The California Court of Appeals recently decided an appeal from a trial court ruling that excluded expert opinions in a medical malpractice case. The appellate court agreed that those opinions were not based on facts and therefore could not be considered as evidence of malpractice.

Facts of the Case

Baby Ngide was born at St. Agnes Medical Center in Fresno on September 27, 2011. The next day, a nurse noticed that the baby was not responsive. The baby was transferred to the Neonatal Intensive Care Unit (NICU) for resuscitation. The NICU is located in St. Agnes Medical Center but is operated by Children’s Hospital of Central California.

Dr. Patrick Nwajei, a neonatologist, did not see the baby girl until she arrived at Children’s Hospital. Dr. Nwajei was not the baby’s treating physician and was not authorized to treat St. Agnes patients unless he was asked to consult by a treating physician. Dr. Nwajei was, however, among the doctors who were responsible for providing patient care at the NICU.

When the baby arrived at NICU, staff members called for Dr. Nwajei. He treated the baby by providing ventilation using a bag mask and by intubating the baby. He then called for a transport team so that the baby could be taken to the Children’s Hospital NICU in Madera, where more specialists were available.

Transport started about one-and-a-half hours after Dr. Nwajei first saw the baby. After transport began, the receiving neonatologist was responsible for the baby’s care.

On June 18, 2012, the baby died from complications caused by a hypoxic brain injury. The brain injury occurred before Dr. Nwajei saw the baby.

Summary Judgment

The father sued St. Agnes Medical Center and Dr. Nwajei for medical malpractice. St. Agnes and Dr. Nwajei both moved for summary judgment, arguing that the undisputed facts established that they were not responsible for the baby’s death.

In opposing summary judgment, the father submitted the affidavit of an expert witness. Dr. Arie Alkalay opined that the nurses and staff at St. Agnes, as well as Dr. Nwajei, failed to provide an appropriate standard of care and that their respective failures contributed to the baby’s death.

Dr. Nwajai relied on an affidavit of his expert witness, Dr. Gilbert I. Martin, who concluded that Dr. Nwajei followed an appropriate standard of care and that none of his actions were a cause of the baby’s death.

St. Agnes submitted the expert affidavit of Dr. Philippe Friedlich, who opined that the actions of the nurses and staff at St. Agnes satisfied the appropriate standard of care.

The trial court concluded that Dr. Alkalay’s opinions were not based on facts established in the record. The court therefore ruled that his opinions were inadmissible. In the absence of expert testimony to establish malpractice, the court granted summary judgment in favor of the medical defendants. The baby’s father appealed.

Objections to Dr. Alkalay’s Opinions

Medical malpractice lawsuits must usually be based on an expert’s opinion that a healthcare provider failed to provide an appropriate standard of care for the patient and that the patient was harmed by that failure. By the same token, medical malpractice defendants must rely on expert witnesses to establish that they met the appropriate standard of care.

Based on his review of medical records and his experience as a neonatologist, Dr. Alkalay expressed the opinion that the mother presented a high-risk pregnancy, that the hospital should have consulted with Nr. Nwajei at the time of delivery, that failing to do so breached the standard of care that a hospital should provide, and that the failure contributed to the baby’s death.

Dr. Alkalay also faulted Dr. Nwajei for waiting until he was notified by St. Agnes of the baby’s need for a neonatologist. Dr. Alkalay opined that Dr. Nwajei had a duty “to ensure that he would be informed and included in the delivery diagnosis, care and treatment of high risk deliveries and high risk newborns.” Dr. Alkalay concluded that Dr. Nwajei failed to abide by an appropriate standard of care when he neglected to remedy the “systems failures” at St. Agnes.

The California Court of Appeals agreed with the trial court that Dr. Alkalay had no factual basis for his criticism of Dr. Nwajei. Dr. Alkalay assumed that it was Dr. Nwajei’s duty to correct “systems failures” at St. Agnes, but Dr. Nwajei was employed by Children’s Hospital, not by St. Agnes. Dr. Alkalay did not explain why Dr. Nwajei would have any responsibility or authority to correct problems at St. Agnes. The court therefore concluded that Dr. Alkalay’s opinion about the standard of care was based on speculation, not on facts.

The appellate court also agreed with the trial court that no factual basis supported Dr. Alkalay’s opinion that St. Agnes staff members should have notified a neonatologist of a high-risk pregnancy. The mother’s attending pediatrician did not do so, and the St. Agnes staff members merely carried out the pediatrician’s orders when he was not there. Since Dr. Alkalay did not explain why nurses would have the authority, much less the duty, to second-guess the pediatrician’s judgment, his opinion about St. Agnes’ alleged breach of the standard of care was again unsupported by the facts.

Since the trial court properly excluded Dr. Alkalay’s opinions, the appellate court concluded that it appropriately granted summary judgment in favor of the medical defendants.