Opinion ID: 1164262
Heading Depth: 1
Heading Rank: 2

Heading: expert evidence in opposition to motion for summary judgment

Text: Having determined that the affidavits offered by appellant were properly refused by the trial court, it is now necessary to determine if the evidence contained in the appellant's deposition and the affidavits of appellees was sufficient to establish an issue of material fact. Appellant stated in his deposition that the deceased was not fed while in the hospital and that a gastrostomy tube was inserted incorrectly, causing a condition that led to the death of Mrs. Harris. Appellant further contends that some appellee expert witnesses stated that the cause of death was pneumonia, while other appellee expert witnesses specified a different cause of death. Appellant contends that statements in his deposition and the doctors' different opinions in their affidavits as to the cause of death establish a question of fact sufficient to defeat appellees' motions for summary judgment. Such an argument ignores, among other things, the fact that appellant has failed to establish a causal connection between appellees' actions and decedent's death. We held in Keller v. Anderson, supra, that a showing of injury, the treatment provided, and the fact of the loss are insufficient to defeat a motion for summary judgment. In Keller there was no admissible medical testimony to show that the treatment was the cause of the plaintiff's injury. We said,    The problem is not of a nature which lends itself to solving through non-professional inquiry. For all we know, the leg would have been lost no matter what kind of care the patient received. We cannot guess about such matters. We are not doctors. Keller v. Anderson, supra, at 1261. In order to defeat a motion for summary judgment in a medical malpractice action, a plaintiff:    has the obligation to establish (1) the accepted standard of medical care or practice, (2) that the doctor's conduct departed from the standard, and (3) that his conduct was the legal cause of the injuries suffered. Orcutt v. Miller, Nev., 595 P.2d 1191, 1193 (1979). Appellant has wholly failed to establish these things by admissible medical testimony. Appellant, in the present case, attempts to avoid the general rules of Keller and Orcutt by saying that the facts fit the exception set forth in Stundon v. Stadnik, Wyo., 469 P.2d 16 (1970). In that case we held, The basis for departing from the normal rule that a standard of care must be provided by expert medical testimony arises where asserted negligence consists of conduct so obviously wanting in reasonable medical skill and prudence that it may be so adjudged even by laymen. Stundon v. Stadnik, id. at 22. Appellant has misconceived the exception in Stundon. First, appellant fails to show that the present situation is one in which a layperson is competent to determine that the conduct is so wanting in reasonable medical skill and care that medical testimony is not needed. Second, appellant's testimony in his deposition is not based on first-hand observation, nor does it show a lack of the requisite care or treatment. Third, even if this situation were one in which a layperson could testify, the appellant fails to draw the requisite causal connection between the acts alleged and the death of Mrs. Harris. One of appellant's complaints is that the gastrostomy tube was incorrectly inserted. Expert testimony is necessary to support a complaint of this type. Appellant, as a layperson without any special training in the areas complained of, is not competent to show that conduct by appellees in regard to the insertion of gastrostomy tubes, in the scheduling of feeding or other treatment and care is so wanting in reasonable medical skill that no expert testimony is needed. The Supreme Court of Nevada in Bialer v. St. Mary's Hospital, 83 Nev. 241, 427 P.2d 957 (1967), stated that expert testimony is necessary when injections are administered by a nurse:    Further, it cannot be said that the full spectrum of possible consequences from the giving of a shot are within the layman's common knowledge. At least a minimum showing by expert testimony is required that some variance from the recognized standard of care proximately caused the injury. [Citation.] Unforeseen and undesirable reactions from an injection can result from a number of causes other than negligence; for example, the emotions and allergies of the patient, the manner in which the injection was given (though not amounting to negligence), the internal condition of the patient before or after an operation, and perhaps others. Bialer v. St. Mary's Hospital, id. at 958-959. The rule in Bialer requiring expert testimony is applicable to the case at hand. Expert testimony is necessary to establish that the gastrostomy tube was inserted incorrectly. It is well settled that in all but the extraordinary medical malpractice case, the plaintiff has the burden of producing expert testimony to support a prima facie case of negligence. If the origin of the injury is obscure and not readily apparent to a layman, or if there are several equally probable causes of the condition, testimony of a qualified physician is essential to establish a reasonable probability that the physician's negligence caused the injury. This is such a case. Appellant's deposition is not competent to show that the insertion of the gastrostomy tube was done incorrectly. The only competent evidence before the court, based upon personal knowledge, is found in the affidavits of Doctors Sharp, Grizzle, Flick, and Hunton. Doctors Sharp and Grizzle cared for, treated and observed plaintiff's decedent during her hospitalization from May 17, 1976, to June 12, 1976. Dr. Sharp stated that for this period, the treatment and attendance of plaintiff's decedent was performed with that degree of care, skill and learning ordinarily possessed and exercised by hospitals throughout the United States. Dr. Hunton stated that the nutrition prescribed for plaintiff's decedent was proper, and her management, care and treatment met or exceeded the standard of care and skill ordinarily exercised by hospitals in these circumstances. Doctors Sharp, Grizzle and Flick personally observed the decedent during the period involved. Their sworn statements are the only competent evidence before the court concerning the gastrostomy tube and indicate that it was properly inserted. The evidence is undisputed and must be accepted. A physician or surgeon is presumed to have carefully and skillfully treated or operated upon a patient. Moreover, there can be no presumption of negligence from the mere fact of an injury or adverse result. Expert testimony is ordinarily required to establish negligence or a lack of reasonable care on the part of a physician in his performance of surgical procedures and in the care and treatment of his patients. Crowley v. O'Neil, 4 Kan. App.2d 491, 609 P.2d 198, 201, 202 (1980). The answers in Mr. Harris' deposition are not based on personal observation or knowledge and are inadmissible to show the care received by decedent or the cause of her physical condition. Mr. Harris' statements regarding the nurses' failure to feed his wife are based on other people's comments to him and are inadmissible as hearsay. Mr. Harris' deposition also fails to contain a first-hand recounting of any improper insertion of the gastrostomy tube.