Opinion ID: 1760009
Heading Depth: 1
Heading Rank: 2

Heading: Negligent Treatment

Text: The second issue presented by this appeal is whether the trial court erred in directing a verdict for defendants against the malpractice action brought by plaintiffs on a theory of negligence in treatment. In reviewing a trial court's order for a directed verdict, this court makes an independent determination of the sufficiency of the evidence to present a fact question for a jury determination. See Walton v. Jones, 286 N.W.2d 710, 714 (Minn.1979). We must accept as true all evidence in a light favorable to the adverse party and affirm the order only where (1) in the light of the evidence as a whole, it would clearly be the duty of the trial court to set aside a contrary verdict as being manifestly against the entire evidence, or where (2) it would be contrary to the law applicable to the case. Id., quoting J.N. Sullivan & Associates v. F.D. Chapman Construction Co., 304 Minn. 334, 336, 231 N.W.2d 87, 89 (1975) (footnote omitted). To establish a prima facie case of medical malpractice for negligent treatment, a plaintiff is required to demonstrate (1) the standard of care recognized by the medical community as applicable to the particular defendant's conduct; (2) that the defendant departed from that standard;   (3) that the defendant's departure from that standard was a direct cause of [the patient's] injuries; and (4) damages. Plutshack v. University of Minnesota Hospitals, 316 N.W.2d 1, 5 (Minn.1982). In establishing this prima facie case, the plaintiff must introduce expert testimony to establish the standard of care, the defendant's departure from that standard, and causation, when these issues are not within the common knowledge of laymen. See Smith v. Knowles, 281 N.W.2d 653, 655 (Minn.1979). Expert testimony is crucial to plaintiffs' claim of negligent treatment. Because we uphold the trial court's exclusion of Dr. Greene's testimony, the plaintiffs are left without an expert of their own. Even absent Dr. Greene's testimony, however, plaintiffs argue that the requisite expert testimony is in the record in the form of defendant Dr. Colton's testimony, who was called by plaintiffs as an adverse witness, and in the form of the drug manufacturer's package insert. With regard to Dr. Colton's testimony, a plaintiff in a malpractice action may establish his claim with expert testimony elicited solely from the defendant doctor. See, e.g., Anderson v. Florence, 288 Minn. 351, 360-61, 181 N.W.2d 873, 879 (1970). In reviewing Dr. Colton's testimony, it is evident that, although his testimony may be construed to establish the standard of care, it does not constitute the required expert testimony on departure from the standard or on causation. There simply are no direct admissions to that effect by Dr. Colton, nor can they reasonably be inferred from his testimony. Plaintiffs place considerable reliance upon the drug manufacturer's package insert. In Mulder v. Parke Davis & Co., 288 Minn. 332, 181 N.W.2d 882 (1970), we held that a deviation from a manufacturer's clear and explicit recommendations regarding the use of medication is prima facie evidence of negligence if there is competent medical testimony that [the] patient's injury or death resulted from the doctor's failure to adhere to the recommendations. 288 Minn. at 340, 181 N.W.2d at 887. Assuming the relevancy of the package insert admitted at trial, [4] Dr. Colton did testify that he only estimated blood platelets whereas the package insert advised a direct platelet count, and this evidence might be construed as sufficient to satisfy plaintiffs' burden of production on the issue of defendants' breach of an applicable standard of care. However, the Mulder rule still requires expert testimony to establish that the failure to take a direct platelet count was the direct cause of Mrs. Reinhardt's injuries, for this element of causation cannot be established through the introduction of a package insert. Mulder, 288 Minn. at 339, 181 N.W.2d at 887. Again, the only competent expert testimony in the record is that of one of the defendants, Dr. Colton, and his testimony does not satisfy the causation element of plaintiffs' prima facie case. Accordingly, we hold that it was proper for the trial court to direct the verdict in favor of defendants with respect to plaintiffs' claim of negligent treatment.