Court of Appeals Clarifies Standard for Expert Testimony in Medical Malpractice Decision

Since certain subject matter falls beyond the knowledge or experience of an average juror, cases will occasionally require that a plaintiff or defendant provide expert testimony that will assist the jury in making necessary factual determinations for resolving a case. In particular, expert testimony is often necessary in medical malpractice cases, since many jurors lack sufficient medical knowledge to make determinations regarding a medical provider’s negligence. In a recent decision, Freeman v. LTC Healthcare of Statesboro, Inc. (PDF-embedded link), the Georgia Court of Appeals addressed who can provide this necessary expert testimony.
Freeman arose from an alleged act of medical malpractice at Westwood Nursing Center, a long-term care facility. The plaintiff in this action is the husband of a patient who died shortly after arriving at Westwood. The deceased had undergone brain surgery the month before and experienced severe complications, including quadriplegia. Medical orders accompanying the transfer instructed that the deceased receive albuterol and that her oxygen be monitored and tracheostomy tube suctioned. The day of her transfer, Westwood’s medical records show that a feeding tube was placed but does not indicate that any of the other treatments were followed. Shortly before midnight, a nurse noticed that the deceased was in distress, and by the early morning the deceased passed away as a result of respiratory failure.

Following these events, the deceased’s husband, as administrator of the deceased’s estate, brought a medical malpractice action against Westwood and several others. Following discovery, Westwood moved for summary judgment, arguing that the plaintiff had failed to provide evidence that its alleged breach of the standard of care caused the death. Although the plaintiff had provided testimony from a registered nurse to establish causation, the trial court declined to consider this testimony, holding that the nurse was not competent to provide testimony regarding causation. Having declined to consider the nurse’s testimony, the trial court concluded that the plaintiff failed to provide evidence establishing causation and granted Westwood’s motion for summary judgment. Thereafter, the plaintiff brought this appeal.
In order to succeed on a claim for medical malpractice, a plaintiff must demonstrate, with a reasonable degree of medical certainty, that a defendant’s breach of its applicable duty of care both directly and proximately caused the plaintiff’s injury. Zwiren v. Thompson, 276 Ga. 498, 499, 503 (2003). A plaintiff must provide expert testimony to make this showing, since jurors lack the competence to make such a determination without the assistance of expert testimony. Id. at 500-01. As noted above, the plaintiff in this action provided expert testimony from a registered nurse who testified that Westwood breached the standard of care by failing to follow medical orders, assess the deceased’s condition at the time of admission, and assess, treat, report, or document changes in the deceased’s condition. In addition, the nurse further testified, “had [the defendant’s] nursing staff met the standard of care for nurses caring for quadriplegic patients with tracheostomy tubes … this would have significantly altered Mrs. Mary Freeman’s treatment and prevented her death….”
Although the trial court held that a nurse was not competent to make provide expert testimony on causation, the Court of Appeals refused to impose a bright line rule. Instead, the court reaffirmed preexisiting state law, which “does not mandate that only medical doctors be permitted to testify regarding medical issues.” Sinkfield v. Oh, 229 Ga. App. 883, 885 (1997). Instead, “others with certain training and experience may testify on issues within the parameters of their experience.” Id. Accordingly, a licensed registered nurse may provide expert testimony regarding subject matter within the ambit of his or her expertise. See, e.g., McCormick v. Avret, 246 Ga. 401 (1980). Thus, the trial court erred insofar as its decision rests on the notion that nurses categorically could never provide expert testimony in a medical malpractice cases.
However, the Court of Appeals nonetheless affirmed the trial court’s grant of summary judgment. In this case, the Court of Appeals found that establishing causation in this case fell beyond the bounds of the nurse’s expertise, and thus her testimony could not be used to establish causation. Under Georgia law, opinions regarding medical diagnoses fall beyond the limits of the expertise of a non-physician. See O.C.G.A. § 43-34-21 (3). Establishing the cause of death in this case depends on making a medical diagnosis, not a nursing diagnosis, which is limited to identification of signs and symptoms of illness. In fact, in her deposition, the nurse acknowledged that she could not provide an opinion regarding the cause of the deceased’s respiratory failure, including whether that respiratory failure was attributable to Westwood’s breach of care, for such a determination would be a medical diagnosis. Since liability depends not on whether the plaintiff died of respiratory failure, but rather on whether the breach of care caused that respiratory failure, it follows that the nurse’s testimony could not be used to establish causation. Since the plaintiff had failed to proffer sufficient expert testimony creating an issue of material fact regarding causation, the Court of Appeals affirmed the trial court’s grant of summary judgment.
Given the particularized evidentiary rules that apply in medical malpractice cases, those injured in a possible case of medical malpractice must take care to assemble all evidence necessary to support each part of their claims. Often, the assistance of experienced counsel is valuable to those in this position, and potential litigants should consider acquiring representation prior to undertaking action to recover for their injuries. The Atlanta medical negligence attorneys at the Law Office of Terrence R. Bethune have a solid understanding of Georgia medical malpractice law and are prepared to offer assistance to those with possible claims against a health care provider. Feel free to contact us if you are in this position and are interested in a complimentary case evaluation.