Opinion ID: 2562586
Heading Depth: 4
Heading Rank: 2

Heading: Hertz's medical malpractice claims

Text: The superior court granted summary judgment in favor of the defendants on Hertz's medical malpractice claims after concluding that Hertz had failed to supply expert testimony necessary to carry his burden of proof. Hertz argues this conclusion was erroneous for two reasons. Hertz first contends that he did produce expert testimony: the DOC Medical Advisory Committee's response to his grievance appeal of August 14, 2006, in which the Committee observed that Hertz's decayed tooth had been extracted by a contract dentist, his upper partial denture fit correctly and needed no further adjustments, and he had been transferred to an Anchorage correctional facility where [a] new treatment plan involving extractions and a full denture has been proposed. Although Hertz argues this response is expert testimony sufficient to rebut Dr. Morrow's opinion, it is not  it does not describe the standard of care ordinarily exercised by dentists under similar circumstances, nor does it assert that the defendants fell below this standard. Although the Committee acknowledged a new course of treatment for Hertz, that acknowledgment was not expert opinion that the old course of treatment was negligent. [27] The grievance response does not carry Hertz's burden of proof in his medical malpractice claims. [28] Hertz next contends that the superior court erred in requiring expert testimony because his claim falls within a narrow exception to the expert testimony requirement: the negligence here is clear enough, he argues, that it is evident to a layperson even without the aid of expert testimony. In medical malpractice actions. . . the jury ordinarily may find a breach of a professional duty only on the basis of expert testimony. [29] But we have recognized an exception: expert testimony is not needed in non-technical situations where negligence is evident to lay people. [30] In a medical malpractice action by a prisoner against DOC medical personnel, we recently drew a distinction between actions that involve professional judgment or skill and those that do not: Most of the [plaintiffs'] contentions involved treatment decisions, prescriptions, or other medical issues that are arguably technical; if so, they must be supported by expert evidence. But some of the allegations could possibly fall into the `non-technical' category, such as the failure to provide medication and adequate access to licensed physicians.[ [31] ] Whether Hertz's claims require the support of expert testimony depends on whether the actions from which they arise involve specialized medical care, skill, or judgment.
Hertz argues Beach and Hawkins committed malpractice in two ways: in failing to provide him treatment themselves and in delaying his treatment with Dr. Anderson. The superior court granted summary judgment in favor of Beach and Hawkins because Hertz failed to supply expert testimony to support his claims. [32] Nurses are health care providers under the medical malpractice statutes, including the expert testimony requirements of AS 09.55.540. [33] To show that Beach and Hawkins committed malpractice in failing to treat him themselves, Hertz needed to provide expert evidence showing negligence. He did not. As to his delayed treatment, Hertz does not deny that Hawkins and Beach placed his name on the dental list when he complained of his loose-fitting denture or his decayed tooth. The nurses communicated names and conditions to a dentist, Dr. Anderson, to determine the course and treatment priority for Hertz and other inmates on the list. Hertz acknowledges that Beach alerted a doctor and gave him pain relievers after he informed Beach that his decayed tooth was causing severe pain. Assuming the nurses actually had or exercised the authority to make prioritization recommendations to Dr. Anderson, whether they were negligent in not prioritizing Hertz's dental needs over those of other inmatesa medical judgment is a question the ordinary layperson cannot answer without expert evidence describing the standard of care required of nurses under the circumstances. Hertz supplied no such evidence. We therefore affirm the superior court's grant of summary judgment in favor of the nurses on Hertz's medical malpractice claims.
