Traci Mitchell v. Dr. Lance Lincoln

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Traci MITCHELL v. Dr. Lance LINCOLN  05­1369  ___ S.W.3d ___  Supreme Court of Arkansas  Opinion delivered June 22, 2006  1.  NEGLIGENCE  –  MEDICAL  MALPRACTICE  –  MERE  STATEMENT  OF  WHAT  TREATMENT  SHOULD HAVE BEEN PROVIDED DID NOT QUALIFY AS STATEMENT SETTING FORTH THE  APPLICABLE STANDARD OF CARE. – The asserted negligence  did not lie within the  jury’s comprehension as a matter of common knowledge as it could hardly be said to  be common knowledge that the transfusion of a leukemia patient with an allegedly  improper  blood  type  could  cause  injury  to  the  patient;  without  expert  testimony  demonstrating why a specialist’s recommendations should have been followed, a jury  could not know how, why, or whether the alleged negligence caused the plaintiff’s  harm.  2.  NEGLIGENCE – MEDICAL MALPRACTICE – EXPERT’S AFFIDAVIT WAS INSUFFICIENT TO  CREATE A QUESTION OF FACT. – Where the plaintiff’s expert’s affidavit was devoid of  any mention of the standard of care in Baxter County, the site of the alleged medical  malpractice, the expert’s affidavit was insufficient to create a question of fact on the ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 2  issue,  and  the  trial  court  did  not  err  in  granting  the  appellee  doctor’s  motion  for  summary judgment.  Appeal from Marion Circuit Court; Roger V. Logan, Jr., Judge; affirmed; court of  appeals reversed.  Law  Offices  of  Charles  Karr,  P.A.,  by:  Charles  Karr  and  Shane  Roughley,  for  appellant.  Cox, Cox & Estes, PLLC, by:  Walter B. Cox and James R. Estes, for appellee.  TOM  GLAZE,  Justice.  This  is  an  appeal  from  the  trial  court’s  decision  to  grant  summary judgment in a medical­malpractice case in favor of defendant­appellee Dr. Lance  Lincoln.  The court of appeals reversed the trial court’s decision in a 2­2­2 vote, and Dr.  Lincoln petitioned this court for review.  When this court grants a petition for review, we  consider the appeal as though it had been originally filed in this court.  Dixon v. Salvation  Army, 360 Ark. 309, 201 S.W.3d 386 (2005); Sharp County Sheriff’s Office v. Ozark Acres,  349 Ark. 20, 22, 75 S.W.3d 690 (2002).  The plaintiff­appellant in this case, Traci Mitchell, is the widow of Guy Mitchell, who  had been diagnosed with chronic myelogenous leukemia in June of 1994.  Guy was admitted ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 3  to M.D. Anderson Cancer Center in Houston on August 3, 1994, and discharged on August  13, 1994; he returned to M.D. Anderson for a bone marrow transplant on September 22,  1994.  On January 6, 1995, Dr. James Gajewski of M.D. Anderson sent a letter to Guy’s  treating physician, Dr. Lincoln, containing the following recommendation:  All blood transfusions need to be irradiated.  His original blood type  was A­positive, [and] his donor type is O­positive.  I would recommend, if he  needs a blood transfusion, to transfuse him with O­positive red cells.  If he  requires platelet products, at this point in time he should be transfused with B­  positive platelets.  All  blood  products should be given with a Pall filter to  reduce  risk  of  cytomegalovirus  infection.    An  alternative  would  be  to  use  CMV­negative blood products.  Guy required blood transfusions in the early months of 1995; between January 18,  2005, and March 22, 1995, Dr. Lincoln performed eleven blood transfusions.  However, Dr.  Lincoln failed to use O­positive red cells or B­positive platelets.  Guy was readmitted to  M.D.  Anderson  on  March  24,  1995,  and  upon  his  discharge,  he  was  admitted  to  the  University of Arkansas for Medical Sciences and remained there until he was discharged on  July 14, 1995.  Guy died at his home in Flippin on July 23, 1995.  Traci Mitchell was appointed special administrator of Guy’s estate on September 8,  1995.  On October 29, 1996, Mitchell filed suit against Dr. Lincoln, Baxter County Regional  Hospital, St. Paul Fire & Marine Insurance Company, and John Does Numbers 1­3.  After  the defendants moved for summary judgment, Mitchell moved for a voluntary nonsuit, which ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 4  1  was granted on August 20, 1999.  Mitchell then refiled her complaint on August 17, 2000.  In her complaint, Mitchell asserted that Dr. Lincoln had violated the standard of care and had  been  negligent  in  giving  Guy  the  “wrong  type  of  blood  products  as  ordered  and  recommended by his physicians at M.D. Anderson.”  