Court Opinion

ID: 9910881
Source: CourtListenerOpinion
Date Created: 2023-12-18 19:01:05.095347+00
Date Added: 2024-06-11T12:54:47.689192
License: Public Domain

NOT FOR PUBLICATION                           FILED
                    UNITED STATES COURT OF APPEALS                       DEC 18 2023
                                                                      MOLLY C. DWYER, CLERK
                                                                       U.S. COURT OF APPEALS
                           FOR THE NINTH CIRCUIT

ANAND RATHOD; AESHA RATHOD;                     No.    22-36045
JOSHUA BROTHERS, as Guardian ad
Litem for minor P.R.,                           D.C. No. 2:20-cv-00064-RSL

                Plaintiffs-Appellants,
                                                MEMORANDUM*
 v.

UNITED STATES OF AMERICA,

                Defendant-Appellee,

and

PROVIDENCE HEALTH & SERVICES,
DBA Providence Hospital of Everett, DBA
Providence Regional Medical Center Everett,
a Washington corporation; DANA
BLACKHAM, MD; OBSTETRIX
MEDICAL GROUP OF WASHINGTON,
INC. PS; DOES, John/Jane 1-50,

                Defendants.

                   Appeal from the United States District Court
                     for the Western District of Washington
                    Robert S. Lasnik, District Judge, Presiding

                     Argued and Submitted December 4, 2023
                              Seattle, Washington

      *
             This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
Before: N.R. SMITH, SANCHEZ, and MENDOZA, Circuit Judges.

      Anand Rathod, Aesha Rathod, and Joshua Brothers, Guardian ad Litem for

the Rathods’ child P.R. (collectively, “Rathods”) appeal the district court’s grant of

summary judgment in favor of the United States1 on the Rathods’ medical

negligence claim related to the birth of P.R. in 2017. We have jurisdiction under

28 U.S.C. § 1291. Reviewing the district court’s grant of summary judgment de

novo, see United States v. City of Tacoma, 332 F.3d 574, 578 (9th Cir. 2003), we

affirm.

      Summary judgment is appropriate where “the movant shows that there is no

genuine dispute as to any material fact.” Fed. R. Civ. P. 56(a). “A moving party

without the ultimate burden of persuasion at trial . . . has both the initial burden of

production and the ultimate burden of persuasion on a motion for summary

judgment.” Nissan Fire & Marine Ins. Co., Ltd., v. Fritz Cos. Inc., 210 F.3d 1099,

1102 (9th Cir. 2000). Where, as here, a moving party without the ultimate burden

at trial satisfies its initial burden, “the nonmoving party must produce evidence to

support its claim or defense.” Id. at 1103. “If the nonmoving party fails to

produce enough evidence to create a genuine issue of material fact, the moving

party wins the motion for summary judgment.” Id.

1
 In March 2020, the United States substituted itself as a defendant for Dr. Amy
Rodriguez, Ms. Rathod’s family medicine doctor who provided prenatal and
obstetrics care, pursuant to 28 U.S.C. § 2679(d)(1) and 42 U.S.C. § 233.

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      In a Federal Tort Claims Act case like this one, we apply the substantive law

of the state in which the alleged tort occurred. Conrad v. United States, 447 F.3d

760, 767 (9th Cir. 2006); Tekle v. United States, 511 F.3d 839, 853 (9th Cir. 2007)

(collecting cases). The alleged medical negligence at issue here took place in

Washington. The elements of medical negligence under Washington law are

“duty, breach, causation, and damages.” Colwell v. Holy Fam. Hosp., 104 Wash.

App. 606, 611 (2001).

      Under Washington law, the Rathods were required to submit expert medical

evidence on causation because the intricacies of labor, delivery, and hypoxic-

ischemic encephalopathy (“HIE”) are not commonly known. Frausto v. Yakima

HMA, LLC, 188 Wash. 2d 227, 232 (2017) (“[E]xpert testimony is always required

except in those few situations where understanding causation does not require

technical medical expertise.” (internal quotation marks omitted)). Medical expert

testimony “must be based upon a reasonable degree of medical certainty,” “must

rise above speculation, conjecture, or mere possibility,” Reese v. Stroh, 128 Wash.

