Court Opinion

ID: 9686352
Source: CourtListenerOpinion
Date Created: 2023-08-24 15:44:14.510111+00
Date Added: 2024-06-11T09:49:00.536019
License: Public Domain

GILBERT, Justice
(concurring in part and dissenting in part).
I concur with the majority’s conclusion in regard to the dismissal of appellant PREF, but respectfully dissent as to the remainder of the opinion. This case involves serious allegations of medical malpractice that caused the death of a 14-year-old boy. The undisputed cause of his decreased respiratory state leading to his respiratory arrest was morphine toxicity. It is undisputed that an accurate and timely medical diagnosis of Thad Roddy’s deteriorating medical condition was required, along with the administration of appropriate medication in this hospital setting. However, whether the treating physician erroneously diagnosed and treated Roddy in a timely fashion when time was of the essence is disputed. Under these facts, there is a genuine issue of fact as to the applicable standard of care, the violation of that standard, and the chain of causation between the violation of that standard and Roddy’s death.
As the majority opinion points out, Minn.Stat. § 145.682 was adopted to eliminate nuisance medical malpractice suits. Stroud, 556 N.W.2d at 555. However, the majority fails to label this case as a nuisance suit. The obvious reason for this failure is that the facts of this case do not warrant such a label. First, in regard to the initial affidavit that an attorney must serve with the summons and complaint, appellants do not dispute nor does the majority opinion take issue with the suffi-*432eieney of that affidavit. The attorney affidavit requires a statement under oath that the facts of the case have been reviewed by the plaintiffs attorney with a medical expert whose qualifications provided a reasonable expectation that the expert’s opinion could be admissible at trial and in the opinion of the expert the defendant’s deviation from the applicable standard of care caused injury to the plaintiff. Minn. Stat. § 145.682, subd. 3. The respondent submitted an affidavit conforming to these requirements that was signed by an experienced attorney who has successfully practiced medical malpractice law for over two decades. The expert that this attorney consulted with has impeccable credentials and has served as the medical director of the pediatric intensive care unit of the University of Wisconsin Children’s Hospital at Madison, Wisconsin from 1982 until at least 1998, when this litigation commenced. Additionally, he is board certified in pediatrics and pediatric critical care and has held numerous teaching positions and is a nationally renowned expert in both pediatric care and pediatric critical care. The facts of this case, coupled with the sworn affidavit of an attorney as an officer of the court, not only demonstrate that this case is not a nuisance case or frivolous in any sense, but in fact has substantial merit.
So why did the district court summarily dismiss this legitimate cause of action, with prejudice, on the merits before trial? The answer lies in a combination of errors in the district court’s analysis and the standards used to adjudicate disputed facts in this pretrial context. The district court ruled that this eminently qualified physician was not only not qualified to render an opinion in this case, but even if he was, his sworn affidavit failed to meet the substantive requirements of section 145.682, subd. 4. Even though this involves a motion to dismiss, rather than a summary judgment motion, the district court not only used the summary judgment standard in its analysis in “[vjiewing the evidence in the light most favorable to the [pjlaintiff,” but considered evidence beyond the pleadings and the expert affidavit and ignored our precedent in how to adjudicate issues of disputed facts in a summary judgment context.
In a summary judgment motion, a court may not weigh the evidence or make factual determinations, but is required to view the evidence in the light most favorable to the nonmoving party. Fairview Hosp. and Health Care Servs. v. St. Paul Fire & Marine Ins. Co., 535 N.W.2d 337, 341 (Minn.1995). Here, the district court not only weighed the evidence, but also made an ultimate factual determination that there were additional risks related to the treatment of bone marrow transplant patients that would be unfamiliar to Dr. Per-loff, because he allegedly did not have “any practical or clinical experience in diagnosing or treating bone marrow transplant patients.” However, there is absolutely no evidence in the record that indicates whether or not Dr. Perloff had such experience or that supports the district court’s reasoning that morphine toxicity is treated any differently when dealing with a bone marrow transplant patient rather than any other type of patient. Appellants did not submit any sworn testimony of other independent medical experts that would support that contention. Even if they had, it would have been inappropriate for the court to consider such evidence because dismissal under section 145.682, subd. 6, is based on failure to comply with the disclosure requirements of the statute, not weighing the disclosures against other evidence. Furthermore, as to the ultimate issue of the sufficiency of the affidavit actually submitted, the court implicitly found that instant diagnosis and treatment *433was not possible even though there is again no evidence in the record that would support that this conclusion or, alternatively, at a minimum there is disputed evidence on that issue because Dr. Blazar and Dr. Weigel seemed to instantly recognize it — albeit too late.
