Opinion ID: 1707689
Heading Depth: 3
Heading Rank: 3

Heading: The Law Applied to the Case Sub Judice

Text: In the summary judgment proceeding in the case sub judice, Wooten bore the burden of persuading the judge that no genuine issue of material fact exists and that he is entitled to judgment as a matter of law. Through affidavit or other means, Wooten needed to present some evidence showing that proof of one or more of the elements of negligence is absent or insufficient. If Wooten met his burden, Palmer was required to rebut by producing significant, probative evidence establishing that Patricia's death was proximately caused by Wooten's negligence. Mere allegation or denial of material fact is insufficient; Palmer must have set forth by affidavit or other means specific facts showing that triable issues of fact exist. Wooten filed his motion for summary judgment with supportive documents. These documents include: (1) the pleadings; (2) an affidavit of Buckley; (3) an affidavit of Kent, his expert witness; (4) his own affidavit; and (5) a copy of the death certificate of Patricia. Perusal of these documents clearly supports the conclusion that Wooten met his burden of persuasion. The burden then shifted to Palmer but, according to the trial judge, Palmer failed to sustain her burden for three reasons  each of which is independent of the other. These reasons are analyzed in the following subsections.
The first reason for which the trial judge granted Wooten's motion concerned Palmer's failure to respond to discovery. Indeed, Palmer's conduct was so egregious that even a harsh sanction as dismissal may seem warranted. However, a dismissal on this basis under Rule 56 is procedurally erroneous. Dismissal under Rule 56 can only be based on the insufficiency of evidence  not on violation of procedure. Imposition of sanctions for failure to make or cooperate in discovery is governed by Rule 37 (operation of this rule will be discussed in a subsequent section which addresses BRMC's motion to dismiss). Because other independent bases for granting summary judgment were relied upon, this error is deemed harmless.
The trial judge provided two more reasons or bases for granting summary judgment: disqualification of Palmer's experts and the failure to present a triable issue of fact. These bases will be considered together in this subsection.
As stated, in negligence actions such as the one sub judice, expert medical testimony is generally a vital means to establishment of the plaintiff's prima facie case. Medical malpractice cases generally require expert witnesses to assist the trier of fact to understand the evidence. Kilpatrick v. Mississippi Baptist Medical Center, 461 So.2d 765, 768 (Miss. 1984). Hull, 516 So.2d at 491; Hall, 466 So.2d at 873-74. Most important, a plaintiff in a medical malpractice case must, through expert testimony, establish the applicable standard of care and a breach of that standard. Hawkins v. Ozborn, 383 F. Supp. 1389 (N.D. Miss. 1974); Kilpatrick v. Mississippi Baptist Med. Center, 461 So.2d 765 (Miss. 1984); Dazet v. Bass, 254 So.2d 183 (Miss. 1971); see also Cunningham v. Mitchell, 549 So.2d 955, 959-60 (Miss. Sept. 1989). Once a trial judge determines that expert testimony will be of assistance to the trier of fact, Mississippi law requires that he determine whether the proffered witness is qualified as an expert by knowledge, skill, expertise, training or education. Hall, 466 So.2d at 873, quoted in Hardy v. Brantley, 471 So.2d 358, 366 (Miss. 1985). That is, an expert witness [must] be qualified before he ... may provide opinion evidence. Hardy, 471 So.2d at 366; see also Hall, 466 So.2d at 875; Pharr v. Anderson, 436 So.2d 1357, 1359 (Miss. 1983). The trial judge is afforded widest possible discretion. Dixon v. International Harvester Co., 754 F.2d 573 (5th Cir.1985); see also Barnes v. General Motors Corp., 547 F.2d 275 (5th Cir.1977) (discretion is broad); Wyeth Laboratories, Inc. v. Fortenberry, 530 So.2d 688 (Miss. 1988) (qualification of witness is within trial judge's discretion); Hardy, 471 So.2d at 366 (qualification determination necessarily involves trial judge's discretion). Unless an abuse of discretion is evident, the judge's determination will remain undisturbed on appeal. Illinois Cent. R.R. Co. v. Benoit Gin Co., 248 So.2d 426 (Miss. 1971); see Crawford v. Worth, 447 F.2d 738 (5th Cir.1977) (judge's determination of expert qualification is conclusive unless clearly erroneous); see also City of Mound Bayou v. Roy Collins Constr. Co., Inc., 499 So.2d 1354, 1360-61 (Miss. 1986) (trial judge's disqualification