Dr. Lincoln answered and moved for summary judgment, arguing that Mitchell had  not produced any expert testimony regarding the standard of care in her medical­malpractice  case, or any expert testimony demonstrating that Dr. Lincoln’s alleged negligence was the  proximate  cause  of  Guy’s  death.    In  support  of  his  motion  for  summary  judgment,  Dr.  Lincoln attached an affidavit from Dr. Gary Markland, a physician licensed in the State of  Arkansas.  Dr. Markland averred that he was “familiar with the standard of care in Arkansas  as it relates to the transfusion of blood and blood products to patients suffering with chronic  myelogenous  leukemia.”  In  addition,  Dr.  Markland  stated  that  he  had  reviewed  Guy’s  medical  records,  and  based  on  his  review,  Dr.  Markland  stated  that  it  was  his  medical 1  The trial court dismissed St. Paul Fire & Marine Insurance Company from this  action for reasons unrelated to this appeal.  When the court granted Dr. Lincoln’s motion  for summary judgment, the order did not mention the John Doe defendants, and the court  of appeals initially dismissed Mitchell’s appeal without prejudice for lack of a Rule 54(b)  certificate.  Mitchell subsequently took a nonsuit with respect to the John Doe defendants  and the trial court entered an order treating Mitchell’s motion as a motion to dismiss the  John Doe defendants, which the court granted on February 2, 2005.  ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 5  opinion, to a reasonable degree of medical certainty, that Guy was not given the “wrong  type” of blood, that the transfusions that he did receive were within the applicable standard  of care, and that the transfusions were not the proximate cause of Guy’s death.  Mitchell responded to Dr. Lincoln’s motion for summary judgment, asserting that  there were genuine issues of material fact.  In support of her response, Mitchell attached a  copy of a letter from Dr. Gajewski to Dr. Lincoln; in that letter, Dr. Gajewski stated his  recommendation,  quoted  above,  that  Guy  receive  O­positive  red  cells  and  B­positive  platelets.  Mitchell subsequently filed a “first supplement” to her response to Dr. Lincoln’s  motion for summary judgment, attaching a copy of a clinic note from Dr. Gajewski in which  Dr. Gajewski noted that Guy had “received what we think is six units of group A red cells  inappropriately in Arkansas . . . , and we have previously recommended that he receive group  O [red blood cells].”  In his reply to Mitchell’s response to his motion for summary judgment, Dr. Lincoln  asserted that summary judgment was appropriate because Mitchell had failed to establish 1)  the existence of medical negligence with expert testimony; 2) the appropriate standard of  care; and 3) the existence of proximate cause.  See Ark. Code Ann. § 16­114­206 (Repl.  2006).  In  response,  Mitchell  filed  a  “second  supplemental  response”  to  the  summary­  judgment motion, attaching an affidavit from Dr. Barry L. Singer, a hematologist­oncologist ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 6  licensed in Pennsylvania, who stated, in relevant part, the following:  I have reviewed the medical records of Guy Mitchell concerning his  chronic myelogenous leukemia.  The standard of care would require a primary  care  physician,  such  as  Dr.  Lincoln,  to  follow  the  recommendations  of  a  specialist, such as Dr. Gajewski. Transfusing Mr. Mitchell with A­positive red  cells, as was done in this case, was a violation of the standard of care.  In my  opinion,  within  a  reasonable  degree  of  medical  certainty,  the  failure  to  transfuse Mr. Mitchell with O­positive red cells and B­positive platelets as a  2  significant contributing factor in the recrudescence  of his disease and ultimate  demise.  After  a  hearing, the trial court entered an order on October 3, 2003, granting Dr.  Lincoln’s motion for summary judgment.  In its order, the court found that Mitchell had  failed to provide expert testimony that established the standard of care, that Dr. Lincoln had  breached that standard of care, and that any alleged negligence was the proximate cause of  Guy’s death.  Specifically, the court found that Dr. Singer’s  affidavit did not say that he was  familiar with the standard of care in Arkansas, and as such, it failed to raise an issue of fact  as to whether there was negligence in this case.  