Opinion ID: 1955029
Heading Depth: 1
Heading Rank: 3

Heading: Dr Kanaga's Motion for a Directed Verdict

Text: At the close of the Russells' case, and again at the close of all the evidence, Dr. Kanaga's attorney moved for a directed verdict. The grounds for the motion, among others, were that the Russells failed to introduce expert testimony that Dr. Kanaga deviated from the standard of care and, alternatively that the Russells failed to introduce any expert testimony that Mrs. Russell's injuries were proximately caused by the alleged malpractice. Dr. Kanaga's motion for a directed verdict was denied on both occasions. On appeal from the Superior Court's denial of a motion for a directed verdict, the standard of review is whether the evidence and all reasonable inferences that can be drawn therefrom, taken in the light most favorable to the nonmoving party, raise an issue of material fact for consideration by the jury. Moody v. Nationwide Mut. Ins. Co., Del.Supr., 549 A.2d 291, 294 (1988); Law v. Gallegher, Del. Supr., 197 A. 479 (1938). Applying that test to the circumstances presented here, we find the record does not support the Superior Court's conclusion that there was a material issue of fact as to whether Dr. Kanaga negligently performed the surgery and caused the symptoms complained of by Mrs. Russell. The record reflects that Dr. Spence, one of the Russells' experts, did opine that Mrs. Russell's problems were the result of adhesions. However, Dr. Spence also stated that it is not medical negligence to cause adhesions, since all surgery leaves adhesions, which are the result of the human body's natural healing process. [14] Dr. Bartlett, another of Mrs. Russell's treating physicians, testified that he was unable to find a nexus between Mrs. Russell's problems and the surgery performed on her by Dr. Kanaga. Dr. Bartlett, who is chief of infectious diseases at Johns Hopkins Hospital and was in charge of Mrs. Russell's care at that medical institution, testified, in part: Q. Have you ever formed an impression as to whether Mrs. Russell's current problems, at least the ones when presented to you with, were causally related to her surgery performed by Doctor Kanaga? A. Well, I never was impressed that there was an identifiable cause of pain. That is why we call it pain of unknown etiology. And I certainly was not able to say it was due to the surgery that had been performed, nor were we ever able to find any organic cause of the pain. . . . . Q. And for the last time, then, as I understand it, you have been unable to link her current complaints or the complaints she was having when you saw her with the surgery performed by Doctor Kanaga? A. That is correct. We  as far as I know, we did every test that is feasible for describing the etiology of pain. She had a diagnostic evaluation that, in my view, is unparalleled. In fact, we may have gone overboard, I think in part because she kept coming back and presenting with what she perceived as such severe pain. But in the process of doing that, we could never identify a specific etiology nor could we come up with a beneficial plan of her therapy. Q. Did any of these battery of tests which you had performed on Mrs. Russell point to the surgery performed by Doctor Kanaga? A. No. The need for expert medical testimony upon which to posit liability in a medical malpractice action had been clearly established under Delaware case law prior to the [enactment of the Act]. Robinson v. Mroz, 433 A.2d at 1056 (citing Christian v. Wilmington Gen. Hosp. Ass'n., Del.Supr., 135 A.2d 727 (1957); Peters v. Gelb, Del. Supr., 314 A.2d 901 (1973)). However, [t]he Act particularized the need for expert medical testimony and defined those cases in which a rebuttable inference of negligence could arise without it. Id. at 1057. According to the mandate of the Act [no] liability shall be based upon asserted negligence unless expert medical testimony is presented as to [ both ] the alleged deviation from the applicable standard of care in the specific circumstances of the case and as to the causation of the alleged personal injury. 18 Del.C. § 6853 (emphasis added). See Wahle v. Medical Center of Delaware, Inc., Del.Supr., 559 A.2d 1228, 1231 (1989). In their complaint, the Russells alleged that Dr. Kanaga committed medical negligence by suturing Mrs. Russell's bladder to her colon. In their answering brief in this Court, the Russells stated [a]lthough it is true that no expert medical witness ever stated directly that there was a reasonable medical probability that Dr. Kanaga sutured Mrs. Russell's bladder to her colon, there can be little question but that the expert medical testimony that was presented to the jury was sufficient to permit the jury to infer that Dr. Kanaga did just that. The Russells rely upon Strauss v. Biggs, Del.Supr., 525 A.2d 992 (1987). Strauss does not support the Russells' position. In Strauss, this Court specifically recognized the requirements for expert medical testimony set forth in the Act and found that [t]here was expert testimony indicating that Dr. Strauss' failure to perform the [operative procedure] deviated from the applicable standard of care. Id. at 997. The Russells failed to produce any expert testimony that Dr. Kanaga deviated from the applicable standard of care. A fortiori, the Russells were unable to produce any expert testimony that Mrs. Russell's pain was caused through the medical negligence of Dr. Kanaga. In the absence of such expert medical testimony, or the applicability of an exception to that requirement, the Superior Court erred, as a matter of law, in not granting Dr. Kanaga's motion for a directed verdict. 18 Del.C. § 6853. [15]