2d 300, 309 (1995) (internal citations and quotation marks omitted), and “must at

least be sufficiently definite to establish that the act complained of ‘probably’ or

‘more likely than not’ caused the subsequent disability,” O’Donoghue v. Riggs, 73

Wash. 2d 814, 824 (1968). Summary judgment is appropriate where a plaintiff’s

expert fails to identify specific facts in support of a causation analysis. See Guile

                                           3
v. Ballard Cmty. Hosp., 70 Wash. App. 18, 25 (1993); Rounds v. Nellcor Puritan

Bennett, Inc., 147 Wash. App. 155, 164-65 (2008).

       The district court held that the Rathods’ medical expert, Dr. Harold

Zimmer, did not offer reliable expert testimony on causation sufficient to create a

genuine dispute of material fact. Dr. Zimmer testified that Dr. Rodriguez’s failure

to consult an obstetrician or order a cesarean delivery following certain worrisome

fetal heartrate tracings fell below the standard of care and was the proximate cause

of P.R.’s HIE. The district court properly concluded that Dr. Zimmer’s declaration

was insufficient to raise a triable issue as to causation. Dr. Zimmer’s causation

analysis was premised on P.R.’s fetal heartrate tracings during labor, which he

admitted cannot show that a brain injury is occurring. Dr. Zimmer acknowledged

that infants with worrisome tracings can be born without neurological deficits, and

infants with unremarkable tracings can be born with neurological deficits. Dr.

Zimmer failed to identify specific medical evidence demonstrating how Dr.

Rodriguez’s conduct proximately caused P.R.’s brain injury to a “reasonable

degree of medical certainty.” See Reese, 128 Wash. 2d at 309.

      Dr. Zimmer made several concessions that undermine his causation analysis.

Dr. Zimmer conceded that he only performed a prospective analysis “to anticipate

what injury might occur on the basis of that injury—or on the basis of that

tracing,” leaving to other physicians to “look[] backward [] to determine what

                                          4
might have caused the injury” (emphasis added). Dr. Zimmer also conceded that

he did not engage in an analysis of the guideline factors promulgated by the

American College of Obstetricians and Gynecologists (ACOG) to determine

causation. Under the ACOG factors, causation of early-onset brain injury “can be

derived from a comprehensive evaluation of all potential contributing factors,”

including fetal heartrate monitoring. The ACOG factors establish that one factor

alone cannot support a causation finding, and Dr. Zimmer conceded that he did not

review other ACOG factors, including P.R.’s magnetic resonance imaging.

      Dr. Zimmer’s concessions, coupled with his conclusory statements on

causation, cannot defeat a motion for summary judgment. See Arpin v. Santa

Clara Valley Transp. Agency, 261 F.3d 912, 922 (9th Cir. 2001) (“[C]onclusory

allegations unsupported by factual data are insufficient to defeat. . . [a] summary

judgment motion.”); Guile, 70 Wash. App. at 25-26 (affirming a grant of summary

judgment because the expert affidavit “failed to identify specific facts supporting

his conclusion”). Viewing the facts in the light most favorable to the Rathods, Dr.

Zimmer’s expert testimony does not support the inference that Dr. Rodriguez’s

interpretation of the tracings, which do not show the onset of injury, more likely

than not caused P.R.’s HIE.

      Regarding P.R.’s spinal cord injury and Ms. Rathod’s perineal tear resulting

from a forceps delivery by another doctor, the Rathods failed to raise a triable issue

                                          5
of fact connecting Dr. Rodriguez’s actions to these injuries. Dr. Zimmer conceded

that “Dr. Rodriguez did not cause the spinal cord injury.” Dr. Zimmer also

confirmed that his expert report did not discuss Ms. Rathod’s perineal tear, and he

testified that he was not offering an opinion that Dr. Rodriguez was responsible for

the tear. These two concessions, coupled with the absence of any evidence to the

contrary, support the grant of summary judgment.2

      AFFIRMED.

2
 Because summary judgment is affirmed on proximate causation grounds, we do
not reach the parties’ additional arguments.

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