The court, however, retained jurisdiction of  the  matter  to  give  the  parties  a  chance  to  file  motions  for  reconsideration,  if  such  were  deemed warranted.  Mitchell  filed  a  motion  for  reconsideration  on  October  15,  2003,  attaching  an 2  To “recrudesce” means to “break out anew or come into renewed activity.”  American Heritage College Dictionary 1142 (3d ed. 1997).  ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 7  additional affidavit from Dr. Singer in which the doctor stated his opinion as to the standard  of care for a physician in Baxter County.  However, the trial court struck the additional  affidavit from the record and declined to consider the new allegations contained therein,  ruling that it had given leave to raise additional legal arguments, not to provide additional  facts.  The court then concluded once more that Mitchell had failed  to provide evidence of  the standard of care in Baxter County and that she had failed to meet proof with proof to  rebut Dr. Markland’s claim that Dr. Lincoln’s alleged negligence was not the proximate  cause of Guy’s death.  Mitchell appealed the trial court’s decision to the court of appeals, arguing that the  trial court erred in finding there was no genuine issue of material fact.  She did not, however,  appeal the trial court’s decision to strike the supplemental affidavit of Dr. Singer; therefore,  we can only consider, as did the trial judge, whether Dr. Singer’s first affidavit was sufficient  to create a fact issue that would survive a motion for summary judgment.  A trial court may grant summary judgment only when it is clear that there are no  genuine issues of material fact to be litigated, and that the party is entitled to judgment as a  matter of law. Harris v. City of Fort Smith, 359 Ark. 355, 197 S.W.3d 461 (2004).  Once the  moving party has established a prima facie case showing entitlement to summary judgment,  the opposing party must meet proof with proof and demonstrate the existence of a material ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 8  issue of fact. Young v. Gastro­Intestinal Ctr., 361 Ark. 209, ___ S.W.3d ___ (2005).  On  appellate review, we determine if summary judgment was appropriate based on whether the  evidentiary items presented by the moving party in support of its motion leave a material fact  unanswered.  Id.  This court views the evidence in a light most favorable to the party against  whom the motion was filed, resolving all doubts and inferences against the moving party.  Adams v. Arthur, 333 Ark. 53, 969 S.W.2d 598 (1998).  Under Arkansas law, the burden of proof for a plaintiff in a medical malpractice case  is fixed by statute.  See § 16­114­206.  The statute requires that, in any action for a medical  injury, expert testimony is necessary regarding the skill and learning possessed and used by  medical care providers engaged in that speciality in the same or similar locality.  See Young,  supra; Williamson v. Elroy, 348 Ark. 307, 72 S.W.3d 489 (2002).  Specifically, the statute  provides as follows:  (a) In any action for medical injury, when the asserted negligence does  not lie within the jury’s comprehension as a matter of common knowledge, the  plaintiff shall have the burden of proving:  (1)  By  means  of  expert  testimony  provided  only  by  a  medical  care  provider  of  the  same  specialty  as  the  defendant,  the  degree  of  skill  and  learning ordinarily possessed and used by members of the profession of the  medical care provider in good standing, engaged in the same type of practice  or specialty in the locality in which he or she practices or in a similar locality;  (2)  By  means  of  expert  testimony  provided  only  by  a  medical  care  provider of the same specialty as the defendant that the medical care provider  failed to act in accordance with that standard; and ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 9  (3) By means of expert testimony provided only by a qualified medical  expert that as a proximate result thereof the injured person suffered injuries  that would not otherwise have occurred.  We first address Mitchell’s argument that she was not required to produce expert  testimony because the asserted negligence lies within a jury’s comprehension as a matter of  common  knowledge.  As  set  out  above,  our  medical­malpractice  statute  requires  expert  testimony when the standard of care is not a matter that lies within the jury’s comprehension  as a matter of common knowledge.  