This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2014). STATE OF MINNESOTA IN COURT OF APPEALS A15-1753 Sharon Schirmer, trustee for the next of kin of Cary F. Schirmer, Appellant,

vs. The Duluth Clinic, Ltd., d/ b/a “Essentia Health - Hi bbing Clinic,” et al., Respondents. Filed July 5, 2016 Reversed and remanded Connolly, Judge St. Louis County District Court File No. 69HI-CV-14-542

James T. Smith, Huffman, Usem , Crawford and Greenberg, P.A., Minneapolis, Minnesota (for appellant) Barry G. Vermeer, Jennifer M. Waterwor th, Gislason & Hunter LLP, Minneapolis, Minnesota (for respondents)
Considered and decided by Connolly, Pr esiding Judge; Cleary, Chief Judge; and Ross, Judge.

U N P U B L I S H E D O P I N I O N CONNOLLY , Judge Appellant challenges the district court’s di smissal of her medical-malpractice claim for failure to comply with the expert-disclosure require ments of Minn. Stat. § 145.6822 (2014). Because appellant submitted expert affi davits sufficient to satisfy the statutory requirements, we reverse and remand. FACTS In November of 2010, Cary Schirmer saw his primary care doctor, respondent Dr. Mark D. Wagner, to have a lesion on hi s back examined. Dr. Wagner diagnosed the lesion as a benign seborrheic keratosis a nd removed it using liquid nitrogen. On November 29, 2011, Schirmer saw Dr. Wagner with regard to a tender mass in his right armpit that he had noticed three weeks prior. The Mayo Clinic subsequently performed an excisional biopsy of the mass, which patholog y later showed to be malignant melanoma. During a full-body exam, a treati ng doctor at the Mayo C linic found a lesion on Schirmer’s right lower back, adjacent to the area of the 2010 lesion. A biopsy was performed on the lesion and subsequent testi ng confirmed that the lesion was the primary melanoma. Based on its tes ting, the Mayo Clinic’s diagno sis was stage III melanoma with in-transit metastases. Despite treatment, Sc hirmer’s cancer progressed to stage IV and spread to his brain. In October of 2 012, Schirmer entered hospice care and died. In June 2014, appellant Sharon Schirmer, as trustee for Schirmer’s estate, brought a medical-malpractice wrongful-death suit agains t Dr. Wagner and his employer, respondent Duluth Clinic Ltd. Appellant alleged that Dr. Wagner’s medically negligent treatment of Schirmer led directly to his death. She id entified Corey J. Habe r, D.O., and Thomas M. Waits, M.D. as her expert witnesses and served their affidavits on re spondents. Dr. Haber is a family medicine physician an d is licensed to practice medicine in the State of Michigan. Dr. Waits is an oncologist and hematol ogist currently practicing in Indiana.3 In his expert affidavit, Dr. Haber opin ed that Dr. Wagner di d not comply with accepted standard of care under the circumstances when he did not orde r a biopsy or shave excision of Schirmer’s lesion in November of 2010. Dr. Ha ber further stated that Dr. Wagner’s failure to provide a description of the lesion in his medical documentation also deviated from the standard of care. In D r. Haber’s opinion, severa l factors required Dr. Wagner to perform a biopsy, including Schirmer’s age and the solitary nature of the lesion. Appellant’s expert as to causation, Dr. Wa its, opined in his affidavit that, “based on the rapid growth of the melanoma once it gain ed access to the lymphatic and vascular systems, it is unlikel y the melanoma ha[d] progressed to those systems . . . in 2010.” Additionally, Dr. Waits stated that “the prog nosis of melanoma patie nts is closely linked to stage of diagnosis,” and “[i]f resection had taken place in November of 2010, it is more likely than not that [Schirme r] would have been cured.” In response to the filings, respondents moved for dismissal under Minn. Stat. § 145.682, subd. 6(c) on the gr ounds that the expert affidav its failed to comply with the substantive requirements of the statute. Dr. Haber and Dr. Waits serv ed amended affidavits under the 45-day safe harbor provisi on of Minn. Stat. § 145.682, subd. 6. In his amended affidavit Dr. Haber attemp ted to clarify the alleged deviation from the standard of care. He cite d Schirmer’s age, the solitary na ture of the lesion, and the size of the lesion as facts that should raise the suspicion of any physici an inspecting a skin lesion or mole that the standard of care re quired testing. Dr. Waits’s amended affidavit sought to clarify the causation element be tween Dr. Wagner’s alleged negligence and the progression of Schirmer’s melanoma. Dr. Waits stated that correct diagnosis and treatment4 of the lesion in 2010 would be associated with a 90% cure rate based on the “high unlikeliness that [the lesion] would have ga ined access to the lymphatic and vascular systems.” A hearing was held on responde nts’ motion to dismiss. After considering arguments from both parties, the district court granted the motion to dismiss, concluding that the expert affidavits failed to meet the substa ntive requirements of Minn. Stat. § 145.682, entitling respondents to dismissal with prejudice. This appeal follows. D E C I S I O N