If there was any question as to Dr. Perloffs qualifications at this stage in the case, that should go to the weight of his testimony rather than the admissibility. See Ruether v. State, 455 N.W.2d 475, 477 (Minn.1990). In its reasoning, the district court imported language from subdivision 3 relating to the required attorney affidavit and confused the standards set out in subdivision 4 with those of subdivision 3. Compare Minn.Stat. § 145.682, subd. 3 with Minn.Stat. § 145.682, subd. 4. Not only did the district court confuse the language of these two subdivisions, its ultimate foundational determination as to Dr. Perloff cannot be justified even if the subdivision 3 language were used. Specifically, if the subdivision 3 language were imported into subdivision 4, then the subdivision 4 affidavit would have to be submitted by “an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial.” Minn.Stat. § 145.682, subd. 3 (emphasis added). This language clearly indicates that a final foundational determination for the expert’s opinion should occur at trial. Otherwise, the phrase “could be admissible at trial” becomes meaningless. Dr. Perloffs qualifications surely provide a reasonable expectation that his opinion could be admissible at trial. It is troubling that the majority fails to recognize this and instead concludes that district court correctly concluded that section 145.682 requires a final foundational determination at this stage of the litigation. What is even more troubling is that the majority fails to recognize that the district court still ordered dismissal after acknowledging that the statement in Dr. Perloffs first affidavit sufficiently specified two acts and omissions of the appellants that fell below the appropriate standard of care: timely recognition of morphine toxicity and administering Nubain instead of Nar-can.
If Dr. Perloffs qualifications were viewed in the proper context of a motion to dismiss, Dr. Perloff is eminently qualified to render an opinion. Section 145.682 is silent as to the qualifications required of an expert signing the expert affidavit and appellants have not contested the attorney affidavit, which merely requires that an attorney review the case with “an expert whose qualifications provide a reasonable expectation that the expert’s opinions could be admissible at trial.” Minn.Stat. § 145.682, subd. 3. The expert does not even have to be identified at this stage, provide any details of the expert’s opinion or even have to be called at trial.
Furthermore, subdivision 4 does not require the expert affidavit to include all of the information relevant to the expert’s opinion such that the district court can make a final, definitive holding on whether the expert identified in the affidavit will be qualified to offer admissible testimony at trial. As we have recognized, “the most important disclosure of the affidavit required by [subdivision 4] is the identity of an expert who is willing to testify as to the alleged negligence.” Sorenson, 457 N.W.2d at 191 (emphasis in original).
It is ironic that the majority affirms the district court even though the district court placed great reliance upon the testimony of two other treating physicians that appear to have similar if not identical qualifications as to those of Dr. Perloff. First of all, Dr. Kenneth Tegtmeyer is a fellow in pediatric intensive care employed by the *434University of Minnesota and he was the first physician consulted by Dr. Wetmore when Roddy’s condition deteriorated. There is nothing in the record indicating that Dr. Tegtmeyer had any more training than Dr. Perloff or that he had any more special expertise in bone marrow transplants than Dr. Perloff did. Similarly, Dr. Wetmore testified that she also called Dr. Michael Shannon, who was an attending physician in the pediatric intensive care unit. Again, Dr. Shannon appears to have similar, if not identical qualifications, to those of Dr. Perloff. Instead of speaking with Dr. Shannon, Dr. Wetmore ended up speaking with Dr. Tegtmeyer, asking for his advice because she believed him to be “a very experienced, knowledgeable fellow whom [she] respected.” The district court elevated the expertise of Dr. Shannon and Dr. Tegtmeyer because they “performed daily rounds on the bone marrow transplant unit.” However, there is nothing in the record that supports the district court’s conclusion that either the “daily rounds” in the bone marrow transplant unit would provide any specialized knowledge of how to treat morphine toxicity or that morphine toxicity in this context would be treated any differently than in any other context. Dr. Perloff was at least as qualified to render an opinion on the diagnosis and treatment of morphine toxicity in this situation as Dr. Shannon and Dr. Tegtmeyer.