of engineer as expert affirmed); Pharr, 436 So.2d at 1359 (trial judge's disqualification of proffered medical expert affirmed). In the case sub judice, the decision to disqualify Palmer's experts occurred during the summary judgment hearing  not during a trial; this fact, however, is inconsequential. The law empowers a trial judge to determine whether a proffered expert is qualified to testify and does not restrict exercise of this power to the trial stage only. That is, a judge has as much power to resolve doubts on the qualifications of proffered experts during the summary judgment stage as he has during the trial stage. And of course, the standard which this Court must apply when reviewing a trial judge's decision to disqualify remains unchanged  notwithstanding that the decision was made during the summary judgment stage. That is, this Court will determine whether the trial judge abused his discretion. In the case sub judice, discretionary abuse is not evident. Mississippi law required the judge to determine whether Palmer's proffered experts are qualified ... by knowledge, skill, expertise, training, or education. Hall, 466 So.2d at 873. The judge accordingly followed the rule of evidence enunciated in Hall v. Hilbun . Pursuant to Hall, a proffered expert must base his opinions  regarding the conclusions (possible diagnoses or areas for further examination and testing) minimally knowledgeable and competent physicians in the same specialty or general field of practice would draw, or action they would take  on information reasonably available to the physician [defendant], i.e., symptoms, history, test results, results of the doctor's own physical examination, x-rays, vital signs, etc. Id. at 874-75. Moreover, a proffered expert must [b]e familiarized with the facilities, resources, services and options available. This may be done in any number of ways. The witness may prior to trial have visited the facilities, etc. He may have sat in the courtroom and listened as other witnesses described the facilities. He may have known and over the years interacted with physicians in the area. There are no doubt many other ways in which this could be done but, significantly, we should allow the witness to be made familiar with the facilities (and customs) of the medical community in question via a properly predicated and phrased hypothetical question. Id. at 875. Once [the proffered expert] has become informed of the facilities, [the patient's medical data], etc. available to the defendant physician, the ... expert may be deemed qualified to express an opinion what the care duty of the defendant physician was and whether the acts or omissions of the defendant physician were in compliance with, or fell substantially short of compliance with, that duty. Id. The evidence in the case sub judice shows that Lamphier, Palmer's only proffered expert who is a medical doctor, lacked both knowledge and familiarity with the hospital or similar facility. A lack of knowledge is reflected in Lamphier's opinions which are mere conclusions devoid of factual bases. Specifically, medical records and other documents which Lamphier supposedly examined and relied upon in forming his opinion were neither produced during his deposition nor attached to his affidavits filed in opposition to the motion for summary judgment as mandated by Rule 56(e). [12] A lack of the required familiarity with the facility available to Wooten in his treatment of Patricia is reflected in Lamphier's testimony given during his deposition. He testified that he has never visited BRMC nor any other hospital in Mississippi or in the Gulf Coast region. He specifically admitted that he is unfamiliar with these facilities and their staff. And he currently has no affiliations with any hospital anywhere and has had no hospital privileges for the past nine years. Notwithstanding these demonstrable deficiencies, Palmer emphasizes that Lamphier is qualified simply because he is a surgeon licensed in Massachusetts and New Hampshire. Additionally, Lamphier is a member of the Medical, Legal, Malpractice Peer Review Foundation [hereinafter Foundation], a corporation which consults with lawyers and insurance companies involved in medical malpractice suits. The trial judge, however, heeded this Court's advice: [T]rial judges are admonished to ascertain that the [proffered] witness really is an expert in the particular field at issue[; n]ot every M.D. is a qualified expert in every malpractice case.  