Court Opinion

ID: 9954365
Source: CourtListenerOpinion
Date Created: 2024-03-25 22:15:52.01154+00
Date Added: 2024-06-11T08:12:06.387151
License: Public Domain

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

 MICHAEL and SHERRIE BUSHMAN,
                                                    No. 85278-7-I
                      Appellants,
                                                    DIVISION ONE
               v.
                                                    UNPUBLISHED OPINION
 VIRGINIA MASON MEDICAL CENTER;
 and MADHANKUMAR (VADHAN)
 KUPPUSAMY,

                      Respondents.

       MANN, J. — Michael and Sherrie Bushman appeal the summary judgment

dismissal of their medical malpractice action. We affirm the trial court’s dismissal on

summary judgment.

                                                I

       On September 6, 2019, Dr. Madhankumar Kuppusamy performed a laparoscopic

surgery on Michael Bushman at Virginia Mason Medical Center to repair a

paraesophageal hernia. Bushman seemed to tolerate the surgery well and no

complications were observed during the procedure. Bushman was discharged from the

hospital two days later in good condition.

       On September 12, 2019, Bushman went to Yakima Memorial Hospital

complaining of throat discomfort, retching, and a fever of 101 to 103. Yakima Memorial

staff performed a computed tomography (CT) scan, which showed “posterior
No. 85278-7-I/2

mediastinal fluid collection suggestive of leakage from the esophagus.” Bushman was

transported to Virginia Mason, where Dr. Kuppusamy performed an open laparotomy to

attempt to repair the esophageal tear. Bushman suffered several complications

following the surgery and was not released from the hospital until October 14, 2019.

        Bushman initially filed suit against Dr. Kuppusamy and Virginia Mason for

medical malpractice on May 26, 2021. In April 2022, Bushman voluntarily dismissed his

first suit and subsequently refiled the complaint. Attached to both the original and

refiled complaints were seven declarations signed by Bushman’s family and friends who

were present at Virginia Mason on the date of the second surgery. According to those

seven individuals, Dr. Kuppusamy informed them that during the first surgery, he had

“nicked” Bushman’s esophagus and left the sutures too loose, causing the esophageal

tear.

        On September 16, 2022, Bushman moved for partial summary judgment,

asserting that the seven declarations attached to the complaint established the

defendants’ liability as a matter of law. The defendants moved for a continuance

pursuant to CR 56(f), as they had not yet received any responses to discovery from the

plaintiffs and had not been able to depose any of the seven individuals who submitted

declarations. 1 The trial court granted the request for a continuance.

        On February 10, 2023, Dr. Kuppusamy and Virginia Mason moved for summary

judgment, asserting that Bushman did not have a medical expert as required for medical

         1 Before the trial court ruled on either motion, the defendants submitted the declaration of Dr.

Kuppusamy, in which he denied making any of the statements attributed to him in the Bushman
declaration. Bushman moved to strike respondent’s references to the Kuppusamy declaration in their
appellate brief. We agree with Bushman that the Kuppusamy declaration was not designated in the trial
court’s order granting summary judgment as required by CR 56(h). Other than this reference to the
declaration as background, it was not considered on appeal.

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malpractice actions under chapter 7.70 RCW. In response, Bushman did not submit

any expert declarations but instead argued that Dr. Kuppusamy’s statements, as

described in the declarations attached to the complaint, constituted the requisite expert

testimony. Bushman also asserted that res ipsa loquitur applied to his claim.

       In reply, Dr. Kuppusamy and Virginia Mason submitted the declaration of Dr.

Timothy Bax, an expert in general surgery. Dr. Bax opined that Dr. Kuppusamy had

complied with the standard of care in his treatment of Bushman and that Bushman’s

injuries were not the result of negligence. Dr. Bax also opined that “Dr. Kuppusamy’s

surgery and Mr. Bushman’s injuries are beyond the general understanding of a lay

person,” that Bushman’s injuries were not necessarily “caused by an instrument that

was within the exclusive control of Dr. Kuppusamy,” and that “Mr. Bushman’s reported

injuries are not the type that would create an inference that the physician negligently

caused them.”

       The trial court ruled that res ipsa loquitor did not apply to Bushman’s claims. The

trial court provided Bushman with an extra 28 days to obtain an expert witness to

respond to Dr. Bax’s declaration. After the 28 days had passed without Bushman

submitting any additional material, the trial court granted the summary judgment motion

and entered judgment in favor of Dr. Kuppusamy and Virginia Mason.

       Bushman appeals.

                                            II

       We review summary judgment orders de novo. “In a summary judgment motion,

the moving party bears the initial burden of showing the absence of an issue of material

fact.” Young v. Key Pharms., Inc., 112 Wn.2d 216, 225, 770 P.2d 182 (1989). If the

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defendant is the moving party and makes their initial showing, then the inquiry shifts to

the party with the burden of proof at trial to make a showing sufficient to establish the

existence of an element essential to that party’s case. Young, 112 Wn.2d at 225. If the

party with the burden of proof at trial fails to make that showing, then the trial court

should grant summary judgment. Young, 112 Wn.2d at 225.

       Bushman asserts that the trial court erred by granting summary judgment in favor

of Dr. Kuppusamy and Virginia Mason because he was not required to produce expert

testimony in support of his claim. Bushman argues that Dr. Kuppusamy’s statements to

Bushman’s family and friends constitute expert testimony and, in the alternative, that res

ipsa loquitur obviates the need for expert testimony. Neither argument has merit.

