Few Exceptions to Requiring Med-Mal Expert Witness: Ala. Sup. Ct.

If medical malpractice is so apparent laypersons can clearly understand on their own, an expert witness is not required under Alabama law, but the court sets a high bar for the exception.

The case of Shadrick v. Grana, Ala. 2018, [Ms. 1170513] stems from the death of William Shadrick in the hospital after suffering a heart attack. William had been admitted complaining of shortness of breath and chest pain. An emergency room physician found that William had suffered a heart attack, and informed the cardiologist on call, Dr. Osita Onyekwere, and the hospitalist, Dr. Wilfredo Grana. Dr. Grana admitted William to the hospital.

After reviewing several tests, Dr. Grana testified that he believed that William was in cardiogenic shock and that an emergency heart catheterization was necessary.

As an internist, Dr. Grana could not perform the procedure, and he telephoned Dr. Onyekwere at around 6:00 p.m. to tell him that William had low blood pressure, an elevated heart rate, elevated troponin levels, fluid in his lungs, that he believed William was in cardiogenic shock, that William should be transferred to the ICU and that Dr. Onyekwere should see William that night.

Dr. Onyekwere went home for the night without seeing William, although he did have a "nurse extender" monitor William.

By the next morning, William's condition had worsened and he was moved to the ICU. Before Dr. Onyekwere arrived to see William, William suffered cardiac arrest. A heart catheterization was performed showing that William he had heart blockages that might have been bypassed through surgery had they been discovered earlier. William later died from insufficient oxygen to his brain.

Sue Shadrick, the estate representative for William, sued Dr. Grana, Dr. Onyekwere, and the Northeast Alabama Regional Medical Center Board, retaining Dr. James Bower, a board-certified cardiologist, as her expert witness. The trial court entered a summary judgment for the hospital, which Shadrick did not object to. She also settled her claims against Dr. Onyekwere, but not with Dr. Grana.

Dr. Grana moved the trial court to strike the standard-of-care testimony of Dr. Bower, who was not a board-certified internist or a hospitalist as was Dr. Grana. Under Alabama case law, a plaintiff's expert in medical malpractice cases must ordinarily be of a "similarly situated health-care provider." The trial court agreed with Dr. Grana, and granted his motion for summary judgment as well

Shadrick appealed, arguing that medical expert testimony was unnecessary. Dr. Grana simply failed to inform Dr. Onyekwere that an emergency existed, and a layperson was capable, without expert testimony, to understand that breached the applicable standard of care.

The Alabama Supreme Court disagreed. It noted, although there was a dispute as to whether or not Dr. Grana used the term "emergency" when he consulted with Dr. Onyekwere the night before William died, it was undisputed that Dr. Grana had informed Dr. Onyekwere of William's low blood pressure, eleveated heart rate, elevated troponin levels and fluid in his lungs. Dr. Oneykwere had denied that Dr. Grana had expressed an opinion that William was in cardiogenic shock, although he admitted that Dr. Grana informed him of William's echocardiogram indicating a "low ejection fraction" which meant that William's heart was not pumping enough blood.

The Court found that, whether or not Dr. Grana told Dr. Oneykwere that he believed William was in cardiogenic shock, Dr. Grana provided Dr. Oneykwere "substantial diagnostic information." More importantly, give the "technical nature" of their conversation, it was not evident that Dr. Grana clearly breached the applicable standard of care that expert testimony was unnecessary.

While the Court noted that there were exceptions to the general rule that plaintiffs in medical-malpractice cases must present expert testimony on the applicable standard of care, those exceptions were limited to obvious cases, such as leaving a foreign object in a patient's body after surgery.

The Court affirmed the trial court's decision.