5 (Del. Super Ct. Feb. 3, 2015) (quoting Green v. 

Werner, 766 A.2d 492, 495 (Del. 2001)) (Medical experts are not required to “couch 

their opinions in legal terms or to articulate the standard of care with a high degree 

of legal precision or with ‘magic words.’”)

96 See e.g., Mammarella, 93 A.3d at 634-35.

97 Holsapple Supp. Rpt.

98 Ans. Cessna at 5-6 (Representing that Dr. Holsapple’s Supplemental Report 

“specifies that a delay of about 2 to 5-1/2 hours on part of the nursing in failing to 

communicate these neurological deficits is a significant delay causing the tragic 

outcome of Mr. Trott’s condition.”) (emphasis added).

99 Holsapple Supp. Rpt.
23

establish causation to a reasonable medical degree of probability. Dr. Holsapple

fails to offer the necessary opinion linking the nurses’ failings as the cause of Trott’s 

injury.

Trott contends that “[g]ranting defendants’ motion is tantamount to 

precluding failure to communicate medical malpractice claims as a matter of law in 

the state of Delaware.”100 Not so. Rather, the Court’s grant of defendants’ motion 

reiterates the well-established requirement that expert medical testimony must be 

offered to support causation in medical negligence cases.101 Where such a link is 

established, denial of summary judgment is appropriate. But that link is not 

established here. While what Trott describes as a “failure to communicate” claim 

may be difficult to prove, this difficulty does not compel the Court to disregard 

statutory requirements.

An expert need not be certain of subsequent actions of healthcare providers to 

opine on causation. But Dr. Holsapple did not offer an opinion that Trott’s outcome 

would have differed had the nurses promptly informed other medical providers, 

including the Neurosurgery Team, of Trott’s decline. Of course, expert witnesses 

may provide causation opinions in response to hypothetical scenarios.

102

 But here, 

100 Ans. Matt & Bohanon at 7.

101 18 Del. C. § 6853(e).

102 O’Riley, 69 A.3d at 1012 (citing Stafford v. Sears, Roebuck & Co., 413 A.2d 

1238, 1245 n.10 (Del. 1980)).
24

Dr. Holsapple in his initial report, deposition, and supplemental report declined to 

opine with medical probability or certainty that the nurses’ negligence caused Trott’s 

injury. Rather, Dr. Holsapple’s testimony linking the nurses’ care to Trott’s injury 

was speculative; Trott fails to make a prima facie case on the issue of causation.103

V. CONCLUSION

Expert medical testimony must be offered to connect the nurses’ negligence 

to Trott’s injury, and this testimony must be offered with reasonable medical 

probability or certainty. Trott fails to forge that connection here. The Nurses’

motions for summary judgment and Bayhealth’s motion for partial summary 

judgment104 are GRANTED.

IT IS SO ORDERED.

______________________

Sean P. Lugg, Judge

103 Kardos v. Harrison, 980 A.2d 1014, 1019 (Del. 2009).

104 Clark v. Brooks, 377 A.2d 365, 371 (Del. 1977) (cleaned up) (“Where the sole 

basis of liability of an employer is the negligence of the employee, the employer 

cannot be held liable unless the employee is shown to be liable; hence, if absence of 

culpability on the part of the employee to the injured person has been established by 

litigation, the employer cannot be held liable to the injured person”).