Opinion ID: 2314327
Heading Depth: 1
Heading Rank: 3

Heading: The District's Appeal

Text: The District argues that the trial court erred in denying its motion for JNOV, or in the alternative for a new trial or remittitur. Specifically, the District contends that Watkins failed to establish a national standard of care or a causal relationship between the District's alleged breach of that standard and his injuries. Viewing the evidence in the light most favorable to Watkins, as we must, we conclude that the evidence was adequate to sustain the verdict. In reviewing on appeal the trial court's denial of the motion for judgment notwithstanding the verdict, we apply the same standard as the trial court. Oxendine v. Merrell Dow Pharmaceuticals, Inc., 506 A.2d 1100, 1103 (D.C.1986) (citing District of Columbia v. Cassidy, 465 A.2d 395, 397 (D.C. 1983) (other citation omitted)). A judgment notwithstanding the verdict is proper only in `extreme' cases, in which no reasonable person, viewing the evidence in the light most favorable to the prevailing party, could reach a verdict in favor of that party. Id. (quoting District of Columbia v. Cooper, 445 A.2d 652, 655 (D.C.1982) (en banc)). When there is some evidence from which jurors could find that the elements of negligence have been established or where disputed facts or resolution of credibility issues determine the outcome, the case is for the jury. Washington Welfare Ass'n Inc., v. Poindexter, 479 A.2d 313, 315 (D.C.1984) (citing District of Columbia v. Gandy, 450 A.2d 896, 900 (D.C.1982)). The motion may be granted `only when the evidence, viewed in the light most favorable to the nonmoving party, permits only one reasonable conclusion as to the proper judgment.' Id. (quoting Lewis v. Washington Metro. Area Transit Auth., 463 A.2d 666, 669 (D.C.1983)). Cases in which issues of negligence and proximate cause will not be for the jury are unusual. Oxendine, 506 A.2d at 1103 (citing Rich v. District of Columbia, 410 A.2d 528, 532 (D.C.1979)). Against these standards, the District's argument fails.
In an action for negligence, the plaintiff has the burden of proving `the applicable standard of care, a deviation from that standard by the defendant, and a causal relationship between the deviation and the plaintiff's injury.' Toy v. District of Columbia, 549 A.2d 1, 6 (D.C.1988) (quoting Meek v. Shepard, 484 A.2d 579, 581 (D.C. 1984) (other citation omitted)). In a case involving a claim of medical negligence, ordinarily expert testimony is required to prove these elements. Meek, 484 A.2d at 581 & n. 4 (citations omitted). Thus, the plaintiff must establish through expert testimony the course of action that a reasonably prudent doctor with the defendant's specialty would have taken under the same or similar circumstances. Id. at 581 (citing Morrison v. MacNamara, 407 A.2d 555, 560-65 (D.C. 1979) (other citations and footnote omitted)). The conduct for medical professionals is measured by a national standard, rather than a local one. Capitol Hill Hosp. v. Jones, 532 A.2d 89, 93 (D.C.1987); Morrison, 407 A.2d at 565. The District argues that Watkins failed to establish a national standard of care for health providers treating individuals suffering from back pain because Watkins' expert witness testified only to the standard of care in the Washington metropolitan area. The testimony was not so restricted, particularly when viewed most favorably to Watkins. In the course of qualifying Watkins' expert, Dr. Lilly, counsel for Watkins asked the physician whether he was familiar with the standard of care in treating a patient in the Washington, D.C. metropolitan area and whether he was qualified to testify as to whether or not a particular regimen of treatment complies with that standard of care or falls below that standard of care. Dr. Lilly responded that he was, and the court accepted him as an expert witness to render an opinion as to the standard of care appropriate for a person with Watkins' condition. The District did not object. In subsequent testimony, Dr. Lilly testified concerning the standard of care and the District's deviation from it without restricting his responses to a particular locality. Put another way, Dr. Lilly's testimony encompassed not just one particular locality, but what was required of a medical facility under the circumstances involved here. Dr. Lilly testified that, under the circumstances presented here, a medical practitioner would have provided Watkins with something to reduce his pain and that the District's medical personnel fell below that standard of care in failing to provide the medication. Dr. Lilly's testimony was sufficient to establish the treatment that a reasonably prudent doctor would have provided under similar circumstances. Meek, supra, 484 A.2d at 581. The District also argues that Dr. Lilly failed to give a standard of care generally, testifying only about his own personal opinion of the standard of care for health care providers treating a patient with Watkins' condition and not how other health care providers would treat patients under the circumstances. Of course, testimony about what the expert would have done personally for the patient would be insufficient. See Meek, supra, 484 A.2d at 581. However, a fair reading of Dr. Lilly's testimony does not support the argument that his testimony concerned what he would do personally under the circumstances. The following question and answer are illustrative: Q. What would have been the standard of care for someone in Mr. Watkins' condition? A. I think that the standard of care for a patient with a long history of chronic pain; muscle spasms; unstable back, would be that a physician or a physician's assistant, or a nurse, or a medical practitioner of any degree, certainly should have attempted to provide [Watkins] with something to reduce his pain. Although Dr. Lilly prefaced his opinion with I think, the testimony, fairly read, expresses the witness' opinion of the standard of care, rather than what he would do himself. Viewed in the light most favorable to Watkins, the evidence was sufficient to allow a reasonable juror to find that a reasonably prudent physician would have provided Motrin or its equivalent to a patient in Watkins' condition. See Washington v. Washington Hosp. Ctr., 579 A.2d 177, 181 (D.C.1990).