Hall, 466 So.2d at 875 (emphasis added). Accordingly, Lamphier was adjudged unqualified to appraise the actions of Wooten, an oral surgeon, because  in addition to his (Lamphier's) lack of knowledge and familiarity with the hospital  he is neither a dentist nor oral surgeon and his Foundation has no affiliation with one. [13] Based on the evidence examined thus far, this Court can conclude that the trial judge's decision was proper. Any doubt that such a conclusion is correct is expunged upon examination of the following revelations. In 1974, Lamphier was a resident of Florida when he lost his license to practice in that State for professional misconduct  which involved deaths of some of his patients. Revocation of Lamphier's license stemmed from the findings of horrific and deplorable facts by Victor J. Martinez, M.D., hearing officer for the Florida State Board of Medical Examiners [hereinafter Board]. [14] Eight counts of medical malpractice levelled against Lamphier led to the following conclusion by the hearing officer: Timothy Andre Lamphier, M.D., is guilty of unprofessional conduct in that he departed from or failed to conform to minimal standards of acceptable and prevailing medical practice... . Timothy Andre Lamphier, M.D., is guilty of making misleading, deceptive, untrue or fraudulent representations in the practice of medicine... . Timothy Andre Lamphier, M.D., did employ a trick or scheme in the practice of medicine... . Timothy Andre Lamphier, M.D., is guilty of unprofessional conduct... . The Board adopted the hearing officer's conclusions. However, the Board modified the conclusions with the following amendment: Timothy Andre Lamphier, M.D., is guilty of intentionally making misleading, deceptive, untrue or fraudulent representations in the practice of medicine (emphasis added). During the subsequent year, Lamphier petitioned the Board for restoration of his license to practice medicine in Florida; the Board rejected the petition. The rejection was based upon the following determination: The original findings and conclusions noted above were admittedly not in dispute. In this light, questions were put to the practitioner wherein he admitted having made errors in his surgical judgment. Further, questions were put to petitioner concerning his past activities and present qualifications. The petitioner was unable to adequately respond to his past activities and, in fact, noted that numerous civil malpractice matters were settled and some were still pending in Dade County, Florida. With respect to present qualifications, the petitioner merely stated that he had been doing emergency room type work at Ontario Community Hospital in Ontario, California, and has engaged in surgery only as required by his emergency room duties. The petitioner noted that it was his intention to refrain from the type of surgery which caused him his original problems and revocation of license in the State of Florida. In fact, all surgical procedures and medical activities of the petitioner have been limited to his emergency room work as his application for surgery privileges at the Ontario Community Hospital outside of the emergency room is still pending and has not as yet been approved. Throughout the entire proceedings, the petitioner was not able satisfactorily to relate to his peers any real insight into the matters of his surgical competence and surgical judgment to overcome the past events, as fully documented in the recommended order of 1974, which was the basis for license revocation, sets forth a most unfortunate and disgraceful series of events involving unprofessional conduct from which the citizens of this state must be protected (emphasis added). Lamphier's testimony at the hearing regarding his practice in California seems prophetic; that State revoked his license in 1977. Lamphier subsequently lost his license to practice medicine in New York as well. And finally, Lamphier's deposition testimony reveals he has had at least twelve medical malpractice suits filed against him. In sum, this Court holds that, in view of the evidence, the circuit judge's disqualification of Lamphier as an expert against these defendants was fully justified. Clearly, no discretionary abuse is evident. Accord In re Air Crash Disaster at New Orleans, La., 795 F.2d 1230, 1233 (5th Cir.1986) (trial judges' reflexive decisions to let it all in because jurors will give it the weight it deserves, can mask a failure by the trial judge to come to grips with an important trial decision) (discussing abdication of judicial responsibility to question experts' qualifications). In addition to Lamphier, Palmer proffers herself as an expert on Wooten's conduct. The evidence shows that