The Arizona Supreme Court has ruled that medical malpractice cases involving unclear causes of death or injury cannot proceed without sufficient expert testimony to provide guidance to jurors.
In March 2012, Michelle Sampson took her four-year-old son, Amaré Burks, to the Surgery Center of Peoria for a scheduled tonsillectomy and adenoidectomy. Surgery Center of Peoria is an outpatient surgery clinic, and the scheduled procedure was considered routine with an extremely low complication rate.
Dr. Guido administered the general anesthesia and Dr. Libling performed the procedure. Dr. Libling remained with Amaré for about thirty minutes after the surgery and then transferred him to the post-operative anesthesia care unit. Nurse Kuchar attended Amaré in the recovery room. After sixty-one minutes, Amaré scored eight out of eight on a vitals-release test and he was released to his mother’s care.
Sampson took Amaré home and put him to bed. She had been told that it was normal for a patient to sleep after surgery. Approximately two hours after his discharge, Samson checked on Amaré, but he was not breathing. Emergency personnel were unable to revive him.
Sampson brought a wrongful death action against the Surgery Center, Dr. Guido, and other defendants.
Sampson identified Dr. Greenberg as her expert witness to establish cause of death, proximate cause, and standard of care.
Dr. Greenberg testified that “(1) one hour was insufficient to assess a pediatric patient for discharge and that three hours was appropriate, especially for a child with a history of sleep apnea; (2) the anesthesiologist fell below the standard of care by discharging Amaré before that time and Amaré’s death could have been prevented with longer observation in the PACU; and (3) Amaré died from being rendered unable to breathe from the after-effects of surgery and anesthesia, as his pharyngeal tissues were swollen and obstructed his upper airway, and the residual effects of anesthesia did not allow him to awaken to overcome the obstruction.”
Dr. Greenberg also opined that the standard of care required between one and three hours of observation before release.
The Surgery Center and Dr. Guido filed motions for partial summary judgment and argued that Dr. Greenberg’s testimony did not establish that their actions had proximately caused Amaré’s death. The trial court agreed and entered final judgment against Sampson. She appealed and the court of appeals reversed, finding that a reasonable jury could determine that the standard of care for observation was three hours.
The Arizona Supreme Court Decision
The Arizona Supreme Court granted review to determine whether the court of appeals erred.
Upon review, the Arizona Supreme Court noted that Arizona law requires that in medical malpractice cases, “causation must be established by competent expert testimony, and the narrow exception is that a jury may infer such causation if malpractice is ‘readily apparent.’”
The court stressed that in this case, expert testimony establishing causation was essential. However, disagreement existed over the cause of Amaré’s death. “Whereas the autopsy report stated that Amaré died from a ‘disseminated Strep Group A’ infection, Dr. Greenberg opined he died from a ‘swollen and obstructed upper airway’ combined with his inability ‘to breathe from the after-effects of surgery and anesthesia.’ Given that even the medical experts did not agree on the cause of death, it is unrealistic to conclude, as the court of appeals did, that a jury “could properly infer that the early discharge was the probable cause of Amare’s death.”
The court determined that, in this case, the court of appeals had departed from the proper standard for proving causation by allowing the jury to determine causation based on speculation built upon inference. Accordingly, it reversed the court of appeals decision.