By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Los Angeles
News: In a medical negligence case, an appellate court in Missouri recently reversed a trial court’s grant of summary judgment to a chiropractor defendant on the basis that there were factual issues that should have been decided by the jury. After a patient sued her chiropractor when she suffered three broken ribs during a treatment, the chiropractor defendant claimed that the patient was claiming medical negligence by pointing to her injury rather than showing that the chiropractor was negligent or that the chiropractor’s alleged negligence caused her injury.
The trial court agreed with the chiropractor and entered judgment for him. But the appellate court found that this was an error: The evidence showed the patient did more than rely on the fact of injury in arguing negligence, finding that it was inappropriate for the trial court to dismiss her claims. This case is a reminder that it is the province of juries to decide issues of fact, and that even small issues of fact can defeat a motion for summary judgment as long as they are important to deciding medical negligence.
Background: The plaintiff patient had sought treatment from the defendant chiropractor for persistent back and neck pain, following which the chiropractor developed a treatment plan involving spinal adjustments. Despite prior treatments without incident, during her sixth visit, the plaintiff suffered three broken ribs. The plaintiff filed a medical malpractice suit against the chiropractor. The chiropractor moved for summary judgment against the plaintiff. He argued that fractures like the one the plaintiff experienced are a known risk and can occur even without any medical negligence. The chiropractor also claimed that the plaintiff’s only evidence of his alleged medical negligence was that the plaintiff had been injured, and he claimed that the mere fact of injury is not enough to establish medical negligence. The trial court agreed, finding that the plaintiff was not able to show either that the chiropractor was negligent or that the chiropractor’s negligence was the cause of the plaintiff’s injuries. It granted summary judgment to the chiropractor. The plaintiff appealed the ruling.
On appeal, the appellate court began by noting that summary judgment is appropriate only when there are no genuine issues of material fact, and the moving party is entitled to judgment as a matter of law. It stated that summary judgment is an extreme remedy. The appellate court also highlighted that negligence typically is a question for the jury, especially when there are conflicting expert opinions or factual disputes.
The appellate court noted that, to establish medical malpractice, the plaintiff must prove the chiropractor failed to meet the required standard of care, his actions were negligent, and they caused her injuries. On appeal, the chiropractor argued that the plaintiff’s only evidence of negligence was the fact of her injury itself, and he cited legal precedent prohibiting a presumption of negligence based solely on an adverse outcome, such as the plaintiff’s fractured ribs. However the appellate court noted that the plaintiff presented two expert witnesses in chiropractic care and that their expert opinions did not solely rely on the fact that she had been injured to establish that the chiropractor committed medical malpractice. One of the plaintiff’s experts testified that an excessive amount of force must have been used on the plaintiff because the plaintiff had received five prior treatments without incident and that she had no contraindications at the time of treatment. The plaintiff’s other expert testified that if the technique the defendant chiropractor employed was applied properly, there likely would not have been a broken rib injury and concluded that the plaintiff’s broken ribs were the result of the chiropractor’s maltreatment.
The appellate court found that these explanations by the plaintiff’s experts, in its view, went beyond the mere fact that she was injured to establish liability. It also noted that the plaintiff herself claimed that she felt an excessive amount of force was used during the spinal adjustment that broke her ribs. In the view of the appellate court, the testimony of the plaintiff and her expert witnesses was sufficient to overcome the defendant chiropractor’s motion for summary judgment. The appellate court concluded that genuine issues of material fact existed and reversed the trial court.
What this means for you: Summary judgment is a legal procedure that allows a court to decide a case without a full trial as long as there are no genuine disputes of fact. With no facts for the jury to decide, at the request of a party, the trial court simply can apply the law to the facts in the record and determine whether judgment should be entered for that party. In considering a motion for summary judgment, the trial court reviews the evidence presented by both parties, giving any benefit of doubt to the party that is opposing summary judgment (the plaintiff patient in this case). Although many cases are decided at the summary judgment stage, the appellate court underscored here that summary judgment is an extreme remedy and that appellate courts should remain cautious in affirming such judgments. This caution reflects the recognition that summary judgment deprives parties of their right to a trial and only should be granted when the evidence overwhelmingly supports the moving party’s position.
