Opinion ID: 2279729
Heading Depth: 1
Heading Rank: 4

Heading: Alleged Negligence of Other GHA Physicians

Text: Cleary also contends that expert medical testimony was not necessary to establish that the two GHA physicians he saw in 1987 and 1989 breached the applicable standard of care because the physicians admitted that they did not know about the DREZ procedure and because they did not refer him to other physicians who would. The trial court ruled that Cleary had established that the standard of care required physicians treating a particular patient to be familiar with treatment options or to refer the patient to another physician, but that Cleary had not established that, under the circumstances of this case, the GHA physicians violated that duty. It is undisputed that Dr. Pournaras and Dr. Kelly, who were not neurosurgeons like Dr. Ammerman, did not know about the DREZ procedure and did not refer Cleary to other physicians regarding the procedure. However, as the trial court noted, Cleary's contact with the physicians was sporadic. He saw Dr. Pournaras on only two occasions, once in February and again in March of 1987. Treatment was prescribed, but Cleary did not return for recommended follow-up care. Cleary also failed to return for the recommended follow-up visit to Dr. Kelly, who saw Cleary on one occasion in 1989. In medical malpractice negligence actions, the standard of care by which the physician's conduct is measured is the care that a reasonably prudent doctor with the defendant's specialty would have taken under the same or similar circumstances. Meek v. Shepard, 484 A.2d 579, 581 (D.C.1984); Morrison v. MacNamara, 407 A.2d 555, 561 (D.C.1979) (the duty of care is that degree of reasonable care and skill expected of members of the medical profession under the same or similar circumstances). Cleary's only expert witness, Dr. Friedman, was unable to opine whether the GHA doctors violated the standard of care because he had not reviewed Cleary's GHA medical records. Although in some circumstances a lay jury may be able to determine whether a physician's conduct breached the duty to be informed or to refer, we think the facts of this case put it beyond the ken of lay jurors. Here, the procedure in question was evolving over time, and there was no continuing relationship between Cleary and the physicians. The physicians advised Cleary to undertake certain types of treatments, but because he did not return for the follow-up visits, they had no way to know whether the treatments they prescribed were or were not successful. Both Dr. Pournaras and Dr. Kelly testified that such follow-up visits might have resulted in a referral to specialists familiar with the DREZ procedure. Under these circumstances, it was not error for the trial court to require expert testimony to establish a breach of the standard of care. See Nimetz, supra, 596 A.2d at 605-06 & n. 4 (expert testimony required on breach of the standard of care in a failure to consult case where evidence established that the physician admitted that he had not seen the patient's medical situation before and admitted he did not consult with a more knowledgeable physician; an average layperson, even after applying common sense, would not be equipped to decide whether the failure to consult during the time in question deviated from the course that a reasonably prudent physician with the defendant's specialty would have taken under the same or similar circumstances). Because Cleary did not present the required expert testimony establishing that Drs. Pournaras and Kelly breached the standard of care in these circumstances, we hold that the trial court's grant of a directed verdict in favor of GHA on this issue was proper.