See Ark. Code Ann. § 16­114­206(a) (Repl. 2006);  Skaggs v. Johnson, 323 Ark. 320, 915 S.W.2d 253 (1996); Davis v. Kemp, 252 Ark. 925, 481  S.W.2d 712 (1972).  On appeal, Mitchell notes that her response to Dr. Lincoln’s motion for  summary judgment incorporated a letter from Dr. Gajewski about transfusing Guy with O­  positive blood.  Mitchell argues that a jury of laymen should be able to understand that the  recommendations of a specialist in the field should be followed, and that, therefore, she did  not need expert testimony to create a fact question.  We disagree.  Our court of appeals has correctly noted that “mere statements of what  treatment should or should not have been provided do not qualify as statements setting forth  the applicable standard of care.”  See Dodd v. Sparks Reg’l Med. Ctr., 90 Ark. App. 191, ___  S.W.3d ___ (2005) (declining to find an expression of the standard of care in a statement  that, “if the attending doctors and hospital staff had exercised due care, it is more likely than ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 10  not that” the plaintiff’s decedent would not have committed suicide).  See also Robson v.  Tinnin,  322  Ark.  605,  911  S.W.2d  246  (1995)  (rejecting  an  argument  that  assumed  that  “simply because treatment is available for a medical injury, it follows that it is negligence  for a medical care provider not to provide the treatment”).  Moreover,  Mitchell  wrongly  presumes  that  her  case  falls  within  the  “common  knowledge exception.” As noted above, a plaintiff does not need to provide expert testimony  when the asserted negligence lies within the comprehension of a jury of laymen.  See Haase  v. Starnes, 323 Ark. 263, 915 S.W.2d 675 (1996).  The Haase court discussed the issue as  follows:  The  necessity  for  the  introduction  of  expert  medical  testimony  in  malpractice cases was exhaustively considered in Lanier v. Trammell, 207  Ark. 372, 180 S.W.2d 818 (1944). There we held that expert testimony is not  required when the asserted negligence lies within the comprehension of a jury  of laymen, such as a surgeon’s failure to sterilize his instruments or to remove  a sponge from the incision before closing it.  On the other hand, when the  applicable standard of care is not a matter of common knowledge the jury must  have the assistance of expert witnesses in coming to a conclusion upon the  issue of negligence.  Haase, 323 Ark. at 269, 915 S.W.2d at 678.  The vast majority of our cases to have considered this issue hold that expert medical  testimony  is  necessary  because  the  alleged  medical  negligence  is  not  within  the  comprehension of a jury of laymen.  See Fryar v. Touchstone Physical Therapy, 365 Ark. ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 11  295, ___ S.W.3d ___ (2006) (connection between preexisting neck and spine injuries and  alleged injuries caused by an unlicensed chiropractor’s treatment “would not be a matter of  common knowledge or understanding”); Eady v. Lansford, 351 Ark. 249, 92 S.W.2d 57  (2002) (expert testimony required to rebut defense testimony regarding whether a physician  has a duty to inform a patient about rare side effects of a medication); Skaggs v. Johnson,  supra (medical decision to leave a piece of drainage tube in a patient’s leg, as opposed to an  inadvertent  leaving  of  objects  in  a  patient’s  body,  presented  an  issue  outside  the  jury’s  common  knowledge  and  required  expert  testimony);  Robson  v.  Tinnin,  supra  (matters  relating to the changing of dental implants and treatment of fractured teeth are not matters  of common knowledge); Davis v. Kemp, supra (whether it was proper or improper on a first  medical visit to irrigate a wound and administer antibiotics was not a matter of common  knowledge, and the failure to find a piece of glass on the first visit would hinge upon whether  or not good medical practice required the probing of the wound on the first visit); but cf.  Watts v. St. Edward Mercy Med. Ctr., 74 Ark. App. 406, 49 S.W.3d 149 (2001) (no need to  provide expert testimony on the issue of whether a broken hip can cause pain).  In the instant case, although it may be common knowledge that there are four major  blood types, it can hardly be said to be common knowledge that the transfusion of a leukemia  patient with an allegedly improper blood type can cause injury to the patient.   