Opinion ID: 2296355
Heading Depth: 1
Heading Rank: 2

Heading: Legal Sufficiency of Plaintiff's Evidence

Text: In her complaint, Perez premised the statutory claims on the theory that the District committed medical malpractice. It was, therefore, her burden at trial to present medical opinion testimony establishing that the District's substandard medical care legally caused Rosa's death. See Lasley v. Georgetown Univ., 688 A.2d 1381 (D.C.1997) (requiring medical opinion testimony for medical malpractice claims); Washington v. Washington Hosp. Ctr., 579 A.2d 177, 181 (D.C.1990) (citations omitted) (requiring evidence of the standard of care, a deviation from it, and a causal link between the deviation and the injury). The District claims that it is entitled to judgment as a matter of law because the evidence Perez presented at trial fails to establish that the District deviated from the standard of care or that the District's conduct legally caused Rosa's death. On appeal, we review the trial evidence in the light most favorable to Perez and draw all reasonable inferences against the District. We shall not disturb the trial judge's ruling on a motion for judgment as a matter of law [a]s long as there is some evidence from which jurors could find that the party has met its burden. . . . Felix Alliegro v. ACandS, Inc., 691 A.2d 102, 105 (D.C.1997) (citations omitted). In assessing the legal sufficiency of the evidence, neither the appellate court nor the trial court may act as the trier of fact, and each must take care to avoid weighing the evidence, passing on the credibility of the witnesses, or substituting [its] judgment for that of the jury. Id.
There was ample evidence at trial from which a reasonable jury could reasonably conclude that the District's employees at the Adams Morgan Clinic breached the standard of care. The medical experts agreed [7] that if a patient presents symptoms of sickness in addition to fetal death in utero, it is necessary to hospitalize the patient immediately for diagnosis and treatment. A jury could reasonably find that when Dr. Fales examined Rosa on June 26, she did present symptoms of sickness in addition to fetal death in utero. The evidence indicates that she was visibly ill to her family throughout the day. Gloria testified that in the morning Rosa was looking very bad and her skin was yellowish, and Hector testified that after the clinic visit, Rosa was in pain, very pale, vomiting, bony, and her skin was very yellow. Furthermore, Dr. Berke testified that Rosa's symptoms were so severe the next day that she had to look sick the day before. This is not something that came on her overnight. This has been progressing for probably several days. Finally, Dr. Fales himself recorded looks pale in Rosa's medical records. It is, therefore, reasonable for a jury to infer that Rosa presented symptoms of sickness in addition to fetal death in utero during the afternoon examination on June 26. [8] Rather than hospitalize Rosa for diagnosis and treatment of her sickness, however, Dr. Fales merely ordered a sonogram test to confirm his conclusion that her fetus had died. Furthermore, Nurse Bondurant needlessly delayed the testing until the following day. The evidence of the clinic's deviation from the standard of care requiring immediate hospitalization is, therefore, legally sufficient.
The failure of D.C. General Hospital to hospitalize Rosa immediately after the sonogram test constitutes a second basis for the District's negligence. According to Dr. Fales, once fetal death is confirmed, the standard of care requires the hospital to admit the patient immediately. Moreover, according to Drs. Berke and King, the hospital must also conform to the standard of care requiring immediate hospitalization of a patient who is sick in addition to presenting fetal death in utero. Rather than commencing immediate diagnosis and treatment, however, the hospital instead sent Rosa back to the Adams Morgan Clinic to fill out paperwork. The hospital, therefore, waited until 11:23 a.m. to admit Rosa into the emergency room. This evidence suffices to establish that D.C. General Hospital  in addition to the Adams Morgan Clinic  breached the standard of care.
The District contends that even if it deviated from the standard of care, Perez failed to present evidence at trial sufficient to establish a causal link between the deviation and Rosa's death. Citing the Palsgraf and Wagon Mound cases, [9] the District argues that Rosa's death was legally unforeseeable because fatty liver disease is so rare. This recasting of the question distorts the pertinent causation issue. Perez had the burden of establishing only that the District's failure to hospitalize Rosa immediately was a substantial factor in causing her death. Perez easily satisfied this burden because Drs. Berke and King agreed that Rosa would likely still be alive had she been hospitalized on June 26 rather than June 27. The evidence shows that even though fatty liver disease is rare, immediate testing would easily have detected it, and immediate treatment could have saved her. Dr. Berke explained that fatty liver disease is related to pregnancy, so the degenerative process could have been successfully reversed simply by inducing labor and delivering the fetus. He also testified that even at the time of the sonogram testing on the morning of June 27, there still existed reasonable prospects that such treatment would be successful. In his medical opinion, waiting until the afternoon destroyed the last hope of saving her life. We conclude, therefore, that the evidence of causation was clearly sufficient, whether considered in conjunction with the breach by the Adams Morgan Clinic or the breach by D.C. General Hospital. Perez adduced evidence at trial legally sufficient to support the jury's verdict that the District of Columbia committed medical negligence. We, therefore, affirm the judgment. Affirmed.