Hertz's pleadings suggest four separate malpractice claims against Dr. Anderson: (1) the delay in replacing his partial denture between April 28, 2005, and April 8, 2006; (2) the delay in adjusting his new partial denture between April 8, 2006, and September 12, 2006; (3) the overall approach to treating Hertz's longstanding periodontal disease between April 2005 and September 2006; and (4) the delay in treating the decayed tooth, which was ultimately extracted on July 27, 2006. The actions underlying the latter three claims of malpractice all required expert evidence. Dr. Anderson gave Hertz his new partial denture and adjusted it on April 8, 2006. Although Hertz complained the new partial denture was loose, both Dr. Logan, who examined Hertz in July 2006, and Dr. Morrow, who examined him in September 2006, believed that the denture was properly fitted and there were no adjustments that would improve its function. Whether the partial denture needed to be adjusted and whether Dr. Anderson's failure to do so was negligent are questions of medical judgment that a layperson is ill-equipped to evaluate. To avoid summary judgment Hertz needed to produce expert opinion evidence disputing Dr. Morrow's opinion that Dr. Anderson met the standard of care; when Hertz did not, it was not error to grant summary judgment in Dr. Anderson's favor. Hertz's theory that Dr. Anderson's overall approach to treating Hertz's periodontal disease replacing and adjusting the partial denture as necessarywas negligent also required supporting expert evidence. The proper course of treatment for periodontal disease is a matter of professional judgment; laypeople are not ordinarily equipped with the knowledge to second-guess a dentist's approach. Hertz suggests that the more aggressive treatment ultimately proposed by Drs. Logan and Morrowextracting Hertz's remaining teeth and constructing a full denture implies Dr. Anderson's approach was inadequate. That these dentists opted for one approach, however, does not establish that Dr. Anderson's approach fell below the standard of care required of dentists under the circumstances. [34] More than one approach may meet the applicable standard of care; without testimony describing that standard, the ordinary layperson would not know whether Dr. Anderson's approach fell below it. When Hertz failed to produce expert evidence to support this claim, it was not error to grant summary judgment in Dr. Anderson's favor. Finally, Hertz's claim that the treatment of his decayed tooth amounted to malpractice also required supporting expert evidence to survive summary judgment. Dr. Anderson first examined the decay on April 8, 2006. He described the cavity as small and non-acute, and in [his] professional and clinical judgment, the cavity was not an urgent matter nor did it take priority over other inmates with more acute and urgent dental needs. Dr. Anderson's April 8 diagnosis, his decision to postpone treatment, and his decision to prioritize other inmates' needs all involved the exercise of medical judgment and skill; Hertz needed expert evidence to show those decisions were negligent. When Hertz failed to produce expert evidence, it was not error to grant summary judgment in Dr. Anderson's favor. When all inferences are drawn in Hertz's favor the delay of almost a year in replacing his upper partial denture may not have been due entirely to the exercise of Dr. Anderson's professional judgment. Hertz began requesting a new denture in April 2005 after two of his teeth had been extracted. Dr. Anderson made an impression of Hertz's teeth on September 17, 2005, and sent it to the laboratory. Dr. Anderson stated that he was unable to treat inmates from mid-October 2005 to mid-December 2005 because the Lemon Creek dental facility was out of commission at that time. He then explained that, due to the resulting backlog of inmates with more urgent dental needs, he was unable to see Hertz until February 11, 2006. Although there is nothing in the record to indicate whether Dr. Anderson had a new upper partial denture ready to install that day, Hertz's teeth had shifted during the interim, so Dr. Anderson made a new impression. Dr. Anderson delivered the new upper partial denture to Hertz on April 8, 2006. Hertz asserts that the Lemon Creek dental facility was not out of commission in the fall of 2005, but rather from June to September 2005, before his impression was taken. If true, this statement calls into doubt Dr. Anderson's assertion that his failure to treat Hertz between September 2005 and February 2006 was due to closure of the facility and to his subsequent professional judgment about whom to treat first. Without knowing whether the months-long wait resulted from the lack of an appropriate facility or appropriate staffing, from Dr. Anderson's professional judgment regarding Hertz's needs relative to those of other inmates, or from some other factor, we cannot determine whether expert evidence is necessary to evaluate Dr. Anderson's actions. On the current record, it was error to grant summary judgment for lack of expert evidence on this particular malpractice claim. [35] We affirm the grant of summary judgment on Hertz's malpractice claims against Dr. Anderson, except for the claim arising from the year-long delay in replacing his denture. We remand that claim to the superior court for further proceedings.