Opinion ID: 2335740
Heading Depth: 1
Heading Rank: 3

Heading: Professional Medical Negligence

Text: ¶ 12 Like all negligence claims, a prima facie case of medical negligence has three elements: 1) a duty owed by the defendant to protect the plaintiff from injury; 2) a failure to perform that duty; and 3) injuries to the plaintiff which are proximately caused by the defendant's failure to exercise the duty of care. [7] ¶ 13 Here, the dispute centers around the causation element. The cause of a plaintiff's injury is a question of fact for the jury to decide. [8] Causation becomes a question of law only when there is no evidence and no reasonable inference from the evidence from which the jury could reasonably find a causal link between the negligent act and the injury. [9] The question is whether a reasonable person could believe that the defendant's negligent conduct was a cause of the plaintiff's injury. [10] ¶ 14 In medical negligence cases, a physician's negligence is ordinarily established by expert medical testimony. However, when a physician's lack of care is so grossly apparent that laymen would have no difficulty recognizing it, expert testimony is not required to establish deficient care. [11] Here, the patient provided the opinion of an expert witness, a board-certified neurologist, to support her allegations. [12] ¶ 15 The neurologist noted that prior to the surgery there was nothing wrong with the movement or nerves in the patient's thigh but after the surgery there was femoral nerve damage. [13] He stated that it is more probable than not that the injury developed during the surgical procedure and except for the complication of the surgery she would not have developed a left femoral neuropathy. [14] Nevertheless, he also noted that he would require additional information before the cause can be determined with certainty. [15] ¶ 16 In Robinson v. Oklahoma Nephrology Associates, Inc., 2007 OK 2, ¶ 11, 154 P.3d 1250, we explained that: ... Our case law requiring a medical malpractice plaintiff to produce evidence that injuries were caused by a particular physician's negligence has never required the production of experts who will utter a particular magic phrase, but focused instead on the particulars of each case. While the plaintiff must present evidence to remove the cause of her injuries from the realm of guesswork, she need not establish causation to a specifically high level of probability merely to withstand a demurrer to the evidence ...Absolute certainty is not required. [16] (Citations omitted.) (emphasis supplied.) ¶ 17 This explanation regarding medical evidence is consistent with a long history of cases in which causation as presented by a medical professional was discussed. For example, in Cohenour v. Smart, 1951 OK 339, ¶ 7, 240 P.2d 91, the physician testifying for the plaintiff in a negligence action stated that the accident could have caused the injury, not probably caused the injury. The Cohenour Court, determining that corroborating evidence was lacking, noted: ... [I]t is incumbent upon the plaintiff, under the facts of this case, to prove not only that the accident could have caused the injury, but that it probably did ... [T]he authorities clearly hold that medical testimony as to the possibility of a causal relation between a given accident or injury and the subsequent impaired physical condition of the person injured is not sufficient, standing alone, to establish such a relation. `Testimony as to possibility' is said to mean testimony in which the witness asserts that the accident or injury `may have' or `could have' caused, or `possibly did' cause the subsequent physical condition, or that a given physical condition `might have,' `may have,' `could have,' or `possibly did' result from a previous accident or injurytestimony, that is, which is confined to words indicating the probability or likelihood of its existence. [17] ¶ 18 In Oklahoma Natural Gas Co. v. Kelly, 1944 OK 283, ¶ ¶ 8-10, 153 P.2d 1010, a case in which two chiropractors testified as expert witnesses as to the cause of an injury in an automobile accident, but two medical doctors testifed to the contrary, the Court said: ... While there is authority to the contrary, we are committed to the rule that opinion evidence, such as that given by the plaintiff's expert witnesses, that a certain cause `might', `could' or `possibly' did or would bring about a certain result is competent and may have some probative value... The value of such evidence is ordinarily for the trier of the facts. But where such evidence is not corroborated or supplemented by other evidence, and where the fact necessary to be established must be proved by testimony of a qualified expert, such evidence, standing alone, is generally held to be insufficient to make out a prima facie case.... On the question of whether the accident `could' cause the curvature of the spine, there was a disagreement between the chiropractors testifying for the plaintiff and the medical doctors testifying for the defendant, but it was for the jury to resolve the conflict and to give such weight to the testimony of each of the expert witnesses as it deemed proper.... We are of the opinion, and hold, that the evidence was sufficient to submit to the jury the question of whether the injuries complained of by the plaintiff, including the curvature of the spine, were caused by the accident. True, as above stated, the testimony of plaintiff's expert witnesses that said injuries `could' have been caused by the accident, standing alone, would not have been sufficient to submit to the jury the question of whether the curvature of the spine and the discomfort and injuries springing therefrom were caused by the accident, as the answer thereto would have been based upon conjecture and speculation, since it was shown that the curvature of the spine could have been brought about by several different causes. But proof of the cause and effect of the injuries in such a case need not rest entirely upon expert testimony. And when the expert testimony that the curvature of the spine `could' have been caused by the accident is considered along with the testimony that there was no curvature of the spine before, but was shortly after, the accident, and there is no factual evidence tending to prove any other cause, and the plaintiff's evidence reasonably tended to exclude every other possible cause, the jury could reasonably find that it was more probable that the curvature of plaintiff's spine and the ailments resulting therefrom were caused by the accident than by any other cause, and such a finding cannot be said to be based upon speculation and conjecture. [18] (citations omitted.) ¶ 19 A motion for summary judgment should be sustained only when the pleadings, affidavits, depositions, admissions, or other evidentiary materials establish 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. [19] All conclusions drawn from the evidentiary material submitted to the trial court are viewed in the light most favorable to the party opposing the motion. [20] Even when basic facts are undisputed, motions for summary judgment should be denied, if under the evidence, reasonable persons might reach different conclusions from the undisputed facts. [21] ¶ 20 The determination of causation may be removed from the province of the fact-finder only when there is a complete lack of evidence and no reasonable inference tending to link the defendant's negligence to the plaintiff's harm. [22] Here, there is not an absence of proof that the surgeon's treatment proximately caused the patient's injuries. Rather, the neurologist's conclusions are probative and supported by corroborating evidence that nothing was wrong with her thigh before the surgery. After the surgery she suffered from nerve damage and atrophy and nothing else indicated that such nerve damage was caused by any other event. Consequently, the expert testimony may be used to support the claim of negligence under the teachings of our previous decisions. The patient has presented competent and sufficient evidence to make a prima facie case that she was injured during knee surgery and that the surgeon caused the injury. In other words, a reasonable person could conclude that an injury was sustained during the surgery and that surgeon was the cause of the injury. Accordingly, the trial court erred in granting the motion for summary judgment on the claim of negligence.