                                              A

       “[W]henever an injury occurs as a result of health care, the action for damages

for that injury is governed exclusively by RCW 7.70.” Branom v. State, 94 Wn. App.

964, 969, 974 P.2d 335 (1999). Claims that an injury resulted from a failure to follow

the accepted standard of care are addressed by RCW 7.70.030(1) and RCW 7.70.040.

The plaintiff has the burden to prove by a preponderance of evidence each essential

element of the claim. RCW 7.70.030.

       The following are necessary elements of proof that injury resulted from the failure

of the health care provider to follow the accepted standard of care:

       (1) The health care provider failed to exercise that degree of care, skill, and
       learning expected of a reasonably prudent health care provider at that time
       in the profession or class to which he or she belongs, in the state of
       Washington, acting in the same or similar circumstances;

       (2) Such failure was a proximate cause of the injury complained of.

RCW 7.70.040.

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        Expert testimony is generally “‘necessary to establish the standard of care . . .

and most aspects of causation.’” Young, 112 Wn.2d at 228 (quoting Harris v. Groth, 99

Wn.2d 438, 449, 663 P.2d 113 (1983)). To defeat summary judgment in almost all

medical negligence cases, the plaintiff must produce testimony from a competent

medical expert. Young, 112 Wn.2d at 228.

        The trial court did not err in granting summary judgment in favor of Dr.

Kuppusamy and Virginia Mason. Dr. Kuppusamy and Virginia Mason’s motion argued

that Bushman lacked medical expert testimony to establish the standard of care and

causation. Bushman’s response offered no medical expert’s testimony in support of

either a violation of the standard of care or causation. Without medical expertise,

Bushman cannot establish either the standard of care or causation.

        Bushman nevertheless asserts that Dr. Kuppusamy’s own testimony constitutes

the requisite expert testimony. This argument fails for two reasons. First, Bushman did

not present any testimony from Dr. Kuppusamy. Instead, Bushman presented

declarations from various lay witnesses about what Dr. Kuppusamy purportedly said to

them. 2 For this reason, Douglas v. Freeman, 117 Wn.2d 242, 250, 814 P.2d 1160

(1991), is of no assistance to Bushman, as that case concerned the trial testimony of

the defendant medical professional.

        Second, Dr. Kuppusamy’s alleged statements reflected in the declarations speak

to neither the standard of care nor causation. General assertions of negligent care are

         2 Dr. Kuppusamy and Virginia Mason contend that none of the declarations are admissible

pursuant to RCW 5.64.010. Bushman argues that RCW 5.64.010 applies only to statements made to the
patient and the patient’s representative, rendering all declarations except Sherrie Bushman’s admissible.
We need not resolve this issue. Even if all of Bushman’s declarations are admissible, they are not
sufficient to defeat summary judgment.

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No. 85278-7-I/6

not enough; the testimony must state specific facts to show the applicable standard of

care, how it was breached, and how the breach caused the plaintiff’s injuries. Reyes v.

Yakima Health Dist., 191 Wn.2d 79, 89, 419 P.3d 819 (2018). Dr. Kuppusamy’s alleged

statement that he “nicked” Bushman’s esophagus contains none of the required

specificity.

                                              B

       In the alternative, Bushman asserts that he need not present expert testimony

because res ipsa loquitur applies. A plaintiff may rely on the res ipsa loquitor

permissive inference of negligence in lieu of expert testimony if “(1) the accident or

occurrence that caused the plaintiff's injury would not ordinarily happen in the absence

of negligence, (2) the agency or instrumentality that caused the plaintiff’s injury was in

the exclusive control of the defendant, and (3) the plaintiff did not contribute to the

accident or occurrence.” Nguyen v. City of Seattle, 179 Wn. App. 155, 172, 317 P.3d

518 (2014). The first element can be met by showing one of the following:

       “(1) [w]hen the act causing the injury is so palpably negligent that it may
       be inferred as a matter of law, i.e., leaving foreign objects, sponges,
       scissors, etc., in the body, or amputation of a wrong member; (2) when the
       general experience and observation of mankind teaches that the result
       would not be expected without negligence; and (3) when proof by experts
       in an esoteric field creates an inference that negligence caused the
       injuries.”

Pacheco v. Ames, 149 Wn.2d 431, 438-39, 69 P.3d 324 (2003) (internal quotation

marks omitted) (quoting Zukowsky v. Brown, 79 Wn.2d 586, 595, 488 P.2d 269 (1971)).

Bushman makes none of these showings.

       The declaration of Dr. Bax establishes that Bushman’s injuries were not

necessarily caused by an instrument in Dr. Kuppusamy’s exclusive control, and that the

                                                  6
No. 85278-7-I/7

injuries were not of a type that would not be expected in the absence of negligence. 3

Despite the burden shifting framework that applies to summary judgment motions,

Bushman provided no evidence to refute this testimony, even after being given an extra

28 days to do so. Absent such a showing, the trial court correctly determined that res

ipsa loquitur does not apply to this case.

                                                    IV

        Bushman failed to create a genuine issue of material fact with regard to any

conduct of any defendant that breaches a specified standard of care. We affirm the trial

court’s dismissal on summary judgment.

WE CONCUR:

        3 Bushman’s own medical records show that he was warned that injury to the esophagus was a

possible complication of the hernia repair surgery he underwent, thus also demonstrating that the injuries
were not of a type that would not be expected in the absence of negligence.

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