Marilyn Palmer is a registered nurse; however, she has never worked in an intensive care unit in a hospital and has not worked in any hospital since 1966. In 1966, she was employed by Singing River Hospital in Pascagoula where she was a drug room nurse, and from 1958 to 1959, she was an operating room nurse at Jackson County Hospital in Pascagoula. Palmer did not explain how she may have acquired  through her limited nursing experiences  the knowledge, skill, expertise, training or education necessary to qualify her as an expert on the conduct of an oral surgeon. Hall, 466 So.2d at 873; Hardy, 471 So.2d at 366. Clearly, in view of her weak credentials, the judge did not abuse his discretion by disqualifying Palmer as an expert. [15] As noted, in negligence actions such as the one sub judice, expert medical testimony is a vital means to establishment of the plaintiff's prima facie case. Wooten provided expert testimony and other evidence to establish his compliance with the applicable standard of care. Palmer rebutted by proffering the testimony of two witnesses who were properly disqualified as experts. Absent expert testimony, the record is devoid of significant, probative evidence from which a genuine issue of material fact may derive and, consequently, Palmer's claim must be rejected. [16] A recent decision in another medical malpractice case is poignantly supportive of this conclusion. In Phillips v. Hull, 516 So.2d 488 (Miss. 1987), the defendant-physician moved for summary judgment and presented affidavits to substantiate his contention that he exercised the appropriate standard of care when he performed a surgical procedure. The plaintiff, however, presented no expert testimony establishing the converse of this contention and, consequently, the trial judge granted the physician's motion. On appeal, this Court rationalized its affirmation of the decision: [A]ssuming we are in an area not within the common knowledge of laymen, absent expert medical testimony which (a) articulates the duty of care the physician owes to a particular patient under the circumstances, and (b) identifies the particular(s) wherein the physician breached that duty and caused injury to the plaintiff patient, the plaintiff's claim for negligence regarding the surgery must fail. The trial court was proper in dismissing, against all plaintiffs, the cause of action based upon negligent surgical procedures. Id. at 491 (trial judge's decision to grant summary judgment was reversed in part on other grounds). Finally, the foregoing discussion provides a predicate upon which three issues presented by Palmer on appeal may be resolved. Palmer asks whether or not the [trial judge] erred in finding that [his] experts were not qualified to testify in opposition to [Wooten's] motion rather than allowing a jury to determine weight and credibility. See Issue No. 2 in Section III of this opinion, supra. The substance of this issue is perplexing; it does not relate even remotely to the facts discernible in the record. The decision that Palmer's proffered witnesses are unqualified to render expert opinions does not concern weight or credibility; rather, it concerns qualification. See MISS.R.EVID. 702; see also Appellant's Brief at 17-18 (where Palmer cites authority which is neither analogous nor persuasive). [17] Through Issues 4 and 9, Palmer basically contends that the trial judge erred when he struck opinions of Palmer's experts. Palmer did not provide support for this contention, and the record and briefs are devoid of evidence showing discretionary abuse.
Assuming, arguendo, that Palmer's proffered experts are qualified to testify, examination of the record reveals no evidence  particularly testimonial evidence  of significant and probative value establishing her allegation that Wooten's negligence proximately caused Patricia's death. Therefore, the conclusion that Palmer failed to carry her burden of rebuttal as required under Rule 56 remains valid; no triable issue of fact exists. Palmer levelled numerous claims to support her negligence allegation. Palmer claimed that repair of Patricia's fractured jaw should have been delayed until her neurological condition improved, but the record reveals no evidentiary support. The decision to proceed with the surgery was not made by Wooten; it was made by Buckley, a neurosurgeon and Patricia's primary physician. Palmer's own expert, Lamphier, conceded that Buckley was the appropriate decision maker and that Wooten was correct to rely on Buckley's advice. [18] Palmer admits in her own brief that Buckley found ... Patty was sufficiently