It also does not appear to be disputed that the proper medication that should have been administered was Narcan, rather than Nubain. Dr. Perloff rendered an opinion in that regard that was identical to the opinion of Dr. Blazar and Dr. Weigel, who in fact were the two treating physicians specializing in pediatric critical care and ordered the first dose of Narcan immediately after assessing Roddy’s condition.
The majority opinion glosses over these numerous errors in reversing the court of appeals and affirming the district court’s dismissal. While expanding the district court’s considerable discretion to determine whether an expert has the necessary qualifications, which is normally resolved in the context of a trial, the majority ignores the obvious mistakes the district court made in using language from subdivision 3 to justify dismissal based on the expert affidavit required under subdivision 4 and in using summary judgment reasoning to come to an inapposite conclusion. At the same time, the majority takes time to criticize the language from the court of appeals on notice and sneak preview of the expert’s testimony and instead creates more stringent requirements than this “unambiguous” statute, Lindberg, 599 N.W.2d at 577, was ever designed to implement.
We have never held that the statute’s purpose is to replace or alter our rules of evidence or to require plaintiffs to provide foundation for district courts to finally determine that the expert submitting the expert affidavit will in fact be qualified to offer admissible expert testimony at trial pursuant to our rules of evidence. See Minn. R. Evid. 702-705. There is simply no support in the plain language of section 145.682 for the majority’s contention that ultimate foundation determinations at this stage of the litigation are necessary for the elimination of nuisance medical malpractice claims. Rather, “[t]he procedural dismissal mandated by section 145.682, subdivision 6 seems * * * to have been designed to deal only with cases completely unsupported by expert testimony.” Sor-enson, 457 N.W.2d at 191 (emphasis added). Therefore, the focus should be on whether it is reasonable for the plaintiff to expect to call the expert witness identified in the expert affidavit at trial. Here, it was clearly reasonable for respondent to *435expect to call Dr. Perloff as an expert witness as to causation.
The majority also concludes that Dr. Perloffs affidavit failed to meet the substantive requirements of section 145.682 as to the University of Minnesota. Contrary to the majority’s conclusion, Dr. Perloffs first affidavit can be readily distinguished from those affidavits that we have held insufficiently outlined the chain of causation. This affidavit, unlike the “empty conclusions” of the expert affidavit in Sor-enson, contained much more than mere assertions that the University of Minnesota doctors failed to properly evaluate, diagnose, or treat Roddy. It definitively states what these doctors failed to diagnose (morphine toxicity), what these doctors should have done (administer frequent boluses or a continuous infusion of naloxone), and why their failure to take these steps resulted in Roddy not reviving, which ultimately led to Roddy dying.
Similarly, unlike the expert affidavit in Stroud, which simply opined that the delay in diagnosis caused a complicated hospital stay, Dr. Perloffs first affidavit explicitly stated that Roddy’s death was directly connected to the University of Minnesota doctors’ departures from the acceptable level of care. Contrary to the majority’s contention, this affidavit is not remarkably similar to the one we considered in Stroud. Unlike the affidavit in Stroud, which did not provide any explanation of how the defendant’s conduct led to the decedent’s death, Dr. Perloffs affidavit describes in detail how the University of Minnesota’s failure to timely administer Narcan led to Roddy not reviving and ultimately dying.
Additionally, unlike the expert affidavit in Lindberg, Dr. Perloffs first affidavit stated the standard of care, indicated how the University of Minnesota doctors departed from it, and connected Roddy’s death to the alleged departure. Dr. Per-loffs affidavit definitively stated, “[T]he departures from accepted levels of care, as above identified, were a direct cause of Thad Roddy’s death.” The majority fails to recognize how these statements are very different than those in the affidavit considered in Lindberg, which stated that the decedent “died as a result of the negligent and careless conduct of the [defendants” without ever stating what the negligent or careless conduct was. Lindberg, 599 N.W.2d at 575.
