A patient underwent open-heart surgery. While recovering, the nurses in the intensive care unit discovered a pressure ulcer that required further procedures and allegedly caused permanent pain. The patient sued the hospital for medical malpractice. The patient retained only one expert to establish the standard of care, its breach, and causation: a board-certified wound-care nurse. The trial court granted the hospital summary judgment, and the Court of Appeals concluded that the nurse was not qualified as a standard-of-care expert.
The Arizona Supreme Court affirmed, but remanded for further proceedings on causation. Specifically, the Court remanded to consider whether expert testimony on causation was required and whether the nurse was qualified to provide expert testimony on that issue.
Expert testimony is required to prove causation in medical negligence cases unless the causal relationship is “readily apparent” to the trier of fact. The Court of Appeals held that it was not readily apparent that the pressure ulcer was caused by the hospital’s negligence. The development of a pressure ulcer depends on multiple factors, and the patient exhibited several risk factors that can contribute to the development of a pressure ulcer. Expert testimony was therefore required to establish causation.
The Court of Appeals rejected the hospital’s proposed bright-line rule that would prohibit nurses from offering causation opinions in medical malpractice actions. Although A.R.S. § 12-2604(A) imposes additional criteria that a standard-of-care expert must satisfy in order to testify in a medical malpractice action, no corresponding statutory provision exists for causation experts. Instead, the Court confirmed that Arizona Rule of Evidence 702 controls whether an expert witness is qualified to provide expert testimony on the issue of causation in a medical malpractice action. And under Rule 702, expert testimony is admissible if it will help the trier of fact understand the facts or resolve a particular issue. The Court observed that the nurse’s testimony would help the jury understand the facts. She had been a registered nurse for over two decades and a hospital director of wound care for several years; she therefore possessed greater knowledge and skill than the average layperson. The Court vacated summary judgment in favor of the hospital and remanded for further proceedings.
Judge Espinosa authored the opinion; Judges Staring and Eppich concurred.
Posted by: Phillip W. Londen