stable neurologically to sustain oral surgery. Admission aside, evidence produced by Wooten shows no complications were encountered during or after the surgery. Indeed, Palmer's own expert, Lamphier, testified during his deposition that, based on information provided him, he knows of no complications that resulted during or after the surgery. Palmer also claimed that the procedure employed to repair Patricia's jaw was improper. According to Palmer, Wooten should not, under the circumstances, have wired Patricia's mouth shut and that, having done so, should have provided post-operative instructions that she was not to receive anything by mouth. Lamphier adds that [Wooten] had a responsibility if he wired this girl's teeth together, that she be given nothing by mouth, because of the great danger of aspiration. [19] Palmer and her expert were obviously confused at this point. Evidence shows that Wooten did not wire Patricia's mouth shut; other than mere speculation, Palmer provides no evidence to the contrary. As described by Wooten, the procedure entailed placement of two loose elastics ... one on the right and one on the left [side of Patricia's mouth] to simply encourage the jaw to stay closed. She could easily open it anytime she [needed] to vomit, to speak or to lick her lips or whatever function she desired. But see Appellant's Main Brief at 11 (he wired[?] her mouth ... by placing rubber bands in her mouth). The two elastics did not inhibit opening of her mouth. The discharge summary, written by Buckley, notes that Patricia was conversive after the surgery and spoke in a rational way. In fact, Patricia did vomit on at least one occasion several days following the surgery, and she experienced no difficulty expelling the vomitus material. The point of Palmer's allegation regarding the procedure to repair the jaw is unclear. Is Palmer claiming that the procedure proximately caused Patricia's death because her mouth was allegedly wired shut and, consequently, she was unable to expel vomitus material? If so, then this claim was not specifically enunciated, and an evidentiary basis is nonexistent. On the contrary, the medical records, Buckley's discharge summary, the autopsy, and the death certificate do not indicate that aspiration of vomitus material caused or contributed to Patricia's death. In sum, Palmer's claim  that the procedure to repair Patricia's jaw was improper  is without merit. Indeed, Palmer does not even delineate an alternative procedure which allegedly should have been employed. In the pleadings, Palmer levelled another claim  that an ulcer was the cause of Patricia's death and that the defendants ... negligently failed to exercise ... the degree of care and skill exercised by physicians and surgeons in like cases by failing to properly diagnos [sic] and treat the stress ulcer. The autopsy report, however, contradicts Palmer's unsubstantiated determination that an ulcer caused Patricia's death: No clear cause of the cardiac arrest was determined. The report additionally concluded that  [n]o actual ulcerations [were] found  in the gastrointestinal tract. The death certificate did note that Patricia died of cardiopulmonary arrest due to a stress ulcer as a consequence of an automobile accident. This notation was written by an individual other than the pathologist who conducted the autopsy and is unsupported by the evidence presented in the record. But if Patricia did die of an ulcer, then Palmer's claim should nonetheless be rejected because she failed to present specific facts, as required under Rule 56, showing that Wooten breached the still undetermined standard of care and a relation between the breach of duty and the cause of Patricia's death. Fruchter, 522 So.2d at 199 (citing Matter of Lanius, 507 So.2d 27, 30 (Miss. 1987), and First Fed. Savs. & Loan Ass'n, 460 So.2d at 792). As stated, mere allegation or denial of material fact is insufficient to generate a triable issue of fact sufficient to avoid an adverse rendering of summary judgment. Sanders, 485 So.2d at 1054; Hill v. Consumer Nat'l Bank, 482 So.2d 1124, 1128 (Miss. 1986), cited in Fruchter, 522 So.2d at 198-99. Finally, in addition to her unsubstantiated claims that aspiration or an ulcer caused Patricia's death, Palmer levelled yet another claim: that Patricia fatally choked on a rubber band which Wooten used in repairing the fractured jaw. The record is devoid of supportive evidence. In sum, Palmer put forth numerous claims concerning the cause of Patricia's death, but failed to produce evidence of sufficient value to defeat Wooten's motion for summary judgment.