While summary judgment can streamline the legal process and resolve cases efficiently, courts must exercise discretion in determining whether it is appropriate. Courts should not grant summary judgment if there are genuine issues of material fact that require resolution by a jury. Whether negligence occurred, as the appellate court noted, typically involves questions of fact for a jury to decide. Even where the facts are undisputed, summary judgment still may be inappropriate if reasonable minds can draw different conclusions from those facts, as the court noted.
In showing medical negligence, a plaintiff cannot rely merely on the fact that they were injured. Just because a patient experiences harm does not automatically imply that the healthcare provider acted negligently. Not all adverse outcomes are the result of negligence. As the chiropractor highlighted, they sometimes can occur despite the healthcare provider’s adherence to the appropriate standard of care. For that reason, plaintiffs must establish that the care they received fell below the standard that a medical professional should have met. In addition to proving that the healthcare provider breached the standard of care, a plaintiff also must establish causation. This means demonstrating that the provider’s actions or omissions directly caused the plaintiff’s injuries. Establishing both breach of the standard of care and causation requires expert testimony in medical malpractice cases.
Even though courts prohibit showing negligence based only on the fact of injury, expert witnesses still can take that injury into account as long as they have other bases for their opinions. In this case, the plaintiff’s experts looked not only at her injury but also at her previous treatments with the chiropractor. She had received five prior treatments without any incident. They also considered that the plaintiff gave no other indications that the procedure was unsafe for her at the time of treatment. Based on these facts, they concluded that her injury must have resulted from a departure from the standard of care by the chiropractor. Moreover, the plaintiff also testified about her own experience at the chiropractor as well, noting that she felt that the force used on her during the procedure was excessive. The testimony of the experts and the plaintiff was enough to send the case to the jury.
The appellate court’s characterization of summary judgment as tool that should be used rarely emphasizes the importance of the jury in medical negligence cases. Sending cases to a jury demonstrates judicial restraint. Courts often emphasize that juries are well-equipped to assess witness credibility, weigh conflicting evidence, and reach just outcomes in cases where there is any uncertainty or ambiguity. From a practitioner’s perspective, it also is far more difficult to overturn a jury’s verdict for failing to correctly weigh the evidence than it is to claim that the trial judge should not have granted summary judgment. Jury verdicts are rarely overturned on the grounds that the jury reached an unreasonable verdict based on the evidence.
Note also that physicians and other licensed independent healthcare practitioners, such as chiropractors, should and usually do ask patients to sign an informed consent document, which includes potential risks to treatments they provide. However, this does not, in and of itself, absolve the physician from a negligence claim should that injury occur from that risk, especially if the practitioner has provided the same care on multiple occasions without harm. The practitioner clearly was capable of providing care without injury. Therefore, something different likely happened this time either due to the technique used by the practitioner or a change in the physical condition of the patient.
The result in this case may be encouraging for medical malpractice plaintiffs’ attorneys and their clients. It reaffirmed that in negligence cases, courts will lean heavily on the jury to decide whether a medical practitioner’s actions fell below the standard of care and, if so, whether that subpar performance was the cause of the plaintiff’s injuries. As long as the plaintiff can create a record that plausibly suggests that defendant medical professional fell below the standard of care, the trial court will, or should, send the case to the jury.
Reference
- Decided on May 14, 2024, in the Missouri Court of Appeals, Eastern District, Case No. ED111973.
In a medical negligence case, an appellate court in Missouri recently reversed a trial court’s grant of summary judgment to a chiropractor defendant on the basis that there were factual issues that should have been decided by the jury. After a patient sued her chiropractor when she suffered three broken ribs during a treatment, the chiropractor defendant claimed that the patient was claiming medical negligence by pointing to her injury rather than showing that the chiropractor was negligent or that the chiropractor’s alleged negligence caused her injury.
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