Many states have adopted laws that limit the universe of potential experts who are permitted to testify about the standard of care in a medical malpractice lawsuit. The question before the North Carolina Supreme Court in Da Silva v. WakeMed was whether an internist is qualified to give expert testimony about the standard of care that should be exercised by a hospitalist. The court ruled that North Carolina law permits the testimony.
Facts of the Case
Before she was admitted to a WakeMed hospital, 76-year-old Dolores Pierce was taking prednisone, a prescription drug that treated her inflammatory disorder. She was admitted to the emergency room with symptoms that were diagnosed as a urinary tract infection.
Concerned that the infection had induced sepsis, a hospitalist ordered the antibiotic Levaquin to be administered intravenously. A known side effect of Levaquin is the increased risk of tendon ruptures in patients over the age of 60 and in patients who are taking prednisone or other cortical steroids.
Three hospitalists treated Pierce over the next few days. All three continued to prescribe Levaquin. They were all aware of Pierce’s age and they all continued to administer her daily dose of prednisone.
After a few days, Pierce was discharged to a rehabilitation facility. The hospitalists prescribed Levaquin and prednisone during the first four days of her stay in that facility, after which the Levaquin was discontinued. A few days later, Pierce completed her recovery and was discharged.
About a week after her discharge, Pierce ruptured her Achilles tendon. The rupture required a surgical repair, but Pierce never fully recovered. She died from pneumonia about ten months after the rupture.
The hospitalists who prescribed Levaquin for Pierce were board certified in internal medicine. The supreme court described hospitalists as “physicians who specialize in internal medicine in a hospital setting and care for hospitalized patients.”
Pierce’s estate sued the hospitalists for malpractice. They identified Dr. Paul Genecin as an expert witness regarding the applicable standard of care. Dr. Genecin is an internist who is licensed in Connecticut.
Dr. Genecin testified in a deposition that the hospitalists deviated from the standard of care by administering Levaquin to an elderly patient who was taking prednisone. A hospitalist’s standard of care, according to Dr. Genecin, would have required the hospitalist to understand the risk of an adverse drug interaction and to prescribe a different antibiotic. Dr. Genecin also testified that Pierce’s tendon rupture was caused by the interaction of prednisone and Levaquin.
The hospitalists urged the court to disqualify Dr. Genecin as an expert witness because he is an internist rather than a hospitalist. The trial court agreed with their strained interpretation of North Carolina law and disqualified Dr. Genecin. It then entered summary judgment against the estate because, with no expert witness to prove standard of care, the estate could not prove that the hospitalists were negligent.
The North Carolina Court of Appeals reversed the trial court in an unpublished decision. The hospitalists then asked the North Carolina Supreme Court to decide whether internists are qualified to give expert testimony about the standard of care that applies to hospitalists.
North Carolina Law
As is true in many states, North Carolina passed a law that makes it difficult for injured patients to find expert witnesses who will testify on their behalf. Rather than allowing a court to apply the traditional test of an expert’s qualifications — whether the expert has sufficient knowledge, skill, training, or experience to help the jury understand an issue in the case — many states narrow the range of experts who are allowed to testify in medical malpractice cases.
A North Carolina statute specifies that a medical expert who testifies in a lawsuit against a specialist must either specialize in the same field of medicine or “in a similar specialty which includes within its specialty the performance of the procedure that is the subject of the complaint and have prior experience treating similar patients.”
To satisfy North Carolina law, the expert must also have, within the prior year, devoted the majority of his or her time to the active clinical practice of the same or similar specialty as the defendant or to teaching students in that specialty.
Dr. Genecin was board certified in internal medicine, as were the hospitalists. Dr. Genecin testified that a hospitalist is a doctor who is hired to practice the specialty of internal medicine on a full-time basis in a hospital. According to Dr. Genecin, “hospitalist” is merely a job title that describes an internist who works in a hospital.
The defendants presented no evidence to contradict Dr. Genecin’s testimony. The supreme court declined to determine whether hospitalist and internist are two terms that describe the same specialty, but the court had no difficulty concluding that the terms describe similar specialties.
Dr. Genecin explained that when internists treat hospitalized patients, they are doing the same work as hospitalists. Dr. Genecin regularly performs the same duties as hospitalists, including treating hospitalized patients, reviewing the patient’s history, interpreting test results, making referrals to other specialists, prescribing medications, and checking for adverse medication interactions.
Dr. Genecin serves as an attending physician in a hospital for two months each year. He admits and discharges patients and performs all of the other duties that hospitalists perform.
Dr. Genecin also testified that dozens of times each year, he treats hospitalized women in their 70s who suffer from serious infections, including urinary tract infections. The undisputed evidence established that Dr. Genecin had performed the procedures that, according to the complaint, were performed negligently by the hospitalist defendants. Since that evidence was undisputed, the court concluded that Dr. Genecin’s practice included the treatment of patients who were similar to Pierce.
It is difficult to understand why the trial court thought that the description of a doctor who practices internal medicine as a hospitalist rather than as an internist was a reason to disqualify Dr. Genecin as an expert witness. The supreme court determined that Dr. Genecin satisfied the requirements of North Carolina law. It therefore reversed the summary judgment against Pierce.
Finding a doctor who will testify against another doctor is always challenging. State laws protect doctors from the consequences of their negligent acts by imposing expert witness requirements that enhance the challenge of finding a suitable expert.
The court’s decision provides relief for plaintiffs’ lawyers in their search for medical malpractice experts. In a state like North Carolina, lawyers should look beyond the job titles of the defendant doctors and ask what duties they perform. A physician with a different job title might be qualified to act as an expert witness under state law if the expert performs those same duties as the defendant, particularly if the expert and the defendant doctor are board-certified in the same field of medicine.