I. The expert affidavits were sufficient to comply with Minn. Stat. § 145.682. Appellant challenges the district court’s di smissal of her complaint for failure to comply with Minn. Stat. § 145.682. A plaint iff in a medical-malpractice case must submit two affidavits when expert te stimony is required to establis h a prima facie case. Minn. Stat. § 145.682, subd. 2. The second affidavit must contain the substance of the facts and opinions to which the expert plans to testify and summarize the grounds for those opinions. Id. , subd. 4(a). It also must include “specifi c details” about “the applicable standard of care, the acts or omissions that plaintiffs alle ge violated the standard of care and an outline of the chain of causation that allegedly resulted in damage to them.” Sorenson v. St. Paul Ramsey Med. Ctr. , 457 N.W.2d 188, 193 (Minn. 1990). If the plaintiff fails to satisfy these affidavit requirements, then the plaintiff’s malpractice claim must be dismissed with prejudice. Minn. Stat. § 145. 682, subd. 6(c). Minn. Stat. § 145.682 was enacted by the legislature to eliminate frivolous medical-neglig ence lawsuits by requiring that plaintiffs5 file affidavits verifying that thei r alleged claims are well founded. Stroud v. Hennepin County Med. Ctr. , 556 N.W.2d 552, 555 (Minn. 1996). To prove causation, a plaintiff must demons trate that it is more probable that the plaintiff’s injury “resulted fro m some negligence for which defendant was responsible than from something for which he was not responsible.” Plutshack v. Univ. of Minn. Hosp. , 316 N.W.2d 1, 7 (Minn. 19 82) (quotation omitted). This may be accomplished by “provid[ing] an outline of the chain of causation between th e alleged violation of the standard of care and the claimed damages.” Stroud , 556 N.W.2d at 556. “T he gist of expert opinion evidence as to causation is that it explains to the jury . . . ‘how’ and . . . ‘why’ the malpractice caused the injury.” Teffeteller v. Univ. of Minn. , 645 N.W.2d 420, 429 n.4 (Minn. 2002). The plaintiff must provide more than “broad, c onclusory statements regarding causation.” Id. at 429. This court reviews a distri ct court’s dismissal of a medical-malpractice action under Minn. Stat . § 145.682 for abuse of discretion. Anderson v. Rengachary , 608 N.W.2d 843, 846 (Minn. 2000). The district court determined appellant’s e xpert affidavits to be deficient because they relied on broad, conclusory allegations . While the affidavits are not ideal, we conclude that they comply wi th the substantive requirements of Minn. Stat. § 145.682 and that appellant has not brought the sort of “nuisance” or “frivolous ” medical-malpractice suit that the statute seeks to w eed out. Dr. Haber’s opinion is th at (1) the standard of care, given the particular characteristics of the lesi on and the patient, requir ed further testing and a detailed description of the lesion; and (2 ) Dr. Wagner deviated from the applicable standard of care by failing to perform suffici ent testing and by misd iagnosing Schirmer’s6 lesion. Dr. Waits’s opinion is that (1) th e primary melanoma found by the Mayo Clinic was part of the original 2010 lesion treated by Dr. Wagner; (2) based on the speed with which the melanoma spread after gaining access to the lymphatic and vascular systems, it was unlikely it had progressed to such systems in 2010 and; (3) had Schirmer been properly diagnosed and treated in 2010, the associated cure rate woul d have been 90%. We find no missing link in this chain of causation. Becaus e the expert affidavits detail the standard of care, Dr. Wagner’s alleged deviation from that standard, and adequately set forth the chain of causation, the district court abused its discretion in dismissing appellant’s medicalmalpractice action.
II. The district court improperly weighed conflicting evidence. Appellant also argues that the distri ct court improperly took into account information outside of the expert affidavits in assessing their sufficiency under Minn. Stat. § 145.682. Under Minn. Stat. § 145.682, a c ourt must base its decision regarding the sufficiency of an expert affidavit on the conten t of that affidavit, not on any other evidence such as medical records, deposition testimony, or rebuttal affidavits. See Tousignant v. St. Louis Cnty ., 615 N.W.2d 53, 60 (Minn. 2000) (stating that the district court’s analysis “related to the [defendants’] rebuttal of [plain tiff’s] case, not whether [plaintiff] established a prima facie case”); see also Demgen v. Fairview Hosp. , 621 N.W.2d 259, 266 (Minn. App. 2001), review denied (Minn. Apr. 17, 2001) (stating that the district court incorrectly relied on a rebuttal affidavit). In its memorandum in suppor t of its order, the district court stated “Dr. Waits never acknowledges the fact that the Mayo Clin ic providers who treated Mr. Schirmer7 documented it was their belief th at the primary melanoma site which ultimately spread was in fact the lesion adjacent to the lesion that [Dr. Wagner ] treated and not the lesion [Dr. Wagner] actually treated.” Respondents assert that the district court was merely voicing its own observations rather than utilizing th e medical records to determine whether the affidavits were sufficient. This argument fa ils. The district court explicitly utilized Dr. Waits’s failure to rebut the Mayo Clinic records in holding that the chain of causation was not sufficiently stated. Therefore, we hold th e district court erred in considering evidence outside of the expert affidavits.
Reversed and remanded.