Although ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 12  Mitchell attempts to frame the issue as being whether a jury of laymen can understand that  an internist should follow a specialist’s recommendations, the issue is more complicated than  that,  because  it  also  requires  an  understanding  of  why  such  recommendations  should  be  followed. That is, without expert testimony demonstrating why the recommendations should  be followed, the jury cannot know how, why, or whether the alleged negligence caused the  plaintiff’s harm.  Having established that Mitchell was required to provide expert testimony, we next  3  consider her argument that the trial court erred in discounting Dr. Singer’s first affidavit  on  the basis that it did not address the standard of care in Arkansas or Baxter County.  The  medical­malpractice statute and our case law are specific in stating that there must be an  attestation by an expert regarding this locality or a similar one, and this court has affirmed  summary judgment for the failure to do so.  Young, supra;  Reagan v. City of Piggott, 305  Ark. 77, 805 S.W.2d 636 (1991). 3  As mentioned above, Dr. Singer’s second affidavit did state a familiarity with the  standard of care in Baxter County.  However, Mitchell does not argue that the trial court  erred in striking the second supplemental affidavit.  This court has consistently held that  it will not make an appellant’s argument for him or her.  See Hanlin v. State, 356 Ark.  516, 157 S.W.3d 181(2004); Phillips v. Earngey, 321 Ark. 476, 481, 902 S.W.2d 782,  785 (1995) (“[i]t is axiomatic that we refrain from addressing issues not raised on  appeal”).  ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 13  In his affidavit, Dr. Singer stated that he is a physician licensed to practice medicine  in Pennsylvania and that he is a specialist in hematology­oncology.  Regarding the standard  of care, Dr. Singer stated that the standard of care “would require a primary care physician,  such as Dr. Lincoln, to follow the recommendations of a specialist, such as Dr. Gajewski.”  The affidavit is silent as to any locality, but nonetheless, Mitchell argues that it is “implicit  in  Dr.  Singer’s  affidavit  that  he  was  addressing  the  standard  of  care  in  Baxter  County,  Arkansas, since he mentioned the defendant by name.”  This  court  has  held  that  an  expert  need  not  be  familiar  with  the  practice  in  the  particular  locality,  but  must  demonstrate  a  familiarity  with  the  standard  of  practice  in  a  similar  locality,  either  by  his  testimony  or  by  other  testimony  showing  the  similarity  of  localities.  See Wolford v. St. Paul Fire & Marine Ins. Co, 331 Ark. 426, 961 S.W.2d 743  (1998); Corteau v. Dodd, 299 Ark. 380, 773 S.W.2d 436 (1989); Gambill v. Stroud, 258 Ark.  766, 531 S.W.2d 945 (1976).  In Corteau, supra, this court affirmed a trial court’s grant of  summary  judgment  to  the  defendant  doctors  where  the  plaintiff’s  expert’s  affidavit  “contained nothing about his having knowledge as to how a radiologist in a community like  North Little Rock should have interpreted” an x­ray requisition.  Corteau, 299 Ark. at 386,  773 S.W.2d at 439.  Similarly, in Young v. Gastro­Intestinal Center, supra, this court held  that the plaintiff did not establish the standard of care when her expert witnesses, a doctor ___________________________  GLAZE, J. ­ 2  MITCHELL  v. LINCOLN  Cite as 36_ Ark. ___ (2006)  Page 14  and nurse from Texas, failed to testify regarding the standard of care in Little Rock.  Young,  361 Ark. at 213, ___ S.W.3d at ___.  Dr.  Singer’s  affidavit  is  devoid  of  any  mention  of  the  standard  of  care  in  Baxter  County.  Accordingly,  because  our  case  law  is  explicit  in  requiring  expert  testimony  regarding the standard of care in the same or similar locality, Mitchell’s expert’s affidavit  was insufficient to create a question of fact on this issue, and the trial court did not err in  4  granting Dr. Lincoln’s motion for summary judgment.  Affirmed. 4  Dr. Lincoln raises an additional argument wherein he suggests that Dr. Singer’s  affidavit also failed to state that Dr. Lincoln’s negligence was the proximate cause of Guy  Mitchell’s injuries.  However, we find it unnecessary to reach this issue, as Dr. Singer’s  affidavit did not adequately state the standard of care for the locality.  ___________________________  GLAZE, J. ­ 2 

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