Opinion ID: 1452613
Heading Depth: 1
Heading Rank: 3

Heading: The causation evidence

Text: To prevail in a medical malpractice action, the plaintiff must establish the following: (1) that the doctor's conduct departed from the accepted standard of medical care or practice; (2) that the doctor's conduct was both the actual and proximate cause of the plaintiff's injury; and (3) that the plaintiff suffered damages. Perez v. Las Vegas Medical Center, 107 Nev. 1, 4, 805 P.2d 589, 590-91 (1991); Orcutt v. Miller, 95 Nev. 408, 411, 595 P.2d 1191, 1193 (1979). In general, the jury's findings will be affirmed on appeal if they are based upon substantial evidence in the record. Keystone Realty v. Osterhus, 107 Nev. 173, 807 P.2d 1385 (1991); see NRCP 52(a). Substantial evidence has been defined as that which `a reasonable mind might accept as adequate to support a conclusion.' State, Emp. Security v. Hilton Hotels, 102 Nev. 606, 608, 729 P.2d 497, 498 (1986) (quoting Richardson v. Perales, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971)). On appeal, Dr. Prabhu maintains that Ms. Franco failed to establish that he proximately caused her damages. According to him, the expert medical testimony introduced in support of Ms. Franco's claim was insufficient to prove a causal connection between his allegedly negligent failure to diagnose the tumor and Ms. Franco's injuries. The relevant inquiry on appeal is whether Ms. Franco presented competent expert testimony that tended to show, to a reasonable medical probability, that Dr. Prabhu's negligent act or omission caused the injuries or reduced a substantial chance for a more favorable recovery. Perez, 107 Nev. at 6, 805 P.2d at 592; see NRS 41A.100(1). We conclude that Ms. Franco presented substantial evidence that Dr. Prabhu breached the relevant standard of care and reduced her substantial chance for a more favorable recovery. In a medical malpractice case, expert medical testimony may be used to establish the accepted standard of care and any deviation therefrom. NRS 41A.100(1). At trial, Ms. Franco introduced expert testimony that Dr. Prabhu breached the accepted standard of care. Dr. Deppe pointed out that Dr. Prabhu failed to perform a neurologic examination of Ms. Franco and failed to consider any further neurologic workup. Dr. Deppe testified that in light of these omissions, Dr. Prabhu violated the applicable standard of care. Dr. Levine also testified that Dr. Prabhu breached the accepted standard of care because he failed to focus on a neurologic cause for Ms. Franco's symptoms. Although two doctors testified that Dr. Prabhu did not breach the standard of care, it is the jury's province to weigh the experts' credibility. See Robinson v. G.G.C., Inc., 107 Nev. 135, 143, 808 P.2d 522, 527 (1991). Causation in a medical malpractice case may also be proved with expert medical testimony. NRS 41A.100(1); see Perez, 107 Nev. at 6-7, 805 P.2d at 592. Although no direct evidence regarding the tumor's size in February 1982 was available, circumstantial evidence suggested that the tumor was significantly smaller at that time. As outlined above, the experts testified that tumors grow over time and place increasing pressure on the adjoining brain tissue. Dr. Levine testified that the growth of acoustic neuroma tumors over time results in blurred vision and that significant interference with vision does not occur until the tumors are medium sized or larger. Dr. Prabhu testified that Ms. Franco did not complain of vision problems in February 1982, and both Ms. Franco and Dr. Freeman testified that in December 1982 or January 1983, Ms. Franco began developing severe vision problems at close distances. Additionally, Ms. Franco testified that her symptoms grew dramatically worse between February 1982 and July 1983. Dr. Levine also explained that acoustic neuroma patients with tumors of two centimeters or less rarely suffer post-operative paralysis and seldom need additional surgery after the tumor is removed. Additionally, he stated that those patients with small tumors who do suffer post-operative facial paralysis have a better prognosis for recovery than patients with medium or large tumors. During Dr. Levine's testimony, a chapter that he wrote regarding eye care after acoustic neuroma surgery was admitted into evidence. A portion of this chapter mirrored Dr. Levine's testimony about vision problems and tumor size, as well as the prognosis for patients with small tumors and larger tumors. Specifically, the chapter included a summary of statistics regarding acoustic neuroma patients, their preoperative and postoperative symptoms, and correlating tumor sizes (small, medium or large). Dr. Freeman also testified that if a tumor is caught very early, facial nerve paralysis might be avoided. Based upon the information that was presented at trial, we conclude that the jury was presented with substantial evidence from which it could find that Dr. Prabhu breached the standard of care and that this breach reduced Ms. Franco's substantial chance for a more favorable recovery.