The District argues that Watkins failed to establish that its failure to provide him with Motrin was the proximate cause of his paralysis and fall. It also contends that Dr. Lilly's opinion on this issue was insufficient as a matter of law because it was not expressed within the requisite degree of medical certainty and because the opinion was not based upon the facts in this case. We conclude that the evidence on the issue of proximate cause was adequate to sustain the jury's verdict in light of controlling law. To establish proximate cause, the plaintiff must present evidence from which a reasonable juror could find that there was a direct and substantial causal relationship between the defendant's breach of the standard of care and the plaintiff's injuries and that the injuries were foreseeable. Psychiatric Inst. of Wash. v. Allen, 509 A.2d 619, 624 (D.C.1986) (emphasis deleted). [7] The evidence is adequate to establish proximate cause if the expert state[s] an opinion, based on a reasonable degree of medical certainty, that the defendant's negligence is more likely than anything else to have been the cause (or a cause) of a plaintiff's injuries. Id. A `reasonable' medical certainty, reflects an objectively well-founded conviction that the likelihood of one cause is greater than the other; it does not mean the expert is `personally certain' of the cause or that the cause is discernable to a certainty. Clifford v. United States, 532 A.2d 628, 640 n. 10 (D.C.1987) (citing Psychiatric Inst., 509 A.2d at 624). Dr. Lilly's testimony meets the standard governing sufficiency. In this case, Watkins' expert testified first that he had an opinion, within a reasonable degree of medical certainty, as to whether or not Watkins' fall could be attributed to, or caused by, the failure to provide him with Motrin for his pain. He was then asked, And what is that opinion? Dr. Lilly responded: [T]he increase in the pain that Mr. Watkins suffered during those days of incarceration; the increase in the muscle spasms, caused a state of increased low back instability, which contributed [to] or caused his fall. Dr. Lilly's opinion linked the District's medical staff's failure to provide Watkins with Motrin with his increase in pain and resultant instability which caused Watkins to fall. This evidence was sufficient for a reasonable juror [to] find that there was a direct and substantial causal relationship between [the District's] breach of the standard of care and [Watkins'] injuries. Psychiatric Inst., supra, 509 A.2d at 624; see also District of Columbia v. Anderson, 597 A.2d 1295, 1298-99 (D.C.1991). The District also contends that the testimony was insufficient because it was not based on the facts in this case. It argues that the facts adduced at trial showed that Motrin did not prevent the paralysis that caused Watkins to fall and that Motrin is prescribed to reduce pain and fever, not to treat numbness, paralysis or spasms. There was evidence that Watkins experienced paralysis when in pain and that he took Motrin which relieved his pain. In addition to testifying that the failure to give Motrin contributed to or caused Watkins' injury, Dr. Lilly explained the connection between the pain and paralysis, i.e., that the increase in the pain ... the increase in the muscle spasms, caused a state of increased low back instability, which contributed [to] or caused [Watkins'] fall. Whether being deprived of Motrin at the time Watkins sustained his injury proximately caused him to fall or whether there was some other cause is a question of fact for the jury. See Sanders v. Wright, 642 A.2d 847, 849 (D.C.1994) (Where evidence supports a rational finding of proximate cause, the issue is one of fact for the jury.). Viewing the evidence in the light most favorable to Watkins, the non-moving party, there was sufficient evidence for a jury reasonably to find that the District's negligence was the proximate cause of Watkins' injury. [8] See Kane v. Ryan, 596 A.2d 562, 564 (D.C.1991) (reversal of denial of a motion for JNOV warranted only if no reasonable juror could have reached the verdict) (citing Jackson v. Condor Management Group, Inc., 587 A.2d 222, 224 (D.C.1991) (other citation omitted)).