Palmer also claims that Wooten failed to inform Patricia or her family of the risks involved in the surgery. The trial judge determined  though without explanation  the claim was not sufficiently substantiated to defeat the motion for summary judgment on this issue. The doctrine of informed consent represents the application to medical practice of principles of tort law. Thus, when a lack of informed consent is claimed, the plaintiff has the burden to prove by a preponderance each element of the prima facie case: duty, breach of duty, proximate causation, and injury. Hull, 516 So.2d at 492 (providing a detailed discussion on historical aspects of the informed consent doctrine and its development in Mississippi); see also P. APPELBAUM, C. LIDZ & A. MEISEL, INFORMED CONSENT: LEGAL THEORY AND CLINICAL PRACTICE 123 (1979). When a physician-patient relationship exists, the physician owes the patient a duty to inform and obtain consent with regard to the proposed treatment. APPELBAUM, LIDZ & MEISEL, supra, at 123-24. Proving breach of duty requires more than mere allegation that the physician did not obtain informed consent. For example, if the plaintiff's allegation ( i.e., that her consent was not informed consent) is based on a failure to understand the information provided by the physician prior to being administered treatment, then she may need to show the information was too complex or too vague. Basically, this is a question of adequacy of the information provided. In a recent case, this Court delineated a disclosure checklist which should be useful in scrutinizing adequacy of information. Hull, 516 So.2d at 493. Pursuant to this list, a medical practitioner should disclose to a patient (or to the patient's guardian or representative): (1) a diagnosis, (2) nature and purpose of the treatment, (3) risks and consequences, (4) probable success of the treatment, (5) alternatives, and (6) prognosis if the treatment is not administered. Applicability of each item may shift from case to case, depending upon the particular facts. See 11B P. LASKY, HOSPITAL LAW MANUAL: CONSENT TO MEDICAL AND SURGICAL PROCEDURES 38-39, cited in Hull, 516 So.2d at 493. Evidence that the physician complied with the checklist (or some variation) may be sufficient to defeat a claim of informational vagueness; however, a question may still remain with regard to informational complexity. The California Supreme Court aptly noted that the patient's interest is not in a lengthy polysyllabic discourse, but in provision of relevant information in lay terms. Cobbs v. Grant, 8 Cal.3d 229, 104 Cal. Rptr. 505, 502 P.2d 1 (1972); see also Gray v. Grunnagle, 423 Pa. 144, 223 A.2d 663 (1966) (Supreme Court held that consent was invalid because terminology used to obtain consent was too complex for patient to understand). If the allegation of lack of informed consent is based on incompetency, the plaintiff may need to show, for example, that she was under the influence of an anesthetic when infomation was provided and consent obtained. See, e.g., Demers v. Gerety, 85 N.M. 641, 515 P.2d 645 (Ct.App. 1973) (consent invalid because obtained after awakening patient in middle of the night; patient had been administered sleeping pills earlier and was groggy when awakened); see Cahal & Cody, Consent and the Groggy Patient, 40 GENERAL PRACTITIONER 195 (1969). If lack of informed consent is based on involuntariness, the plaintiff may need to show, for example, that she was pressured into signing a consent form or was under duress when consent was obtained. APPELBAUM, LIDZ & MEISEL, supra, at 179. Recovery under the informed consent doctrine is circumscribed by numerous affirmative defenses. For example, the physician may not be required to inform the patient of unexpected [20] or immaterial [21] risks. Obtaining informed consent may not be necessary under circumstances involving an emergency ( e.g., life or death situation), [22] incapacity ( e.g., unconscious patient), [23] waiver ( e.g., patient waived right to receive information), [24] and therapeutic privilege ( e.g., disclosure would be harmful to patient). [25] Once proof of duty and breach of that duty is provided, the plaintiff is required to produce evidence of two subelements of causation. First, the plaintiff must show that a reasonable patient would have withheld consent had she been properly informed of the risks, alternatives, and so forth. Hull, 516 So.2d at 493 (reaffirming Mississippi's adoption of the objective test); APPELBAUM, LIDZ & MEISEL, supra, at 121. And second, the plaintiff must show that the treatment was the proximate cause of the worsened condition ( i.e., injury). That is, the plaintiff must show that she would not have been injured had the appropriate standard of care been exercised. Generally, proof of the latter sub-element requires expert testimony that the defendant's conduct  not the patient's original illness or injury  led to the worsened condition. In the case sub judice, Palmer claimed