Finally, unlike the expert affidavit in Anderson, which failed to adequately connect the alleged negligence to the plaintiffs injury, Dr. Perloffs first affidavit definitively stated that Roddy’s death was a direct result of the University of Minnesota doctors’ deviations from the acceptable standard of care. The majority’s comparison to the affidavit considered in Anderson is again misplaced. In Anderson, the inadequacy of the affidavit as to causation was based on the fact that the phrase “undetermined etiology” suggested that the cause of the plaintiffs injury was unknown and perhaps unrelated to any negligence by the defendant. Anderson, 608 N.W.2d at 848. No such ambiguous phrase exists in this case; Dr. Perloffs affidavit stated, “[T]he departures from accepted levels of care * * * were a direct cause of Thad Roddy’s death.”
In sum, Dr. Perloffs affidavit identified both Roddy’s medical condition that needed attention and specified the practical measures that should have been taken by the University of Minnesota doctors. It also connected the doctors’ delay in properly diagnosing Roddy’s condition to his death. Instead of recognizing this, the district court seemingly made an ultimate factual determination that instant diagnosis and treatment were not possible even though there is nothing in the record to support this conclusion. This was an abuse of discretion. As the majority opin*436ion points out, “The gist of expert opinion evidence as to causation is that it explains to the jury the ‘hoV and the “why’ the malpractice caused the injury.” This explains why a jury, rather than a summary judgment court, should be deciding this issue.
Finally, the majority’s assertion that it was not an abuse of discretion for the district court to dismiss respondent’s claim with prejudice fails to include any discussion of remedies short of this. While we have indicated in the past that Minn.Stat. § 145.682, subd. 6 “cuts with a sharp but clean edge,” Lindberg, 599 N.W.2d at 578, we have continued to recognize that in borderline cases when prejudice is absent, alternatives less drastic than procedural dismissal may be available.1 Anderson, 608 N.W.2d at 848-49; see also Sorenson, 457 N.W.2d at 193 (first acknowledging the “borderline case” exception). Here, the district court dismissed a case with prejudice that was brought by an experienced medical malpractice attorney attempting to comply with the requirements of section 145.682 by submitting an affidavit of a highly qualified doctor specializing in pediatric critical care.
This was not a nuisance suit. Accordingly, dismissal with prejudice did not serve the recognized purpose for which the legislature enacted section 145.682. This conclusion should not change even if the majority were correct in holding that Dr. PerlofPs affidavit did not comply with the subdivision 4 requirements. While subdivision 6 indicates that failure to comply with it results in mandatory dismissal with prejudice, the district court was free to consider alternative remedies. Respondents requested an opportunity to submit additional information on morphine toxicity when confronted with the question of that condition in relation to bone marrow transplants but the district court did not consider any supplemental information before ordering dismissal with prejudice. The majority fails to consider any appropriate alternatives to procedural dismissal with prejudice despite the fact that this was clearly not a nuisance claim.
For these reasons, I would affirm the court of appeals as to respondent’s claim against the University of Minnesota.

. The doctrine that the statute "cuts with a sharp but clean edge” has been recently sheathed by the legislature for all future actions. See Act of May 22, 2002, ch. 403, § 1, 2002 Minn. Laws-(amending Minn.Stat. § 145.682, subd. 6). Subdivision 6 now reads:
Subd. 6. (a) Failure to comply with subdivision 2, clause (1), within 60 days after demand for the affidavit results, upon motion, in mandatory dismissal with prejudice of each cause of action as to which expert testimony is necessary to establish a prima facie case.
(b) Failure to comply with subdivision 2, clause (2), results, upon motion, in mandatory dismissal with prejudice of each cause of action as to which expert testimony is necessary to establish a prima facie case.
(c) Failure to comply with subdivision 4 because of deficiencies in the affidavit or answers to interrogatories results, upon motion, in mandatory dismissal with prejudice of each action as to which expert testimony is necessary to establish a prima facie case, provided that:
(1) the motion to dismiss the action identifies the claimed deficiencies in the affidavit or answers to interrogatories;
(2) the time for hearing the motion is at least 45 days from the date of service of the motion; and
(3) before the hearing on the motion, the plaintiff does not serve upon the defendant an amended affidavit or answers to interrogatories that correct the claimed deficiencies.
This section is effective the day following final enactment and applies to causes of action commenced on or after that date.