lack of informed consent, but failed to produce any evidence of the doctrine's four elements. Conversely, the record contains two documents entitled: Authorization for Medical and/or Surgical Treatment. Palmer's signature is affixed to both documents, which expressly authorized Wooten to make an impression of Patricia's teeth and to repair her fractured jaw. These documents also include a declaration by Palmer, who considers herself to be a medical expert, that she fully understand[s] ... the reasons why [Patricia's] surgery is considered necessary, its advantages and possible complications, if any, as well as possible alternative modes of treatment, which were explained to me by Dr. James Wooten. Admittedly, the documents do not reveal the specific information disclosed and whether the information was adequate; however, the documents constitute some evidence supporting Wooten's claim that informed consent was indeed obtained. In another medical malpractice case before this Court, such evidence may have defeated a plaintiff's claim that her physician failed to obtain informed consent prior to negligently performing tubal ligation. In Phillips v. Hull , the physician successfully moved for summary judgment on the issues of surgical negligence and failure to obtain informed consent. On appeal, this Court reversed in part on the issue of informed consent because [n]o form in the record indicates the patient's consent was in fact an informed consent. 516 So.2d at 494 (emphasis added). [I]n the absence of any documentary evidence substantiating [the physician's] claim of having obtained [his patient's] `informed' consent for the operation, this Court [can]not find that `the strength of [the movant's] showing is such that [she] is entitled to summary judgment as a matter of law.' Id. (emphasis added and citation omitted). In the case sub judice, Wooten clearly met his burden of persuasion by introducing documentary evidence indicating informed consent was obtained from Palmer, a self-proclaimed expert on oral surgery. Palmer's mere allegation to the contrary is insufficient rebuttal. Assuming, arguendo, that Wooten breached his duty to obtain informed consent, then evidence in the record must reflect a causal connection between breach of that duty and the death of Patricia. Reikes v. Martin, 471 So.2d 385, 392 (Miss. 1985), cited in Hull, 516 So.2d at 493. As discussed in the preceding subsection, Palmer has produced no significant, probative evidence showing a causal connection between the repair of Patricia's fractured jaw and her subsequent cardiac arrest. Thus, without more, this Court cannot conclude that summary judgment on this issue was improperly granted.
Palmer's negligence claim also stems from an out-of-state trip Wooten made on April 10, 1981. Palmer alleges Wooten left the state without leaving any orders for [Patricia's] post operative care[; he] also left town without leaving a place or number whereby he could be reached or an oral surgeon in charge to continue his post operative care. This allegation is without merit simply because Wooten did not leave town until April 10  one day after Patricia experienced cardiac arrest. [26] Wooten's post-operative care of Patricia included three visits  once following surgery on April 8 and twice on April 9. His last visit on April 9 occurred at approximately 6:00 p.m.; Patricia's cardiac arrest occurred the same day at approximately 11:40 p.m. Four physicians and numerous medical personnel on duty that night at the hospital responded when Patricia experienced the arrest. No evidence was presented in the record showing that Wooten was called for assistance. Not a scintilla of evidence of significant and probative value was produced showing the standard of post-operative care owed by Wooten and a failure to exercise that standard. More specifically, no evidence was produced showing that Wooten or anyone else could have foreseen the events which transpired on the evening of April 9 or, if the events were foreseeable, that preventative care could have been provided. Finally, the testimony of Palmer's own proffered expert, Lamphier, exculpates Wooten. Wooten: As I understand your response to my question, Doctor, you're saying, and my question was: What did Dr. Wooten do wrong? And you answered by saying ... Lamphier: (interrupting) Maybe I said too much; I'm sorry. Wooten: I'm not worried about that. My question was: What did Dr. Wooten do wrong? And you answered by telling me that at 9:00 on the [9th] she vomited and no one did anything. Are you saying Are you saying that Dr. Wooten should have done something? ..... Lamphier: No, Dr. Wooten was not there. Dr. ... Wooten: (interrupting) Who should have done something? Lamphier: In the ICU. They did nothing. They did absolutely nothing. Wooten: All right. Lamphier: They are a hundred percent responsible for that girl's death. In sum, no evidence was adduced showing that Wooten was negligent in his rendering of post-operative care.